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One Woman's Struggle 

The day before she killed herself at Carousel Center, Desirae Crandall got out of St. Joseph's psychiatric ward on a four-hour pass to see her mother. Crandall, 20, was voluntarily admitted to St. Joseph's Hospital Health Center in Syracuse five days before, after gouging her arms with a paper clip at her therapist's office. It was perhaps the 12th hospitalization of her 2 1/2-year struggle with mental illness, her parents said.

Still, during that April 2 visit, her mother saw hope.

''That Tuesday when Dez was here, she didn't talk about death,'' said her mother, Diane Utter. ''We watched TV. We cooked spaghetti, her favorite. And we were talking about the future ... about her getting her own apartment down the road.''

In the end, Crandall couldn't see that far. The next day, April 3, the hospital released her and put her in a cab to a group home where she lived since December, her parents said. From there, she took a bus to Carousel Center and went to the second-floor atrium. She climbed over a railing, leaned back and plunged 35 feet to the basement floor.

''I feel that I can't take life anymore,'' Crandall wrote in her suicide note. ''I can't get rid of this feeling of hopelessness, the deep black hole that's eating me up moment by moment. I feel like I have no soul.''

Crandall's parents believe St. Joseph's Hospital Health Center made a fatal error in releasing her that day. They have hired a lawyer to pursue whether the hospital was negligent.

Desirae Crandall's story shows the struggle facing people with chronic mental illness in a world that doesn't understand their disorders and often isn't equipped to treat them.
Crandall was the third person to commit suicide at the mall since 1998 and one of 13 people to commit suicide in Onondaga County so far this year, according to the county medical examiner's office.

In the four counties served by the medical examiner's office - Onondaga, Madison, Oswego and Cayuga - a total of 62 people killed themselves in 2001 and 64 in 2000. A 1999 study by the office indicated more than 75 percent of suicide victims were depressed, and about 25 percent suffered from severe mental disorders such as bi-polar or schizophrenia. About a quarter also had serious physical ailments.

Desirae Crandall had been diagnosed with chronic mental disorders, most recently schizophrenia, her parents said. The most disabling mental illness of all, it causes delusions, hallucinations and disordered thinking. A friend of hers described it as being like ''having a radio on in your head, blasting, and you can't control the volume or the stations.''

'Typical' childhood

Her family said Crandall had a seemingly ''typical'' childhood, followed by a breakdown as she reached adulthood. Her parents, Edwin Crandall and Diane Utter, were together five years and had two daughters: Desirae, born Feb. 6, 1982, and her sister, Danielle, born 11 months later. After the couple split, they stayed friends and Ed stayed involved as a father, he and Utter said.

Her father's favorite memory of Desirae as a child shows her early desire to be helpful, he said. At age 7, she saw him washing his car and asked to help. He handed her the hose. The phone rang and he ran to answer it. When he came out, Desirae said, ''Dad, I not only rinsed the car, but your carpets were dirty!'' he recalled, laughing. ''I opened the doors and water came pouring out.''

Desirae and her sister attended St. John the Baptist Academy in Syracuse to sixth grade, then went to Grant Middle School. Desirae did well academically, but confided to the school social worker, Rudy Duncan, that she felt inferior, he said.

''She was a kid that always was kind of fragile,'' Duncan said. ''She thought people didn't like her, even though the evidence suggested otherwise.''

Fun streak

By the time she reached Fowler High School, ''Dezzy'' seemed to blossom into a red-haired beauty described as ''bubbly'' and fun. She played softball and soccer and baby-sat children in her North Side neighborhood, her parents said. In winter, she shoveled older neighbors' driveways for free, and in summer she worked with children at a local CYO program.

''She was very outgoing, very loving, very warm and very compassionate,'' her mother said. ''She was always a big help to basically everybody.''

Her sister, Danielle, 19, said Desirae was constantly teasing and goofing around to cheer people up. She loved smiley faces, kittens, ''anything that was unbearably cute,'' said a former boyfriend, Ted Kingsley, 21, of Syracuse. She would draw smiley faces when signing her name, or paint rocks with smiley faces as gifts, her father said.

Kingsley, who dated Desirae before her ''break,'' said he was prone to depression, but he never saw her ''down.'' She suggested the smiley face tattoo on his right arm, he said.

