| Annys Shin |
STAUNTON, Virginia (WP-BLOOM) – The morning of the recommitment hearing, Alison Hymes sat in a small waiting area of a Virginia mental hospital in a navy blue sweatsuit, clutching a green composition book to her chest.
She’d scribbled down a list of arguments in favour of releasing her from Western State Hospital. They included: “Been here too long” and “Becoming institutionalised”.
“I don’t think they will listen to them,” she said.
Hymes had said similar things at the six other recommitment hearings she’d had over the previous 17 months, after a judge ruled that she was a danger to herself and involuntarily hospitalised her for the second time in three years. Her bipolar disorder had landed her in institutions multiple times over three decades, but never for this long.
The day before the hearing last May, she posted on Facebook: “Afraid I will be committed for two more months.”
Hymes was no ordinary patient. Before landing at Western, she spent years urging others with mental illness and their families not to let doctors, judges and social workers make decisions for them. She was part of a state task force charged with reforming civil commitment laws at the time of the 2007 Virginia Tech massacre, serving alongside doctors, academics and law enforcement officials.
The daughter of a prominent University of Virginia linguist, Hymes argued vehemently — and unsuccessfully — against loosening the state’s commitment criteria.
Hymes, now 58, believed those changes made it easier for authorities to involuntarily commit her in 2011 and again in 2013.
She was still at Western in November 2013, when local officials said they couldn’t find a psychiatric bed for Austin “Gus” Deeds before an emergency protection order ran out, though it later turned out that two private hospitals did have beds. Gus attacked his father, state Senator Creigh Deeds, with a knife the next day, then shot and killed himself.
His suicide dramatically exposed gaps in the state’s mental health system that Hymes and tens of thousands of other Virginians have endured for years. Amid the legislative soul searching that followed, most of the attention was focused on giving mental health officials more time and help finding beds for those in crisis. Hymes represented a different, less-talked-about dilemma: She was occupying one of those scarce beds because there was no appropriate place to discharge her to.
In May, as Hymes waited to find out whether she would be released, her right leg began to shake.
“I’m nervous,” she explained, then she lay down on the bench outside the hearing room and closed her eyes. Strands of her light brown hair were pinned back from her face. There were food stains on the front of her sweatshirt.
To her doctors, her unkempt appearance was evidence that she was still not able to care for herself. On her list of reasons she should be released, Hymes had written, “Hygiene is a choice.”
A few minutes later, the clerk who handled commitment hearings poked her head into the room. The judge was ready to see her.
Anyone who knew Hymes from her days on the state’s commitment task force would not have recognised the timid woman in the hospital waiting room.
She had been a fixture at public meetings on mental health issues for years, with a reputation for challenging anyone, no matter how important.
Author Pete Earley, who served with Hymes on the state panel, described her as the loudest, fiercest voice against involuntary hospitalisation and forced medication. “She wouldn’t give an inch and celebrated being an outsider,” he said. “She was relentless if you disagreed with her.”
Hymes was used to passionate debate. She grew up in Philadelphia in a family of accomplished academics. Her father, Dell Hymes, was a professor at the University of Pennsylvania until he took a position at Virginia in 1987. Her older brother teaches at Columbia University; her sister at the University of Kansas. (All three of her siblings did not respond to repeated requests for interviews. Her mother, Virginia, is 92 and in poor health.)
Hymes went to Bryn Mawr College, then to graduate school at the University of Pennsylvania. She was studying to be a psychologist when she was diagnosed with bipolar disorder after becoming, in her words, “psychotic”. It was a shock to her, she said, though she doesn’t like to talk about becoming sick. She got treatment and remained at Penn, then she decided she liked working as a counsellor more than she liked sitting in a classroom and left.
She had never done mental health advocacy before moving to Charlottesville in 1997 to be closer to her parents. But Hymes was tireless, spending hours on the phone discussing strategy. “She never stopped no matter how sick she got,” said Sherry Rose, a friend who was on the task force alongside her.
Years of taking lithium had ruined Hymes’s kidneys. She was on a transplant wait list as she served on the task force, spending much of her free time going to dialysis. She coped with humour. A stickler for wearing seat belts, Hymes would chide an unbuckled Rose, saying, “Are we donating? I’ll take your kidney.”
