Dual Disorders Are Rarely Treated Properly
Tuesday, July 28, 2009
Danny Watt once leapt from a moving train. He hurtled through the windshield of a rolling car. Got pummeled by drug dealers. Overdosed. Swallowed rat poison. Tried to hang himself.
In his tumultuous 21 years, Danny Watt danced with death in the most amazing, horrible ways. In the end, two college students spotted him facedown in the cold, murky water of the C&O Canal one afternoon in April 2008. The medical examiner said Danny had drowned.
It was an end that Danny's parents, Bobby and Mary Watt of Reston, had struggled to stave off for many years. But after refinancing their house three times to put their son in every substance abuse and mental health program imaginable, after going to countless meetings and hearings and hospitals and jails, after badgering every possible person in Fairfax County who might help them, they could not save Danny.
"We just went through so much for so long," said Mary Watt, breaking into tears. "We tried and tried for so many years, fighting, only to lose."
Danny Watt was a walking symbol of a phenomenon called co-occurring disorders, or dual diagnosis, which is estimated to affect 7 million adults in the United States. These people are both seriously mentally ill and abusing drugs or alcohol. About half of all adults who are seriously mentally ill are also thought to be addicted. The mental health community calls this "self-medication." The federal government estimates that 90 percent of people with co-occurring disorders do not get the treatment they need.
Danny's death shows how hard it can be to treat people with co-occurring disorders and why so many die young.
Danny Watt's story, gleaned from his mental health records, extensive interviews with his family and Fairfax County mental health officials and from his own notes, also shows a county that seemed baffled by his dual demons. Although Danny was given a diagnosis of schizoaffective disorder (a combination of schizophrenia and bipolar disorder) on multiple occasions, many Fairfax therapists thought that Danny's addictions were the sole source of his problems and that if he stayed clean long enough he could help himself.
Danny's parents pleaded for their son to be placed in long-term care in a locked facility. Fairfax has three dual-diagnostic centers, but none is locked. Danny frequently walked out to resume drinking and taking drugs, accompanied by at least one destructive voice in his head and a firm belief that others could hear his thoughts and that he was close friends with entertainers Jay-Z and Mariah Carey.
"They don't understand the voices here, Dad," Danny told his father shortly before his death, referring to "Roy" and others who spoke to him, sometimes from the television, sometimes from Hollywood.
Officials at the Fairfax-Falls Church Community Services Board, one of 40 Virginia agencies that handle mental illness and addiction treatment for those who can't afford private hospitals, made an exception to their policy of not discussing their clients after Bobby and Mary Watt signed a waiver for this article. They said that they did everything they could for Danny, that he repeatedly refused their help. It was his right as an adult, they said.
"He is responsible for his care, and he has decisions and choices to make," said William H. Williams Jr., the agency's director of alcohol and drug services. "When you look at the number of challenges that faced this particular case, I think we did an exceptional job in trying to resolve this young man's issues."
"We didn't see anything that we might have done different that would have changed the outcome," said Gary Axelson, director of clinical operations for the Community Services Board, or CSB.
But E. Fuller Torrey, a psychiatrist with the Treatment Advocacy Center in Arlington and a prominent critic of the widespread deinstitutionalization of psychiatric patients, says forced treatment is essential when people are too mentally ill to realize they need help.
Saying that Danny had responsibility for his care is "fine for someone with substance abuse, but if you're dealing with psychosis, then there's no way you're going to treat someone like that in an unlocked facility," Torrey said. "What you're looking at is the system is not set up to treat the difficult patients."
Danny's parents came to that belief repeatedly.
"It was always, 'Get him stable, get him out,' " said Bobby Watt. "No long-term plans. . . . We wanted him in a place where he was locked up with proper medical attention until he became stable. I begged them to put him in a mental hospital. I told them, 'If you put him out on the streets, he'll be dead in a week.' "
That was April 3, 2008. Eleven days later, Danny was dead.
