Daniel Montalbano, 23, spent 8 years trying to cope with mental illness and drug addiction
Nearly 9 million people are mentally ill and abuse substances, according to federal agency
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Barbara Theodosiou anxiously awaited each text and call. Still, her stomach turned every time her phone would ring or vibrate. Every time there was a knock at the door.
Sometimes, she would even turn her phone off at night – the fear of getting that life-altering news too much to bear.
She lived with that terror for eight years as her beloved son Daniel Francis Montalbano, a boy whom she says “painted, wrote poems and told his mother endlessly how much he loved her,” struggled with mental illness and drug addiction.
In April, after Daniel had gone missing for about a week, her phone rang with a police sergeant at the other end of the line. She immediately called out to her husband to get on the phone with her.
“I never wanted to be alone to find out something happened to Daniel,” she said during a phone interview from her home in Davie, Florida.
It was the call she feared most.
Daniel, just 23, was gone. He had drowned in Florida’s Intracoastal Waterway, she learned.
Her life, like the lives of parents too numerous to count who have also lost children to addiction, was forever changed.
“There is no peace for me. Ever again. This is a life sentence,” she said in a speech paying tribute to her son during a special event in her town in honor of The Addict’s Mom, the Facebook community she founded in 2008 to support families battling the disease of addiction.
“It shocks me. It crushes me. It steals my soul,” she said. “There are no breaks, no holidays, there is no solace here. And I spend every second wishing I had one more moment, one more day with my son before drugs.”
But despite her grief – and perhaps because of it, she is more determined than ever to make sure that Daniel’s life was not lived in vain.
She is now committed to telling his story and raising awareness to help people dealing with both mental illness and substance abuse and pushing for reforms in schools and prisons to make sure they get the treatment they need.
The numbers don’t lie – mental illness and substance abuse often overlap.
Nearly 9 million people have co-occurring disorders, meaning they have both a mental and substance abuse disorder, according to the Substance Abuse and Mental Health Administration.
But only 7% of them get treatment for both conditions, with a staggering 56% receiving no treatment at all, the agency says.
Add in a justice system that isn’t always equipped to handle mental illness, and you have a recipe for disaster, Theodosiou says.
The Addict’s Mom
I got to know Theodosiou last year as I reported a lengthy story on the mothers of addicts, revealing how they cope with the incomprehensible challenges of supporting their addicted child while not enabling their disease.
As the founder of The Addict’s Mom, which now boasts 30,000 members and chapters in every state, Theodosiou, a successful entrepreneur, was a natural person to interview. She has devoted her life to helping those affected by addiction.
She came to this mission not by choice, she says, but after learning – during a six month span – that two of her children were addicts.
Her eldest son Peter, now 26, started using prescription drugs and then escalated to heroin. He has been in recovery for 4½ years, graduated college and plans to start graduate school this fall.
At 15, Daniel started what’s called robotripping, where he would take large quantities of cough medicine to get high.
Theodosiou believes Daniel turned to cough medicine, which he continued to abuse until his death, to cope with the pain of mental illness.
Ever since Daniel started elementary school, he struggled socially, said his mom. He was bullied, ostracized, disruptive in the classroom. By middle school, he was sad and becoming angry.
“I took him to a psychiatrist at the tender age of 12,” said Theodosiou. “There was no definitive diagnosis.”
Was it attention-deficit hyperactivity disorder? Obsessive-compulsive disorder? Bipolar disorder? Asperger’s syndrome? Theodosiou says she’ll never know for sure because as Daniel started abusing drugs, he was never sober long enough to really get to the root of the problem.
When he was younger, one doctor said he might have ADHD and suggested medication, but Theodosiou decided against it. Her brother was a heroin addict, and she worried about her children taking medication and eventually becoming addicted.
“My kids were young. I didn’t really want to start them on medication. I was really scared,” she said.
She now wonders about that decision.
“It might have been effective, but I don’t know. I’ll never know.”
Theodosiou says there were no mental health resources in Daniel’s schools. When students would complain about him, he would be put in detention, sitting by himself in another room, she said.
“Years later, he would begin to tell me that that really broke him,” she said. “As he started to use drugs, what he would say to me when I would go to the hospital … ‘Mom, I only want to be normal.’ “
Her son, she says, was part of a “broken system, a broken mental health system since he was a little boy, and that system failed him.”
The challenges for the mentally ill who abuse substances
People who are mentally ill and abuse substances are at “increased risk of impulsive and potentially violent acts,” according to the National Alliance on Mental Illness (NAMI).
They’re also less likely to achieve lasting sobriety, more likely to become physically dependent on their substance of choice, and to end up in legal trouble from their substance abuse, according to NAMI.
The legal system, says Theodosiou, failed her son too.
