EagleTribune.com, North Andover, MA

November 15, 2012

Police blame mental health system for violent encounter

By Jo-Anne MacKenzie

---- — SALEM — A violent incident Wednesday night could have been life threatening, according to Deputy police Chief Shawn Patten.

No one was injured, but Patten said yesterday he believes it just a matter of time before Thomas J. Burke, 30, does hurt someone.

“He is a clear danger to the community and to his family,” Patten said.

And he puts some of the blame on the state’s mental health system.

Burke is no stranger to police. Patten said he has been arrested more than a dozen times over the last 14 years. He also has been involuntarily committed to the state hospital for psychiatric reasons, most recently in mid-October, according to Patten.

Police were not notified of his subsequent release from New Hampshire Hospital and Patten sees that as a problem.

Just before 9:15 Wednesday night, police received a 911 call from Burke’s father, from the family home on Loren Road.

He told police his son was “out of control” and smashing things, Patten said.

When the first officer arrived on the scene, Burke came out of the house with a large kitchen knife. He ran at police, Patten said, threatening to “cut them up.”

Burke stopped as several more officers arrived at the scene and ordered him to drop the knife. Burke refused and continued to threaten police.

At that point, Sgt. Jason Smith deployed a bean-bag shotgun, Patten said. Burke dropped the knife, dropped to his knees and was taken into custody without further incident.

He is now in the county jail, held on lack of $50,000 cash bail. Burke is charged with three felony counts of criminal threatening, a felony charge of reckless conduct, resisting arrest and criminal mischief.

But Patten doesn’t see an endpoint.

“We’ve had over 40 contacts with him over eight to 10 years,” he said yesterday. “In our opinion, the mental health system in the state of New Hampshire is failing him.”

And with that failure, he said, comes a great physical risk to Burke’s family, police officers and the community.

“This is eventually going to have tragic consequences if this isn’t dealt with,” he said. “We’re in fear for his family, his friends, the safety of our officers who have to respond to these calls on a regular basis.”

Dr. Robert MacLeod, the CEO of New Hampshire Hospital, may appreciate Patten’s frustration, but he sees situations like this one through a different lens.

“When we can, we try to work with law enforcement and, most importantly, we respect and understand the challenges they face with the wide variety of people they come in contact with,” MacLeod said yesterday.

But, he emphasized, involuntary commitment to the state hospital is a civil, not criminal, process. And when patients are committed, it’s generally not for long periods of time and their rights are protected at every step.

“We’re truly an acute care, short-stay institution,” he said. “The days of institutions keeping people indefinitely are over.”

That’s not to say that MacLeod and others at the state hospital dismiss the concerns of law enforcement and others.

“We don’t treat those circumstances or possibilities lightly, and we meet weekly to review certain cases,” he said. “We do the best we can to predict risks and balance that with the right of the patient to be discharged. We don’t treat that lightly, but predicting the future most often is not an exact science.”

In New Hampshire, the law allows the state hospital to admit someone, whether they agree or not, for 72 hours. Within those 72 hours, the individual has a right to have a hearing before a hearing officer or judge. The judge may decide the patient no longer needs to stay in the hospital or that they deserve more treatment, MacLeod said, irrespective of how the patient feels.

After the 72-hour period, there is a period of probable cause, during which a patient can be kept for up to 10 additional days. Beyond that, the individual can be probated through a civil commitment.

But even if a person is civilly committed, MacLeod said, that doesn’t mean they remain at the hospital. Generally, they are stabilized, then treated through one of the state’s community mental health centers for a time ranging from three months to five years. That commitment can be renewed indefinitely, although that is usually not the case, he said.

The goal, he said, is to treat, stabilize and release patients back to the least restrictive environment.

The state hospital has just under 2,500 admissions/discharges a year, he said. Most patients are there for a brief time and tend “not to be problematic.”

“But there is a small cohort of individuals who tend to cycle in and out of this hospital, and tend to be more problematic,” he said. “They tend to be noncompliant.”

Those individuals may get on a regimen of medication and therapy, feel better, go back to the community, then stop taking their medication or, perhaps, start using illicit drugs, stop counseling and backslide, he said.

If that happens, the civil commitment can be revoked and the individual can be sent back to the hospital. But that process begins at the community mental health center level, generally in a hospital emergency room. And, MacLeod reiterated, the patient has “significant” rights and opportunities for a hearing.

“In the civil system, there is a heavy emphasis on protecting the rights of the patient,” he said. “We appreciate the frustration of other public officials, of law enforcement that then face the possible impact of that release. ... It can be, from the other lens, very confounding.”

But, he said, a patient is never discharged from the state hospital until they are stabilized. In all but the most extreme and rare cases, that process is not a long as many may believe.

“What we do know is that someone cannot stay here forever,” he said.