A troubling incident on Patchen Road last month has many wondering if there is a crack in the medical/legal system. But like any case involving potential mental illness, the root cause of the individual’s behavior is more complicated than it seems. Often, it’s about drugs.
In the late morning on Thursday, Oct. 17, South Burlington resident Daniel Williams was seen walking around The Children’s School parking lot with a knife in his hand, according to court documents. Williams asked a passerby to call the police and alert them of an incident at 204 Patchen Road, the affidavit states. When police found Williams near that address, he told them in repeated, inconsistent statements that someone was being held hostage, killed or raped in his apartment, South Burlington Police Sgt. Ed Soychak said in the affidavit.
Police later learned that Williams had methamphetamine in his system. Williams also told officers he had previously been diagnosed and treated for several mental illnesses by a doctor in Brattleboro. That information was later corroborated by professionals with First Call, a service of the Howard Center.
Back on scene, officers noted several knives around Williams and on his person, as well as a homemade Molotov cocktail near his feet, Police Chief Shawn Burke told The Other Paper.
“At no point did he commit a crime when the officers approached him; he didn’t brandish a knife or convey any intentions to use weapons against an officer,” Burke said.
The officers – at that time – lacked sufficient evidence to arrest Williams but detained him while investigating the incident. Just after 12 p.m., Williams allowed police to escort him to the hospital. Police took a backpack from Williams – either with a warrant or his permission, Burke couldn’t recall – prior to the hospital trip, Burke said, adding he believed there were no additional weapons in it.
Soychak’s account says about an hour and a half after dropping Williams off at the hospital, the attending psychiatric doctor, Steven Runyan, told him they would release Williams “because they had determined it was a substance abuse issue and not a mental health concern.” The affidavit says the doctor told Soychak that Williams met two of three parameters for an emergency evaluation – including suicidal and homicidal ideation – but had not been diagnosed with a mental health condition and could not be held.
“They stated they had no history of any type of mental health diagnosis and he had stated he had taken methamphetamine,” Soychak’s account says. “The doctor believed his behavior was because of that.”
Runyan called The Children’s School to warn them of Williams’ release due to threats Williams had made against the school, according to the affidavit. But Burke said police had kept tabs on Williams and were prepared to take him into custody should the hospital deny him an examination.
“We knew from our experience with the system that we had to be prepared that if [Williams] wasn’t going to be admitted at the hospital for whatever was going on with him that we would likely have to accelerate a criminal investigation and seek bail like we ultimately did,” Burke said.
The law and reality
Repeated calls to the UVM Medical Center and Runyan for comment on this story were not returned. However, The Other Paper reached out to Mourning Fox, the Deputy Commissioner of the Vermont Department of Mental Health, to better understand state law around involuntary hospital admission and emergency examinations.
“From the mental health end of things, if they [the patient] do not meet the qualifications for an emergency evaluation we have no other mechanism to involuntarily hold someone,” Fox said.
State law, 18 V.S.A. § 7504, “application and certificate for an emergency examination” allows a doctor to involuntarily hold a patient in their care for an emergency examination. The statute says that an interested party, “under the pains and penalties of perjury” and with a certificate from a licensed physician who is not the applicant, may call for a person to be held for admission in a hospital for an emergency examination to determine if the individual is in need of treatment. The individual must meet several criteria, including having a mental illness, and as a result of that mental illness, having the inability to exercise self-control or judgement. The individual must be deemed a danger to themself or others.
The “interested party” can be an adult relative or guardian, responsible adult friend, mental health professional, law enforcement officer, licensed physician or the head of the hospital. According to Fox, 99% of all emergency exams are initiated by a qualified mental health professional, trained in laws and regulations around involuntary treatment by the department of mental health.
“Basically, what you’re looking at is: Is someone a danger to themselves or others as the result of a mental illness,” Fox said.
“There are a lot of ways that individuals can be dangerous … someone’s intoxicated and drunk driving, someone is intoxicated on crystal meth and making threats, those kinds of things,” he added. “Those are very dangerous things, but they’re not a situation where the department of mental health or a psychiatric provider can mitigate that risk.”