When I interviewed Theodosiou last year, Daniel had been in rehab for five weeks – at that time his longest period ever in treatment – but had relapsed. He’d broken the condition of his release from jail and was back behind bars.
The “horrific cycle” would continue, she said.
It would go something like this: Release from jail. Overdose. Emergency room. Psychiatric wing. Treatment. Relapse. Arrests for petty crimes. Back to jail.
Then, last fall, while Daniel was in the psychiatric wing of the St. Lucie Medical Center, he was charged with a felony for allegedly assaulting a security guard.
According to the arrest affidavit, Daniel was screaming and causing a disturbance in the dining area. The document says two security officers made contact with Daniel and tried to use verbal commands to “de-escalate” the situation. Daniel allegedly attempted to hit them several times with a closed fist, and struck one of the officers in the chest with his fist.
“My son was in a psychiatric unit. He was psychotic. He could have easily been given a shot,” said Theodosiou. “The police came and arrested him. He was given a felony. He ended up in jail with violent, violent felons.”
How could someone who is mentally ill and is being treated in the psychiatric wing of a hospital be arrested, asks Theodosiou.
Daniel had never been charged with a felony before. His previous arrests were all for petty crimes and misdemeanors: shoplifting, loitering, public intoxication, misdemeanor battery, said Theodosiou.
Now she – along with help from other moms from The Addict’s Mom – is hoping to convince the Florida State Legislature to consider a bill that would make it illegal to arrest and take to jail a person who is in a psychiatric hospital or a psychiatric unit of a hospital.
“I don’t want to see anyone arrested (who’s) mentally ill in a psychiatric unit,” said Theodosiou. “It’s awful.”
How to differentiate ‘bad’ from ‘mad’
Dr. Harold Bursztajn, co-founder of the Harvard Medical School Program in Psychiatry and the Law, has been a practicing forensic and clinical psychiatrist for over 30 years. He has devoted much of his career to the field of therapeutic jurisprudence, which is centered on assuring that when the legal system does get involved, it doesn’t make matters worse for people who are mentally ill.
Bursztajn believes the most sensible way to proceed, when someone in an in-patient facility is arrested and moved to the criminal justice system after a violent outburst, is for a forensic psychiatrist to conduct an evaluation to differentiate “bad from mad.”
“The fundamental dilemma is to distinguish those people who are mad because of their addictions versus those people who are simply bad and are using their addictions as part of self-gratification rather than self-medication, so there’s a fundamental distinction,” said Bursztajn, who is also an associate clinical professor of psychiatry at Harvard Medical School.
Bursztajn believes more education is needed throughout the criminal justice system; attorneys, judges and prison officials need to understand how to look for and factor in mental illness when someone is arrested for a crime.
“The key is that education and evaluation precedes disposition. The focus all too often is simply jumping to a disposition without the appropriate evaluation, because the level of education in the prison system, in the justice system, is just not there,” he said.
“I have met some wonderful (prosecutors) who really, really understand this, and (who) work with the defense attorneys and forensic psychiatrists and come up with a treatment plan that actually works,” said Bursztajn. The more prosecutors, defense attorneys and judges who understand this, the better, he added.
What Theodosiou hopes to call attention to is the treatment of people behind bars who are mentally ill and addicted.
Often, Daniel would end up in isolation for his own protection, she said. Theodosiou claims her son wouldn’t have access to therapy, medication or physicians to treat either his mental illness or his substance use.
“And he came out worse,” she said. “Every time he came out, he was angrier. He was more paranoid.”
The St. Lucie County Sheriff’s Office, in a statement to CNN, said Daniel “received appropriate medical/mental health treatment” while he served time at the St. Lucie County Jail.
Mark Weinberg, public information officer for the St. Lucie County Sheriff’s Office, said Daniel was evaluated by mental health professionals and prescribed medications, and that he was housed in protective custody, meaning he was the only person in a single-person cell, during much of his stay.
Documents show Daniel had requested to be placed in protective custody on more than one occasion.
’The system is broken’
Some 14% of male jail inmates suffer from a serious mental illness, and that number goes up to 31% for female inmates in jails, according to a 2009 study.
When looking at inmates with a mental health problem, the numbers are staggering: 56% of state prisoners, 45% of federal prisoners and 64% of jail inmates had a recent history or symptoms of a mental health problem, according to the U.S. Department of Justice.
And, for these inmates with mental health issues, isolation can be particularly damaging, researchers say.
While isolation can be psychologically harmful to any prisoner and cause anxiety, depression, anger, paranoia and psychosis, those adverse effects can be “especially significant” for people who have a serious mental illness, wrote Dr. Jeffrey Metzner, clinical professor of psychiatry at the University of Colorado School of Medicine, and Jamie Fellner, senior counsel for Human Rights Watch.