Words such as antichrist, lucifer, and eternal torture cover Michael McDaniel’s hands, arms, and torso, a direct contrast to the 38-year-old’s kind eyes and soft smile.
For McDaniel, who lives with paranoid schizophrenia, the collection of ink reminds him of how far he’s come since he nearly beat his grandmother to death with her cane. But it’s also a painful reminder of the decade that he and his family lost because he was repeatedly turned away from hospitals following Pennsylvania’s stringent mental-health laws, which make it difficult to force someone into treatment.
Studies show that most people with mental illness are not dangerous — that they are more likely to be victims of a violent crime and make up only a small proportion of offenders. “Most violence isn’t due to mental illness or people with a mental illness,” said Jack Rozel. “[Pennsylvania has] the Mental Health Procedures Act because we know there’s a small subset of people who become dangerous.”
This act, passed in 1976, is one of the most restrictive in the nation, requiring a person to be a “clear and present danger” to be involuntary committed to a hospital, which some critics say makes it difficult for people to receive help before tragedy strikes.
Maurice Louis, a 29-year-old West Philly man facing quadruple homicide charges, did not meet the criteria when his mother, Janet Woodson, tried to commit him to a psychiatric crisis center on Oct. 29.
The next day, he allegedly bought a shotgun and killed his mother, stepfather, and 7- and 18-year-old half-brothers.
Most states have revised their laws to increase treatment and care options. But Pennsylvania’s remain largely unchanged, the result of a lack of political motivation, access to funds, and a long-running debate within the mental-health community.
Some experts believe the law in its current form prevents people from getting help before they reach the point of being dangerous, while other groups say making it easier to commit someone would violate their civil rights and deter people from seeking help.
In 1999, states began passing bills supporting Assisted Outpatient Treatment, which is involuntary, court-mandated community treatment plans for mentally ill people resistant to treatment. It provides guidelines, such as weekly therapy and visits to the person at the person’s home, and has been shown to reduce hospitalization and rates of incarceration.
Until last year, Pennsylvania remained one of four states that did not use this treatment. Then, in October 2018, a bill instituting AOT finally passed — except there was no funding attached and counties did not have to implement it.
To date, no counties have opted into the treatment.
“If this law was used, maybe people with mental illness wouldn’t end up in jail or homeless on the street, and maybe families wouldn’t be traumatized,” said Nina McDaniel, Michael’s mother.
Before the late 19th century, people with mental illness were over-hospitalized, locked away inside grimly underfunded and understaffed state hospitals.
By the 1960s, countries began de-institutionalizing and pushing for community-oriented care. Congress passed the Community Mental Health Centers Act in 1963, which required a person to be an “imminent threat” to be committed, and states followed suit with similar interpretations. The systematic closure of state hospitals followed, and since the 1950s, the number of beds in state psychiatric hospitals has declined by more than 91%, according to the National Association of State Mental Health Program Directors Research Institute.
Pennsylvania’s standard requires that a person be a “clear and present danger” to be involuntarily committed.
“That means sometimes the opportunity to intervene and help prevent a really bad outcome is limited to an incredibly narrow window,” said Jack Rozel, a psychiatrist who directs the crisis intervention network in Pittsburgh. He said Pennsylvania’s 43-year-old law has “held up remarkably well” but is “in dire need of revision and updating” due to evolving science and social justice.
He said that although AOT has been helpful for some states, more policy adjustments need to be made to improve the nation’s mental-health care. He listed increasing funding, protecting patients’ rights, providing follow-up care, and expunging the history of unnecessary involuntary commitments as important local and state actions.
Those “really bad outcomes” have happened for decades in Pennsylvania.
And it’s happened again, 34 years later, in West Philly.
It was 5 a.m. on Jan. 23, 2012, when Michael McDaniel woke up in an unusual amount of psychological distress. The 30-year-old hoisted his 6-foot-1 frame out of bed and walked across his house to do what the voices inside of his head demanded he do: kill his grandmother.
He entered the room of his 74-year-old Ukrainian grandmother, Helen Badulak, picked up her cane, and while speaking in tongues, hit her repeatedly until she lay unconscious and covered in blood.
McDaniel walked down the stairs looking for a sledgehammer, but couldn’t find one. He then called 911, telling the dispatcher he had killed his grandmother and to “please sent the police out and shoot me.”
Badulak survived, and McDaniel was charged with attempted murder. He pleaded not guilty for reason of insanity, and was sentenced to 2½ years at Wernersville State Hospital, just west of Reading.
Because of the treatment he received at Wernersville, he has taken his medication for close to eight years and lives a stable life. But his family remains traumatized.
McDaniel was diagnosed with paranoid schizophrenia in 2007 after being involuntarily committed for the first time.
Nina McDaniel brought her son — who would spend his days screaming and crying, threatening his family, and believing he could talk to the devil — to emergency rooms and crisis centers for treatment close to a dozen times between 2007 and 2012. Even when he was involuntarily committed, the hospitals often released him after one day because he would put on a calm persona, deny care, and refuse to take medication.
“I was in denial of everything,” said Michael McDaniel, who lives with his mother, grandmother, and sister in Oley, Berks County. “I didn’t understand mental illness. ... I didn’t really care to know, I just knew that something was happening to me and I didn’t understand it.”
His mother remembers hospital staff telling her that Michael was acting up for attention and that they frequently encouraged her to kick him out of the house if she felt “so threatened.”
“I just accepted it and I thought that I was doing something wrong,” she said. “You want to help them and there’s nothing you can do.”
Assisted Outpatient Treatment is a form of involuntary treatment, usually initiated by county mental-health departments, that provides court-mandated, judge-approved treatment plans for people with a history of mental illness who do not typically take their medication.
“It’s only for a really small group of the most seriously ill who’ve already accumulated multiple incidents of homelessness, arrest, incarceration, or hospitalization,” said D.J. Jaffe, executive director of the Mental Health Policy Org., a New York City-based research and advocacy group.
The treatment plans seek to encourage people to address their mental-health needs and provide accountability, but participants wouldn’t face legal repercussions for not following them.
“It’s shown to lower rates of homeless, arrest, suicide, and needless hospitalization," said Jaffe. In turn, he said, this reduces costs over time.
But funding is needed for communities to hire the personnel and change court schedules, among other services. The lack of funding in Pennsylvania’s bill killed the effort from the beginning.
“There is a desperate need for AOT in Bucks County and throughout the commonwealth,” said Diane Ellis-Marseglia, Bucks County commissioner. “Unfortunately, the law was written without adequate funding and without adequate discussion with counties, so that important aspects were forgotten.”
Marianne Grace, executive director of Delaware County, said that if funding and other structural services were added into the bill, Delaware County would be “ready and willing” to offer AOT.
Rep. Thomas Murt (R., Montgomery), who sponsored the bill, said that passing the measure without funding was the “only way to get across the finish line" and that he wants to add funds for the future.
Families such as McDaniel’s hope that happens.