''She said, 'No matter how depressed you are, some part of you will always smile.' ''

In 1998, at age 16, Desirae poured her energy into karate. Rudy Duncan taught karate at the North Area Athletic Club, and she joined his class. Over two years, she earned six belts and was halfway to a black belt, he said. To Duncan and others, Desirae talked with excitement about her goals.

She wanted to go to college and work with children. She left a lasting impression on her 11th-grade English teacher, Brian Fritzen.

''She was full of life, she always had a smile on her face, and she never talked bad about anyone,'' Fritzen said. ''I really thought that she would make a difference.''

A change dawns

Therapists say mental illness often is ''triggered'' by a stressful situation. Desirae's mother would not comment on a traumatic event in 1999 which she and others said precipitated Desirae's mental illness. Utter said she did not want to violate Desirae's privacy. In her senior year at Fowler, Desirae started having trouble in school, and began to withdraw, family and friends said. Instead of going to karate to train, she would talk to Duncan about her problems.

''She lost interest in most everything that was important to her,'' her father said.

One rainy, fall night she stayed late at school and planned to walk home. At 7 p.m., she called from downtown Syracuse and said ''she couldn't find her way off Warren Street,'' her mother said. Her father found her shaking and confused. They brought her to CPEP - St. Joseph's Comprehensive Psychiatric Emergency Program.

That was her first hospitalization. She was treated with anti-depressants, which helped for a short time, her mother said. But, as Duncan said, ''She never fully recovered.''

Desirae turned 18 in February 2000 and was to graduate that June. In May, her father took her to Sears for her senior picture. It shows a pretty, smiling girl in a cap and gown - an illusion. By graduation day, she was back in the hospital, her father said.

Back home, she tried to go to summer school for her GED, ''but because of her illness, she was inattentive,'' her father said. She developed an eating disorder, lost touch with friends and, finally, tried to overdose on medication, her parents said.

That summer, she spent a month at Four Winds psychiatric hospital in Syracuse. This time she was diagnosed as bi-polar, a disorder that causes mood swings from the highs of ''mania'' to the depths of depression, according to the National Institute of Mental Health. Her parents said she was treated with Lithium, a mood stabilizer that works for many bi-polar patients. It didn't help Desirae, who became lethargic and put on weight, her parents said.

Utter said doctors switched her to Risperdal, a mood stabilizer that is less likely to cause weight gain, but does produce carbohydrate cravings. Over the next 18 months, Desirae's weight doubled, from 115 pounds to 230, her family said.

Painful cycles

She kept trying. In the fall of 2000 she got a job at Au Bon Pain, a deli on the food court at Carousel Center. She worked there a total of 12 hours, said manager Marty Lynch.

''She had an incident working on the counter,'' Lynch said. ''She was making a sandwich for a customer, and she started eating the sandwich right there.'' A co-worker told her to report to Lynch the next day. She didn't show. ''The following week, she picked up her paycheck, turned in her uniform and that was it,'' Lynch said.

Desirae found herself in a vicious cycle. She would get worse, land in a hospital, get different drugs, get a little better and get out, only to get worse again. She had more help than some: a case manager provided by Onondaga County, a therapist and day treatment program at Hutchings Psychiatric Center in Syracuse. She would attend for a time, then try to overdose or scratch her arms with safety pins, and do another short stint as an inpatient, her mother said. She was treated at Four Winds and the psychiatric wards at Community General, University and St. Joseph's hospitals, but never for more than three weeks, her mother said.

In the summer of 2001, her case manager recommended she apply for public assistance and move into a supportive group home for psychiatric patients, her mother said. ''When she lived (at home), she slept a lot and everyone said this was not good,'' Utter said. ''They wanted her to be active and do things.''

She stayed at the Chadwick Residence women's shelter while awaiting placement at a St. Joseph group home, applied for public assistance and went to outpatient programs on weekdays. But the pattern continued.

''They kept putting her in outpatient'' day treatment, Utter said. ''She didn't like it. She thought (it) was boring. She would attend if they did ceramics or a hiking trip, but most days they sat around and drank a lot of coffee.''

Problems mount

In December, she moved into the group home. There, she tried to take advantage of exercise, counseling and art therapy programs. Encouraged to set goals, she made a list.

