Daniel Montalbano: A Victim of our Broken System
As told to Sherry by Barbara Theodosiou, Founder of “The Addict’s Mom”
My son, Daniel Francis Montalbano, passed away in April of 2015, at the age of 23. Daniel was diagnosed with Co-occurring Disorders: Mental Illness (MI), and Substance Use Disorder (SUD). These two deadly disorders are the source of much tragedy and heartache in Daniel’s short, troubled life, as he entered the cycle common to all who suffer with SUD, with or without a co-occurring mental illness: overdose, arrest, mandate to treatment, release, homeless, hospital, psychiatric commitment, jail… Unfortunately, the cycle ends in death if no progress is made in recovery, as my Daniel’s death manifests.
“Our community mental health systems, and our prison systems are broken,” according to Dr. Jeffrey Metzner, a Clinical Professor of Psychiatry, at the University of Colorado School Of Medicine. The day before he drowned in a canal near my home in South Florida, he had walked out of his treatment center after an altercation with another resident. Because the treatment was a probation requirement, Daniel was terrified of being returned to jail where he had been assaulted by violent felons.
Daniel was my 2nd child, brother to Peter. Daniel was a chubby-cheeked, brown-eyed beautiful baby. I loved him as I do all of my children, with all of my heart. Nicole, my daughter, was born when Daniel was 2, and Alex, my fourth child, was born when Daniel was 9. Our precious and peaceful time together was limited, however, when Daniel toddled off to school, bright, and eager to learn. At school, Daniel was ostracized and bullied. He was exceptionally intelligent, however, his social skills were immature and he had difficulty coping with the behavior of his peers. He was the last one chosen to play on a team, he sat alone at the lunch table, and he was disliked by his peers. Daniel was the child who sat on the bench in organized sports, dressed in his uniform, but never permitted to play in the game. One day, I witnessed a boy throw Daniel against the wall at school, with the teacher turning her head aside. He was bullied and beaten at our school bus stop; once I ran to the curb in my bathrobe, hearing Daniel’s screams as a boy was hitting him in the face.
His sister Nicole worried about Daniel; she reported to me daily after school about the trials and tribulations that Daniel suffered as a victim of taunts and torment from the other students. As his mother, it is difficult for me to admit that he could be annoying, by asking a question, or making a demand, over and over again, louder and louder until someone responded. He was obsessive about his personal hygiene, and the products. He tolerated only a specific brand of shampoo, cleanser, or soap, arranged in a specific order, dispensed in a specific order, in a specific amount.
As I reflect on his younger years, I realize that perhaps he was a child with autism; he certainly was inattentive, impulsive, often hyperactive, and demonstrated features of Obsessive Compulsive Disorder. He was often inappropriate in social situations. He suffered from low self-esteem, and grew angry easily. Professionals, including teachers, counselors, and the principal at his school, all of whom interacted with Daniel, never discussed with me autism as a possible cause of his problems.
When he disrupted class, his teachers isolated him and ostracized him further. Daniel began writing poetry and painting, as a way to pass the time, and to capture on paper what he couldn’t speak out loud. He was gifted intellectually, but his was a tortured soul, as his work reveals. He spent hours in detention, and in after-school punishments, becoming further and further distanced from his peers. Not only did his peers resent his behavior in class, the parents complained about Daniel to the school administration. He was never referred by the school administration for diagnosis or interventions. The school mental health system was certainly “broken” for Daniel.
Daniel befriended the mentally and physically challenged at his school, and never realized that they were different than the other students. As he grew older, and wrote volumes of poetry, Daniel would often read his work to the homeless. Daniel was kind-hearted. As Nicole told us at Daniel’s funeral, “All Daniel ever wanted was a friend. He loved to hang out with my friends because they were nice to him.”