* * *
"My proudest moment was when I borrowed my guitar teacher's amplified acoustic guitar and played in front of the whole school. They had an assembly just for me! My most prized possession is my electric guitar. In about ten years from now I hope to be going to Harvard, Yale or Princeton university."
"My Life," by Danny Michael Watt,
Sixth grade, 1998
Danny, a happy and healthy child, took up the guitar as an 8-year-old. "You could play him a song and he'd play it back to you right there," his father said. The guitar would forever be a part of Danny's life, whether he was busking on the streets of Georgetown or sitting in a solitary corner of a treatment center.
In fall 1998, when Danny was 12 and in seventh grade at Langston Hughes Middle School in Reston, he began a long slide into drug abuse. He drank beer and wine, often swiped from a friend's parents' supply, and smoked marijuana.
Bobby, a U.S. Customs Service agent, engineered a reassignment for himself and moved the family to Savannah, Ga., mainly to "get Danny out of this." Things didn't change, though. One night Bobby went downstairs to the refrigerator and found Danny, then 13, guzzling a bottle of wine.
"I can't get to sleep," Danny told his father. "I've got racing thoughts."
The Watts would hear the term "racing thoughts" often from Danny in the coming years, but they didn't connect it to mental illness.
They returned to Reston in 2002. Danny entered South Lakes High School as a junior and soon distinguished himself as one of the top drug users, the school resource officer told his parents. He began staying out all night.
So in March 2003, Bobby drove his son to his first inpatient alcohol rehabilitation, at Clear Brook Lodge in Pennsylvania. He was 16.
That was the first of many such treatments the Watts tried, many at private facilities costing thousands. Records show that Danny told the staff he not only drank large amounts of beer, but he also smoked pot daily and was snorting cocaine and taking "unidentified pills." He completed a month of treatment, at a cost of $7,000. It didn't take. Neither did Alcoholics Anonymous meetings.
Danny began skipping school, and one fall morning he showed up at South Lakes high on drugs. The school resource officer drove him to juvenile court in Fairfax City and recorded their conversation along the way.
"Danny told the officer he met a guy in AA who took him to another guy up in Maryland," Mary recalled, and the men would give Danny money or booze or pot or crack in exchange for sex. "I thought it was the worst day of my life."
After three weeks in juvenile jail, Danny went back to Clear Brook, but his parents said he was asked to leave after two weeks because of aggressive behavior.
After a drug overdose in February 2004, the Watts placed Danny in a private hospital in Maryland, then one in California, and still another in New York. The Watts ran up huge credit card debts, then began remortgaging their home.
It was that fall, after another overdose, that Mary was first told by doctors at Dominion Hospital in Falls Church that Danny was bipolar, or manic depressive. Doctors prescribed Depakote, but Danny refused to take it, wary of side effects. (The manufacturer says those include an "increase [in] the risk of suicidal thoughts or behavior.")
As the Watts ran out of money, they turned more to the Community Services Board. By 2005, records show, Danny reported that he was shooting heroin and smoking methamphetamine as well as crack.
He had turned 18, so the Watts had lost any legal control over him. Every weekend he would disappear and return with a wad of bills, enough to finance his next round of booze and drugs. One time he showed up with a full-length fur coat. Another time, a Chevy Camaro.
Bobby and Mary said they tried to get Montgomery County police to investigate the men Danny hung out with in Maryland, but the police couldn't find anyone committing a crime.
Danny began having minor scrapes with the law: reckless driving, petty larceny, public drunkenness. Often, Fairfax police would just bring him home. "The cops here are unbelievably patient," Bobby said. "They understand the mental health system."
Bobby said a Fairfax officer once pulled him over for a traffic violation, looked at his license and asked, "Are you Danny Watt's father?" Bobby said yes, and the officer handed his license back and wished him good luck.
It was around his 18th birthday that Danny started having delusions. "We're sitting there watching TV," Bobby recalled. "Danny says, 'I just made David Letterman laugh. I think of a joke in my head and he laughs.' " Soon Danny couldn't watch certain shows because "he would become part of the show."