''1) get GED,'' she wrote.
''2) go to college. Hopefully I can ... go to OCC, maybe just start off with humanities. I'm unsure of what I want.''
3) loose weight.''

Her weight became yet another burden, the hope of losing it another insurmountable goal, family and friends said. ''Her whole self image got lost,'' Rudy Duncan said. She told her parents she felt ugly, that boys wouldn't look at her anymore.

''Once pretty, always pretty,'' her mother said. Desirae didn't believe it.

Her mother said an added stress came from public assistance, which required her to attend Jobs Plus training and apply for jobs. The Department of Social Services sent requests for proof of her wages and living expenses. She wrote back that she wasn't working, but was attending outpatient programs.

On March 14, DSS sent a notice that it was cutting off her assistance. By then, she was hospitalized again, at Four Winds, her mother said.

She told her father she had been hearing voices arguing in her head. One told her to harm herself, and ''two good ones were verbally bashing the evil one,'' her father said. ''She told me I didn't realize what kind of torment she was going through.''

In the hospital, doctors treated her for schizophrenia with Haldol, an antipsychotic drug, her mother said. It seemed to help, and she was discharged within a week. Days later, on March 28, she arrived at her therapist's office at Hutchings scratching her arms with a paper clip and ''putting her hand out to see if everything was real,'' her mother said.

Her therapist called her case manager, who escorted her to CPEP, Utter said. After evaluating her, the emergency program moved her to St. Joseph's psychiatric ward.

Final days

When her father visited on Easter, March 31, ''she was kind of upbeat,'' he said. But when he remarked that she was doing things to herself ''for attention,'' she said, ''Dad, I'm serious,' '' he recalled. '' 'I can't live this way anymore.' ''

Her mother, who has blood clots in her legs and can't drive, took the bus to visit Desirae on April 1, she said. The next afternoon, Desirae called and told her she was getting a pass, but had to be escorted to and from the hospital. They arranged for her case manager to bring her to her mother's. Then her mother would bring her back in a cab that evening.

While at her mother's, Desirae called Rudy Duncan. She told him she had been having thoughts of hurting herself.

''I said, 'Are you talking to people?' '' he recalled. ''She said yes, that she was out on a pass but was going back to the hospital that evening. I said, 'Good.' ''

Her mother brought her back to the hospital about 7 p.m. They stopped in the gift shop and Utter bought her a Cosmopolitan magazine, a pen for her crossword puzzles and a chocolate bunny. She gave her $7 for ''snack money,'' she said. That's all the money Desirae had, she said.

The next day, Utter took a bus to the hospital to visit Desirae and was told she had been discharged, she said.

''They said, 'We put her in a cab and sent her back to the group home,' '' Utter said. ''I got home around 3 p.m. and tried to call the group home, but the line was busy. The next thing I know, the police are knocking on the door. ... They said they had reason to believe that Desirae fell to her death.''

The police told her parents Desirae was discharged about 11 a.m., arrived at the group home at 12:15 p.m., then caught a bus to the mall. The 911 call reporting her suicide came in at 1:55 p.m.

Care questioned

Her parents question why the hospital had her accompanied to and from a visit with her mother one day and discharged the next. Patient confidentiality laws prevent St. Joseph's officials from discussing specific cases, said Kathy Ruscitto, the hospital's senior vice president for strategic planning and organizational development. But in general, she said, passes are ''part of the discharge process'' and prepare patients to ''get back to the community.''

Also, a patient over 18 and in the hospital voluntarily could ask to be discharged without parents being notified, Ruscitto said. Patient rights laws would prevent the hospital from keeping a voluntary adult without a court order. Desirae's parents don't yet know if she asked to be released. But they feel that if she had made it through the dark tunnel a little further, there might have been a light at the end.

Instead, there was this note: ''People say that I'm beautiful but I don't think so,'' she wrote. ''I repent unto the Heavenly Father for all my sins. I love Him and I love all of you. Goodbye. Love, Desirae Crandall.''

Underneath her name, she drew a smiley face.

Coming Monday: How the system that strives to help the mentally ill is straining under the demands.

© 2002 The Post-Standard. Used with permission.

Copyright 2002 syracuse.com. All Rights Reserved.
 