When he was 12, I took Daniel to see a Psychiatrist. We did not receive a clear diagnosis. So, back to school he went, with the same results. Then, when he was a freshman, the school secretary called and asked me to come to the school office. Daniel was there, high on DXM, or Dextromethorphan. He admitted that he had been taking the DXM to “feel better about life and himself… to escape.” I rushed him to treatment, which was ineffective, and thus the vicious cycle began. He was arrested many times for shoplifting, loitering, public intoxication, trespassing, resisting arrest without violence, and petty theft. Most are misdemeanor crimes, committed to support his drug use, and for which he was ordered to treatment, but he always relapsed; he never completed the course of treatment. He did not return to school, but completed his GED requirements. He loved to learn, however, and frequently told me that he just wanted to be “normal.” His wish was to earn a College degree.
Daniel was subjected to Civil Commitment stays at least 30 times every year. During one of his countless stays in a Psychiatric hospital, Daniel was diagnosed at the age of 16 with Asperger’s Syndrome, Bipolar Disorder, and Obsessive Compulsive Disorder. Because he began self-medicating as a teen, as many who suffer from mental illness do, he also fit the criteria for a Co-occurring diagnosis.
According to Harold J. Bursztajn, MD, who is an Associate Clinical Professor of Psychiatry and the Co-founder of the Program in Psychiatry and the Law at Harvard University, “substance abuse is not unusual in individuals with Asperger’s and there are treatment modalities that may have changed the course.”
Daniel was deemed eligible for disability funds at the age of 21.
Unfortunately, due to the trauma, he had endured in his life, both when he was arrested, and when he was housed with felons, he also suffered from Post-Traumatic Stress Disorder and anxiety. He was regularly placed in isolation in jail, in order to prevent the others from assaulting him, but according to Dr. Metzner:
“Isolation can be psychologically harmful to any prisoner but is significant for persons with serious mental illness… They suffer psychological effects that can include anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis. The stress, lack of meaningful social contact, and unstructured days can exacerbate symptoms of illness or provoke recurrence.”
Treatment for both disorders is essential if these suffering souls have a hope of recovery and a return to society as a productive member. Unfortunately, the statistics for treatment opportunities while incarcerated are dismal. Dr. Metzner found that “twenty-two of forty state correctional systems reported in a survey that they did not have adequate mental health staff.
Additionally, tragically, perhaps 1/3 of our current prison population is mentally ill, according to the experts. Several professional organizations, including the American Medical Association, and the American Psychological Association have developed a set of guidelines for the treatment of the mentally ill while they are incarcerated. Unfortunately, Dr. Metzner states, “they are guidelines only, and not mandatory. Prison systems are able to obtain accreditation under the guidelines should they wish to, however, they are not required to do so.”
Mental Health America (MHA) is a community-based non-profit organization dedicated to helping all Americans achieve wellness by living mentally healthier lives. Following is their position statement on mental health and the prison system:
“Over the past 50 years, America has gone from institutionalizing people with mental illnesses, to incarcerating them at unprecedented and appalling rates—putting recovery out of reach for millions of Americans. On any given day, between 300,000 and 400,000 people with mental illnesses are incarcerated in jails and prisons across the United States, and more than 500,000 people with mental illnesses are under correctional control in the community.”
MHA supports effective, accessible mental health treatment for all people who need it who are confined in adult or juvenile correctional facilities, or under correctional control. These people need community integration and community-based treatment.
Additionally, according to MHA, Mentally Ill and Co-Occurring Disorders (Substance Use Disorder) diagnosed prisoners have a right to:
- adequate medical and mental health care
- protection from harm including staff abuse
- a facility in which the vulnerable can be protected
- a safe, sanitary and humane environment
- evaluation assessment and treatment by qualified mental health professionals
- diagnosis and treatment of co-occurring disorders, and particularly substance abuse
- individualized treatment plan that is recovery-oriented
- discharge plan
- facilities should follow written guidelines for the use of seclusion, room confinement, and restraints
Daniel’s story, and that of many others’ indicates that guidelines and recommendations from the AMA, APA, and MHA, are not being followed.