His parents took him to the Psychiatric Institute of Washington, a private mental hospital, in August 2005. He was given a diagnosis of schizophrenia.
"They said, 'Your son is severely deranged,' " Mary recalled. "I was shocked."
Mary began doing research. She found a private clinic in California that specialized in co-occurring disorders and put Danny on a plane for Los Angeles, but he got off during a stop in Las Vegas.
Danny was treated numerous times for short periods by the CSB, five times that December alone. He was almost always released within days, after therapists determined he was no longer dangerous.
* * *
"I'm sorry I had to do this. I'm surprised I can even do it, especially since I don't want [to] . . . Roy is always stuck in my head and he wants me dead and that's what he got, he was gonna torture me if I don't. You'll get over it and I'm in a better place."
Suicide note, from Danny
Watt's journal, March 2006
The terrible calls that Bobby and Mary Watt received came at all hours. Here's how they remember some of them:
-- January 2006: "Hello, this is Harlem Hospital in New York; we have your son Daniel here. He jumped from a moving subway train and fractured his skull."
-- February 2006: "Mrs. Watt? This is JFK Medical Center in Edison, New Jersey. Your son was found unconscious on an Amtrak train; he apparently had some sort of drug overdose."
-- March 2006: "Hi, this is the Fairfax County police. Your son was unconscious on a bus in Reston; can you please come pick him up?"
-- March 2006: "Yes, this is Suburban Hospital in Bethesda; your son was found having a seizure in the middle of the street."
That March, after Danny's third overdose in two months, Bobby asked the Montgomery County police to arrest his son, simply to keep him in a safe place. A drug possession charge was filed, and Bobby persuaded a Maryland judge to set a $5,000 bail to ensure that Danny would stay in jail.
While in jail, Danny saw a documentary on Travis Roy, a college hockey player who became paralyzed from the neck down while playing his first game for Boston University in 1995. Danny came to believe that "Roy" was speaking to him. "He said he was scared to death that Roy was coming to kill him," Mary said.
Danny tried to hang himself with his shoelaces. That act put him in solitary confinement, where he tried to hang himself with a sheet, records show. He was sent to Springfield Hospital Center, a state-run psychiatric hospital in Sykesville, where he hanged himself with a sheet again and had to be resuscitated.
After five months in Maryland, Danny was transferred to the Northern Virginia Mental Health Institute near Falls Church. The CSB wanted Danny to go to its main dual-diagnosis residential home, Cornerstones, but it had an eight-month waiting list.
Around that time, the agency assigned Danny a therapist named Stephanie Goodwin. She had experience in dealing with co-occurring disorders, and somehow she connected with Danny. Goodwin persuaded him to attend therapy and to stay on his meds. (Goodwin declined to be interviewed.)
In September 2006, a bed opened at Cornerstones. Danny lasted about a week before bringing in wine and being kicked out. The Watts began using Virginia's involuntary commitment process more desperately.
Most outside examiners gave Danny a diagnosis of schizoaffective disorder and recommended he be hospitalized. But within the CSB, therapists weren't so sure he had both mental illness and substance abuse, records show.
Fairfax County mental health therapist Cynthia Anderson wrote that Danny "has not had enough sobriety/clean time after eight years of polysubstance use/dependence to ascertain that he has a separate and comorbid thought disorder."
Williams, the CSB's alcohol and drug services director, said in an interview after Danny's death that his staff thought Danny needed to stabilize his addictions before treating his mental illness.
"Addiction is a chronic, relapsing brain disorder," Williams said. "That's the answer. The question is his unwillingness, or inability because of his disorder, to have enough stabilization to accept treatment at the level we were attempting to offer it to him."
Top experts in co-occurring disorders say that attitude needs to change as research sheds light on how to treat such patients. "It's a relatively new phenomenon to talk about co-occurring," said James Reinhard, commissioner of the Virginia mental health department. "In my residency in the '80s, we were taught you treat substance abuse first, because you can't get a clear picture of mental illness first. . . . We've at last realized that doesn't make sense."