She had less influence than she wanted on the commitment panel, which she believed was aimed at “the deprivation of what little civil liberties consumer/survivors have,” even before Seung Hui Cho’s killing spree in 2007.
“It felt like 100 to 1,” Rose agreed.
Hymes supported voluntary treatment and did not see mental illness as a primary cause of violent rampages. The answer, she said, was to “get rid of all the guns”.
In the wake of Virginia Tech, lawmakers approved $41 million to bolster community mental health services for about 160,000 Virginians — an amount that was eaten away by recession budget cutting. In 2009 and 2010, spending on community mental health plummeted by $9.2 million and on state hospitals by $13.1 million, state figures show.
More significantly for Hymes, the state adopted the new approach to involuntary hospitalisation recommended by the task force. It allowed commitment not only of people who posed an “imminent danger” to themselves or others, but also those who showed a “substantial likelihood” of harm because of an inability to protect or care for themselves.
A few years later, that was the standard by which she would be judged.
Hymes was struggling, first with the physical drain of a successful kidney transplant in 2008 and then with the emotional toll of her father’s death in 2009.
In hospital records she shared with The Post, she is described as articulate and well-groomed in 2010. A year later, she arrived at University of Virginia Medical Center disheveled and disoriented. When asked if she was mentally ill, she replied, “I don’t believe in mental disability.”
To clinicians, her answer was a sign of her illness, and they sent her to Western for what ended up being a one-year stay. To her friends in what’s called “the psychiatric survivors movement”, her statement was a sign of sanity. She shared their view of involuntary hospitalisation, forced medication and the use of restraints as traumatising and a violation of civil rights. To them, she was not a patient but a political prisoner.
In July 2011, a fellow member of MindFreedom International, a coalition that works to protect people labelled with psychiatric disorders, issued an online action alert to “Free Alison Hymes!”
Those closest to her saw the situation in less militant terms.
“This is not ‘Free Alison’,” said Elizabeth Breeden, a mental health advocate and long-time friend. “The question is, ‘Can Alison take care of herself?’”
After she was released from Western in August 2012, Hymes was allowed to return to her Charlottesville condo. For the first few months, Hymes cooked with her home health-care worker and walked to the nearby store for groceries. Then she started to stay in bed and stopped taking at least some of her 17 medications. Four months after her release, Hymes called the police, accusing her home care worker of stealing from her.
“When police arrived at the scene, they were unable to obtain logical answers from her,” read an account written later by her doctor at Western State, where she was committed a few weeks later. “She appeared not to have bathed in a week, smelt of faeces and … the things she was accusing the worker of stealing were found on her counter.”
She spent her 56th birthday at the mental hospital. Birthday wishes from friends and supporters filled her Facebook page. Hymes replied, using an iPad that her younger brother had sent her for Christmas. Forget the birthday, she wrote, “life s**ks nd then yiu die [sic].”
After what happened the last time she’d gone home, her doctors and social workers concluded she needed more support to live independently. Her younger brother lived in Charlottesville, but he was taking care of their elderly mother. The best option was a nursing home. But many are not equipped to handle younger people with mental illnesses, said Western’s director Jack Barber.
“The more you need, the less there is,” explained Barber, who served on the commitment task force with Hymes, but would not comment on her case, citing privacy laws.
The lack of discharge options ultimately affects the availability of emergency crisis beds, a 2012 inspector general report concluded. In September, about 11 per cent of adults in the state’s eight psychiatric hospitals were clinically ready for discharge but unable to leave because there were no appropriate place to put them, state figures show. The annual cost of serving someone in a state hospital is about $170,000, compared with around $44,000 in the community, the IG said.
Virginia’s mental health system is “out of balance”, said Debra Ferguson, who heads the Department of Behavioral Health and Developmental Services. She described it as “overly reliant on emergency services and in-patient hospitalisation” at a time when state hospitals have been downsizing.
Western, for example, moved from a cluster of low-slung 1940s brick buildings to a $140 million glass-and-brick compound that is a monument to deinstitutionalisation. At its peak in the 1960s, Western housed 3,000 patients at two sites. When the new building opened in November 2013, it housed 184, including Alison Hymes.