The tortured life of Lorenzo Collins
Cindy Starr, Post staff reporter
Lorenzo Collins, the brick-wielding mental patient shot to death by police, had been on the doorstep of the Hamilton County mental health system half a dozen times in the last 80 days of his life. Several mental health experts believe he should have been committed to long-term care, but they say he was the victim of continuing pressure to keep patient numbers down at the state-run Pauline Warfield Lewis Center, Hamilton County's only remaining long-term mental hospital.
''He had an absolute legal right to long-term treatment and we had a moral obligation to give it to him,'' said Cincinnati lawyer and former magistrate Clayton Shea.
''When these people are not taken care of, they get killed or hurt other people,'' said Shea, who probated mental health patients from 1991 to 1995. ''This is real stuff.''
Collins, who was shot three times by Cincinnati and University of Cincinnati police on Feb. 23, legally qualified for long-term institutional care during the 10 weeks leading up to his death, Shea and others say. Instead, he received only repeated short-term treatment at University Hospital.
The State of Ohio has been reducing the number of patients in mental hospitals since 1988 and before.
The state-run Rollman Psychiatric Institute in Corryville closed and merged with the Lewis Center in 1990, and the Millcreek Psychiatric Center for juveniles closed in 1995.
Now, the Lewis Center, which currently has fewer than 200 beds, is projected to lose more by July 1, although state officals won't say how many.
Mental Health administrators won't comment specifically on the Collins case, but say the effort to reduce services does not play a role in treatment decisions.
The county ''does not dump people on the street to reduce beds,'' said Dr. Monica Kennedy, chief clinical officer for the Hamilton County Community Mental Health Board.
''It is against the law to hold a person against (his) will in a treatment setting that is not the least restrictive,'' Dr. Kennedy said.
Whatever the reason, it is clear that Lorenzo Collins left a trail of substance abuse, irrationality, lawlessness, paranoia and threatening behavior during the weeks before Feb. 28 when he died of his wounds. But all he ever got was a quick fix.
During the last 80 days of his life, police records show he:
Was taken to University Hospital for psychiatric treatment four times and probably a fifth.
Said on four occasions he felt like harming others or himself, threatening once to kill his family.
Escaped from University Hospital three times. The final escape led to his death, when officers shot him after surrounding him in a Corryville yard.
Was evaluated on Dec. 24, 1996, for homicidal and suicidal tendencies after choking his brother during an argument about money.
Tested positive for cocaine four times, admitted using $100 worth of cocaine on another occasion and was arrested for possession of cocaine yet another time.
That Collins was receiving only short-term care before he died ''was a travesty,'' Shea said.
Shea and others say the 25-year-old North Avondale man was failed by a mental health system determined to cut costs and long-term hospital beds.
An overriding philosophy of the Hamilton County Community Health Board is to decrease hospital use and increase community-based treatment, even though mental health activists say most mentally ill persons - especially those who abuse drugs or alcohol - cannot be counted on to take their medicines.
State law defines a ''mentally ill person subject to hospitaliza tion by court order'' as someone who ''represents a substantial risk of physical harm'' to himself or others, who risks harm to himself because of his inability to meet his basic needs and who ''would benefit from treatment in a hospital'' because of behavior that ''creates a grave and imminent risk to substantial rights of others or to himself.''
Dr. Stewart Harris, a psychiatrist at the Lewis Center in Roselawn, said Collins could have been hospitalized involuntarily for a prolonged period of time.
''If he had been at Lewis Center, he probably would have been under court commitment and hospitalized a minimum of two months,'' Dr. Harris said.
Why Collins was never probated to long-term treatment is unclear. Some observers say that in an age of downsizing and deinstitutionalization, psychiatrists are under pressure not to seek long-term treatment for patients.
''The system is trying to process these clients quickly because of the dollar,'' said Jesse Reed III, assistant director of ADAPT (Alcohol/Drug Addiction Partnership Treatment) in Avondale. ''Administrators are doing what the higher-ups want, consequently you get a situation like Lorenzo Collins.''
''It's a farce,'' Dr. Harris said. ''They dump these patients out long before they're ready.''
University Hospital declined to comment on the subject.
The mental health board's Dr. Kennedy said that if a patient's aberrant behavior subsides dur ing short-term treatment and the patient no longer presents the symptoms of a mentally ill per son as defined in the Ohio Re vised Code, doctors have no legal choice but to let the person go.
''When someone is admitted to the acute-care facility and no longer meets the involuntary cri teria, they have to be dis charged,'' she said.
Dr. Harris argued that hospi tals cannot possibly treat mental health patients in less than a week.
''Certain psychiatric profes sionals put forth this idea so that they can justify the theory of treating a patient in three to five days and the patient is sta ble enough to go,'' he said.
''You haven't done anything but calm the patient down. That's the only beneficial effect you're going to get from most of these drugs within a week. The patient is calmer. The patient still may be hallucinating, may be delusional, and for all practi cal purposes no better clinically than at the time of admission.
''But they look calm. And the assumption is the treatment will continue once they leave the hospital. But it doesn't. Patients have little if any insight into their mental illness.''
Ohio has followed a long-term plan toward deinstitutionalizing patients begun in 1988.
For years, critics of deinstitu tionalization have said that large numbers of chronically mentally ill are roaming the streets or ending up in the state's correc tional institutions.
Between 1990 and 1996, the number of Ohio prisoners diag nosed as mentally ill leaped 285 percent, while the general prison population increased 43 percent.
''Hamilton County is particu larly aggressive in reducing beds,'' said Nancy Minson, exec utive director of the Mental Health Association.
''The theory was to reduce beds and increase funding to community health services. What has happened is that pa tients with mental illness upon being discharged are in a much less supervised setting.''
Compounding Collins' mental state was his apparent addiction to cocaine. When a person suf fers from substance abuse as well as mental illness, mental health experts describe the person as ''dually diagnosed.''
Mental health patients who also suffer from substance abuse account for half of the patients overseen by the county and represent a major problem, Dr. Kennedy said. With no access to the abused substance during short-term treatment, they often ''are doing fine,'' she said.
Upon release, however, they may revive their substance abuse. ''How are we as a society going to take care of people with substance abuse and mental illness?'' she said. ''We're working on it all the time. It's a big problem.''
But the state lacks the legal means necessary to involuntarily commit a patient for substance abuse, she said.
''One of the problems we face is that whereas you can court-order a person for mental illness, you can't court-order for substance abuse,'' she said.
A patient like Collins could receive long-term treatment, Dr. Kennedy said, if the patient voluntarily requested it. Long-term treatment clearly was not on Collins's personal agenda, however, as his escapes from the hospital attest.
Collins reportedly escaped for the third time, shortly before he died, by exiting behind visitors as they were buzzed out the door.
Sakinah Reed-Carroll, founder of the People of Color mental health advocacy group, warned that Collins was only ''the tip of the iceberg'' and was among many who fail to receive adequate mental health care.
''Lorenzo Collins represents a large population,'' Reed agreed. ''There will be so many Lorenzo Collinses in the future. It's a sad epitaph.''
''Everything about the Lorenzo Collins situation is tragic,'' Minson said . . . But this is 1997, and there are ways of dealing with this in a much more humane manner.''
Publication date: 06-14-97
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