Finally, therapists at Northern Virginia Mental Health Institute hospitalized Danny for several months to test him at length. In February 2007, they determined that he had "schizoaffective disorder, bipolar type," as well as "poly-substance dependence."
The Watts said Goodwin, the CSB therapist Danny trusted, recommended in a meeting with CSB officials that Danny be placed in a more intensive, locked psychiatric hospital where psychotropic medications could be tried until a prescription was found to stabilize him for the long term.
Instead, Danny was released in April 2007, clean but still delusional, his parents said. The CSB recommended Cornerstones again, but again there was no bed available, the Watts said.
Danny kept getting arrested for minor charges, usually shoplifting. By the summer, Danny was spending most of his time in jail. Mary began pleading with anyone with a phone or an e-mail address to help her son survive.
Though the Watts felt their son needed the intensive treatment of a locked state mental hospital, Fairfax kept cycling him through their unlocked facilities. In August, he was again committed involuntarily to Northern Virginia Mental Health Institute.
For reasons that still aren't clear, a doctor at the institute granted Danny a pass to leave the grounds on Sept. 7, 2007, records show. He met up with another dual-diagnosis patient, a young woman, and he later told doctors that they spent the day smoking crack and drinking liquor.
That night, Danny was driving the woman's Toyota sedan the wrong way on Centreville Road. Police gave chase, and Danny veered off the road, overturned the Toyota and was ejected through the windshield. He suffered six broken vertebrae; the woman, a broken arm.
Danny walked out of the hospital three days later, when he learned police planned to file charges. After another series of binges and hospitalizations, Fairfax police picked him up on warrants charging him with eluding the police, reckless driving and driving on a suspended license, and he spent Christmas 2007 in the Fairfax jail.
This time he told his parents he was suicidal, and he was put in isolation.
At Danny's court date in February 2008, Fairfax prosecutors and police agreed to suspend a six-month jail sentence in exchange for his entering treatment. Danny chose not a co-occurring disorder center, but A New Beginning, a substance abuse treatment center in Chantilly, where the focus would be on abstinence and following rules. His parents were stunned that Danny was allowed to make the choice, rather then the judge or the CSB.
In mid-March 2008, Danny walked out and drank a bottle of wine. He was warned not to break the rules again. On March 31, Danny got another bottle of wine, brought it into A New Beginning and was expelled from the center.
The CSB told him he could have no services from the county for 90 days, other than perhaps to see a psychiatrist at a homeless shelter. CSB records show that the county had Danny phone some shelters. No beds were available, so he was allowed to stay at A New Beginning temporarily.
But the CSB also was required to notify the court that Danny had violated the conditions of his suspended sentence. Given Danny's long history of misdemeanors, he was looking at six months in jail.
On April 3, 2008, Danny walked out of A New Beginning, and days later showed up at his parents' house. Mary gave him clean clothes and two days' worth of medication. Two days after that he showed up again, for the last time, and handed over a well-worn book of poems he'd written. "He was really, really crying," Mary said. "Then I was crying. Then he was begging me to stop crying."
When Danny didn't call or show up after several days -- he always called, even when he was high -- Mary knew something was wrong.
About 3:30 p.m. on April 14, two seniors at Georgetown University were walking along the C&O Canal when they spotted what looked like a pile of rocks in the shallow water between the Whitehurst Freeway and the Key Bridge.
Police pulled the body out of the canal around 4 p.m. Television crews reported the discovery of an unidentified man on the air and on their Web sites. In follow-up comments that appeared that night on WRC-TV 4's Web site, someone posted one word: "Danny!!!"
But the body wasn't identified by police until the next day, after they found the business card of Danny's last counselor in his pants pocket. The medical examiner ruled the death was suicide by drowning.
* * *
"This feeling of peace
After I've been deceased,
Is a feeling to envy,
Despite me being missed.
So farewell to all,
And to me a good flight,
Down straight to heaven,
And for once, feel all right."
"I Wanna Drink With You,"
by Danny Watt, undated