Under 18 V.S.A § 7508, what Fox calls the second half of the emergency exam process, the psychiatrist must see the patient within 24 hours of the first two people – the interested party and doctor.
But with incidents in which drugs overlap with mental illness, matters around 18 V.S.A. § 7504 become less clear-cut.
To determine if an emergency evaluation is appropriate, doctors must assess whether the mental illness or the intoxicant is the cause of the behavior.
“If there’s someone who has some mental health diagnosis either by history or by observation, that they exist, and there’s an intoxicant on board, now we have a question as to … [whether] they’re a danger to themselves or others as a result of the mental illness,” Fox said. “Did the ADHD make someone threatening? Did the PTSD make someone threatening? Or was it the intoxicant?”
Fox added that this is determined based on how the individual appears in conversations with the doctor, crisis clinician and screener. Those professionals assess what they believe is causing the threatening behavior, he said.
For example, an individual can have severe depression that they are managing, Fox said. One day they might become intoxicated and say they want to kill themselves, but when the intoxicant wears off, they might say that statement was due to the substance, he continued.
“We don’t look to hospitalize someone, and in fact most hospitals will refuse an admission while someone is currently intoxicated,” Fox said. “You really can’t get a clear picture as to what the driving force behind someone’s behavior is when they have an intoxicant in their system.”
Unless the person is suicidal, the hospital may wait to admit them until they are under the legal limit, Fox said.
He added that if the physicians still believe the individual makes a credible threat to an identifiable victim, the doctor can warn the victim of the individual and their threat. According to the affidavit, this is what Runyan did when he called The Children’s School to let them know Williams was to be released around 4 p.m. Oct. 17.
Indeed, around 4 p.m. Williams was released from the hospital. Police brought Williams to the South Burlington Police Department where he remained until 9 p.m. when he asked to return to the hospital because he was suffering from withdrawals. According to Burke, the hospital again said that absent a formal mental health diagnosis, and with substance abuse, they could not evaluate him. Around midnight, Williams was brought to jail and held on $20,000 bail.
As of press deadline, Williams remains at the Northwest State Correctional Facility in St. Albans.
Drug treatment, involuntary and otherwise
Other states have laws allowing individuals to be involuntarily committed to treatment when substance use plays a role in the incident, according to Fox.
“[When] a court has petitioned that a person’s substance use is putting them or others in harm, other states have the ability for people to be committed for that, absent a mental illness,” He said. “But that’s not something that Vermont has.”
According to Fox, research shows forced treatment has a high recidivism rate. Additionally, involuntary treatment infringes on an individual’s civil liberties.
“We’re restricting their movement, placing them in a facility where they cannot leave,” He said. “You really need to have a high bar for that, that we’re going to take away people’s civil rights.”
According to Burke, the Patchen Road incident has taught the department more about impairment.
“Methamphetamine impairment, as we’re beginning to understand it, displays or manifests in a way that we, law enforcement, immediately recognizes, as a crisis, so that’s tricky,” Burke said, adding Vermont hasn’t had a high concentration of meth users in the past.
“Many of the folks that we deal with have a lot of complicated factors going on in their lives and I think it’s difficult for any one of us to determine what is the primary factor driving the behavior at the time,” he added.
Burke does wonder why the individual couldn’t detox in the hospital. He explained that when officers pick up an individual who is intoxicated on alcohol, the process is smooth. That person is permitted to detox in a medical center. He said that although medical professionals offer space for both detox and for psychological assessment, it seems they face challenges to offer those services when there is a combination drug/mental health crisis incident. And while he doesn’t intend to create an adversarial point between police and medical centers, Burke believes there must be a different method of addressing these incidents.
“The police are ... facing trying to lock someone up ... but we know long-term that’s not a great spot for people that need services; nor should jail be a pathway to services,” he said. “I would really hope that we can figure this out before we have a less than favorable outcome.”