The Post-Standard (Syracuse, N.Y.)
March 16, 2002

State to Four Winds: Admit no more children
By James T. Mulder
Staff writer

Some young patients at Four Winds psychiatric hospital in Syracuse are being punished by staff, deprived of toilet paper when they go to the bathroom and inappropriately drugged, according to state investigators.

Conditions are so bad the state Office of Mental Health has temporarily banned Four Winds from admitting child and adolescent patients. The state is letting the hospital stay open and will not remove any patients, according to Roger Klingman, a spokesman for the office.

The ban on admissions will remain in effect for 60 days or until the state is satisfied that the problems have been solved.

Four Winds, formerly known as the Benjamin Rush Center, is a private for-profit hospital at 650 S. Salina St. with 107 beds, 64 of them for children and adolescents.

Klingman said the state ordered Four Winds to shut off admissions Monday after agency staff made two surprise inspections. The state launched the investigation after receiving complaints from families and professionals over seven months.

In their report, investigators described Four Winds as a chaotic place where there are frequent fights among patients, young people wandering with little or no supervision, fire alarms going off frequently and children living in fear. Many parents have pulled their children out of the hospital because of safety concerns, according to the report.

"Findings indicate an environment that is not consistently clinically appropriate or therapeutic for children and adolescents," the report said. "Four Winds staff resort to withdrawal of items and punitive responses instead of a therapeutic and behavioral intervention."

Eight times during day and evening shifts, no staffers were seen in the children and adolescent units, according to the report. Investigators found staff congregating behind a closed, windowless door in a nurses' station.

Direct care staff had little or no experience in mental health and caring for children, the report said.

Most children and adolescent patients interviewed by investigators said they thought they were being punished for no reason. Those punishments included deprivation of food, toilet paper and access to the bathroom, according to the report.

"One (child) had saved toilet paper to reuse," the report said.

All of the 14 parents interviewed by investigators expressed significant concerns about safety, staffing and availability of soap and toilet paper.

"One (parent) noted that her son had to use the shower curtain for hygiene after a bowel movement," investigators wrote.

In some cases, investigators said staff might be using drugs inappropriately to control patient behavior. One 9-year-old diagnosed with "impulse control disorder" was given thorazine and haldol, powerful anti-psychotic drugs, 42 times in three months, according to the report.

The report also said Four Winds staff did not consistently follow the hospital's policy about the use of restraint and seclusion. In some cases, the necessary records and reviews weren't prepared within 72 hours on all patients who require restraint and seclusion, the report said.

Investigators also said it wasn't clear from hospital records if parents and guardians were told as required when children were restrained or put into seclusion.

Steve Lawrence, administrator of Four Winds, said the hospital is responding to all the items in the report and will make whatever changes are necessary.
"We take this very seriously," he said.

Lawrence said Four Winds told the state Feb. 26 that it was voluntarily shutting off admissions to make necessary changes. The state said the hospital told it March 5 it had decided to reopen admissions.

The state ordered Four Winds to keep admissions closed after a March 11 follow-up inspection showed "they had not really made all the corrections we had hoped they would have," Klingman said. As of Friday, Four Winds had 60 patients, 37 of them children and adolescents. Because the census is so low, Klingman said, state officials think the patients are safe.

"This is a safe hospital," Lawrence said. "We've already improved the staffing ratios."

Lawrence said many of the problems at Four Winds resulted from an increase in the number of severely troubled youths admitted.

In their report, investigators said Four Winds has a "subculture of children and adolescents with very intense behavioral problems that impact on the entire milieu and results in what parents describe as a 'gang mentality.'"

A lack of pediatric and adolescent mental health care has long been one of Central New York's most pressing health issues. The temporary ban on admissions at Four Winds could aggravate that problem, according to David Brownell, Onondaga County's mental health commissioner.

"It makes it harder for us to respond to children who need hospitalization," he said.

Four Winds increased the number of its child and adolescent beds in 2000 to help address the problem. Before that, children who needed to be hospitalized were frequently sent to facilities out of town, according to Deborah Welch, director of mental health at St. Joseph's Hospital Health Center in Syracuse. It might be necessary to do that again until the situation at Four Winds is resolved, she said.

© 2002 The Post-Standard. Used with permission.

Copyright 2002 syracuse.com. All Rights Reserved.

Last Updated on 02/20/05   webmaster@namiscc.org

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