The end of my Daniel’s journey on the agonizing road of addiction began in July of 2014. After overdosing on DXM, Daniel was taken by the police to a Psychiatric Unit at a hospital by application of the Baker Act, where he subsequently suffered from a psychotic episode. Daniel was placed under a 24-hour watch, and confined to his bed in the Psychiatric hospital for 5 days. He became extremely anxious and unstable due to the psychotropic medications being used, one of which caused an allergic reaction. He requested that he be permitted to leave the room, but he was refused. With his distorted perception of reality, he got out of his bed, and was restrained physically by the staff. Physical contact is abhorrent to most people who have Asperger’s Syndrome. He was thrashing as he tried to free himself by pushing away from the staff. No one was injured. The police charged Daniel with a 2nd degree felony of assault on an EMT, but in fact, the man who attempted to restrain Daniel was a hospital security guard. Daniel was subsequently arrested in the unit and transported to the jail on 7/06/14. This episode is deplorable, and demonstrates clearly how our system is “broken” where it concerns the mentally ill. I am outraged that a mentally ill person, while housed in a lock-down Psychiatric Unit, in a psychotic state, can be arrested and charged as a felon, as he exhibits behavior over which he has no control, and without having committed a violent crime!
According to Dr. Bursztajn:
“Those with Asperger Syndrome “when responding to a social situation under duress, may become confused or overwhelmed by a barrage of social information that they cannot readily process… in some individuals, it may precipitate substantial aggression. They have difficulty with the ability to inhibit quickly and appropriately the expression of strong emotions. Behaviorally, deficits in emotion regulation manifest as problems with impulse (usually anger) control, aggression, and often negative peer interactions.”
According to the court-appointed Clinical Psychologist for the county of Daniel’s arrest, Daniel was suffering from substance withdrawal, co-morbid with his mental disorder. He was apparently allergic to the medication that was administered, and he suffered a psychotic episode. The doctor reported that there was “no intent” to commit a crime. In fact, Daniel had no memory of the event. The doctor also reported that Daniel’s insight and judgment were “partially impaired.”
Daniel and the Prosecutor’s office finally agreed upon an arrangement in which he would be placed in a treatment center. He was subject to a strict probationary period, during which, if he was found in violation of the terms, he would be transferred immediately to prison and serve his sentence as a felon for the arrest in the Psychiatric Unit.
While waiting to be relocated to a treatment center, as per his agreement with the Prosecutor, he was assaulted in jail, and subsequently placed in isolation; consequently, Daniel’s mental health deteriorated, which is quite common amongst the untreated mentally ill, as Dr. Metzner has stated. Metzner and other experts recommend an Integrated Treatment program for those suffering from a Co-Occurring Disorder. Few jails in our country offer an Integrated Treatment program.
While he was in jail, Daniel did not receive the appropriate medications for his condition, nor did he have access to a Psychiatrist. He left his treatment center after a minor altercation with another client, and he subsequently drowned. The sad saga of my Daniel is now over. His paintings and poems reveal his inner soul; a tortured soul, a distressed soul.
It is my intention to advocate for a change in the legal system in two key areas: a patient in a lock-down Psychiatric Unit should never be arrested and placed in a jail with violent felons. If those with Co-Occurring Disorders are ultimately sentenced to jail time, they MUST have access to treatment by the experts for both of their disorders. Only under these circumstances can we ever hope to assist these individuals in living a productive, successful life.
Our prisons have become warehouses for the mentally ill. The cost of incarcerating these people is in the millions of dollars per year. The cost to our families, whose loved ones are suffering from a Co-Occurring Disorder and then incarcerated, is incalculable. The system is indeed “broken.” I will continue my work with “The Addict’s Mom” in Daniel’s memory. It is my fervent wish that Daniel’s brief life was not a life lived in vain.