Who’s To Blame For This Death?

The residents of Morrisville, Pa., got an intimate look this holiday season at our troubled mental health care system. Paulette Wilkie, a homeless woman with a long history of schizophrenia, was found dead from exposure. The 56 year-old woman’s   body was discovered last week behind Ben’s Deli, a sandwich shop that she frequented. 

Temperatures the night before had dropped into the mid 20s. But that was not cold enough to trigger the county’s emergency homeless plan. Temperatures must sink to 20 degrees or below for two consecutive days before teams can be dispatched to try to  persuade homeless persons to come indoors.

Reporter Ben Finley, writing in the Bucks County Courier Times, noted that people who knew Wilkie said she likely would not have gone into a shelter anyway. The owner of Ben’s Deli said Wilkie refused help from people concerned about her safety and health.

Wilkie’s father said that his daughter had been in-and-out of a local community mental health center for more than 20 years. She’d lived in a group home until last year. Another resident said Wilkie was asked to leave after she stopped taking her medication. Wilkie’s father said his daughter did not like to take her medication. He said mental health officials told him that she couldn’t move back into the group home until she “got back on the medication and was clean.”  Her father added that his daughter had been hospitalized about a month ago and that he probably should have moved her into his house when she was discharged, but that he was concerned about doing that since she was not taking her anti psychotic pills. 

The owners of Anthony’s Pizza and Ben’s Deli said Wilkie was a regular fixture on their street. Everyone knew her and knew that she had a mental disorder. She always wore the same parka, its hood lined with fur, even in the summertime. Shortly before her death,  the two business owners said they noticed a sharp decline in her mental health. She was losing weight and had stopped bathing.

On the weekend that she died, Wilkie had gone into Anthony’s Pizza, but the store’s owner had asked her to leave because she smelled very bad and customers were exiting the store. “My wife was here and she said (Wilkie) is going to freeze out there,” the owner told the newspaper. Wilkie was last seen sitting on a picnic table behind the deli with her socks and shoes off, smoking a cigarette. 

While I do not have inside information on Wilkie’s death, she is not the first person with mental illness to freeze to death on our streets.

Could her death have been prevented? Absolutely. 

The first question we need to ask is why was this woman homeless?

I’ve heard people say that homeless persons prefer living under the stars rather than being inside. I’ve found this rather romantic notion to be hogwash. Even the sickest homeless person I’ve met doing my research has wanted a warm and safe place to sleep at night. Unfortunately, overnight shelters often are dangerous. Other housing programs are rule oriented and restrictive.

The solution here is Housing First.

Housing First does not require a homeless person to take medication or to stop using drugs/alcohol before he/she moves into an apartment. Instead, that individual is given a safe place to live because no one can get better mentally or physically if he/she is sleeping on the street.

 Most Housing First programs require tenants to pay a percentage of their income for rent. You earn zero, you pay zero. Tenants also are required to meet with a treatment team once a month. In many cases, the team is able to establish a relationship with the tenant. Team members work with tenants to get them the services that they need to control the symptoms of their mental disorders and/or beat their addictions.

In addition to Housing First, communities have had great success with Assertive Community Treatment teams, composed of specialists who visit persons who are homeless. Oftentimes, these teams have doctors, therapists, peer-to-peer specialists, and  job and addiction counselors on them. Their job is to try to get homeless, psychotic persons off the streets and into shelter and services.

Those are just two programs that can help persons who are homeless and have a mental disorder.

What if  there are no Housing First facilities or ACT teams?

There are other alternatives to allowing someone with a brain disorder to freeze to death on our streets. The most obvious is involuntary commitment to a hospital. But that alternative has been undercut by civil rights activists. As a society, we have decided that we are not going to help someone such as Wilkie until she reaches a point where she presents a clear and “imminent danger’ either to herself or others. This is a mistake.

In recent years, states have added other common sense criteria, such as whether a person is “gravely disabled” or “unable to care for themselves.”  But many judges remain reluctant to force someone into a hospital against their will unless there is obvious dangerousness.

Wilkie’s death shows the folly here. She had a long history of schizophrenia. The people who encountered her noticed that her mental condition was deteriorating. The temperature was dropping below freezing and she was last seen sitting on a park bench with her socks and shoes off. Yet, it’s unlikely that she would have met the dangerousness criteria. This is why we need to adopt a more sensible standard.

Of course, involuntarily commitment is only useful if a person actually gets meaningful medical care and social services after they are committed. Ordering someone to a hospital for a shot of Haldol and then having a doctor shove them out the door may be a temporary solution. But it rarely helps anyone recover.   

Another law  that might have saved Wilkie’s life is Assisted Outpatient Treatment. In its simplest form, AOT laws permit a judge to order an ill person to take medication if they meet strict criteria. Usually, the person has to have a history of violence or of frequent hospitalizations. Medication also has to have been shown to be effective in helping the person control the symptoms of their disorders.  If a person doesn’t comply with AOT,  the judge can involuntarily commit them to a hospital.

 Wilkie’s father was quoted saying that “someone dropped the ball.” That’s a bit too easy of an explanation for me. 

I suspect community mental health officials felt their hands were tied. They’d done everything they felt they could do based on their meager resources and restrictive laws. Her father admitted that he couldn’t care for her when she was off her medication. The police said that she was not breaking any city codes. And based on her own actions, Wilkie didn’t want anyone to help her. 

So who, if anyone, is to blame for her death? Mental health professionals? Her family? The police? Civil rights advocates? Or Wilkie herself?

How about all of us  –  for not demanding that persons such as Wilkie get the meaningful community mental health and housing services that they need to recover and for not modifying our laws so that if those services fail, we can intervene?

Here’s my question to you.

When did we decide as a society that it’s acceptable to walk by a woman with a serious mental disorder who is sitting on a park bench not wearing any shoes or socks in freezing temperatures and say, “Oh well, she’s not dangerous, so it’s none of my concern?”

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • Krolla

    Pete,
    Thank you for highlighting this preventable tragedy. In December 2008, another PA woman with severe and untreated mental illness, Susan McDonough, died from “hypothermia due to psychosis.” How many more people must die before we decide that compassionate care actually requires the provision of care and treatment? PA has an assisted outpatient treatment law, but it requires a person to be a “clear and present danger to themselves or others.” Apparently, being on the verge of death does not meet that criteria. Common sense legislation to slightly modify the outpatient standard died in committee during this past session. I implore all your readers in PA to express their outrage and indignation at this continuing atrocity by contacting their state senators and house representatives and asking them to support viable assisted outpatient treatment legislation which will shortly be reintroduced.
    Aileen Kroll, JD
    Legislative & Policy Counsel
    Treatment Advocacy Center

  • Tgskale

    What a tragic, horrible story but it is a harsh reality of what can happen to people with untreated neurobiological illness. Housing First and ACT, especially Homeless ACT can be very effective. As you are aware, Pete, with our “Rick’s Story” video, we see this type of situation with people living in the streets and in the woods all too frequently. But, we were able to get a man who lived 21 years (!!!) outside into an apartment where he’s been happily residing for the past 6 years. The woman you wrote about absolutely should have been hospitalized on a psychiatric hold if she would not go voluntarily. We never take holds lightly but in this case I would do it without hesitation. She had chronic illness and clearly unable to care for herself at the time. She was a clear danger to herself.
    I will be addressing this situation with our Homeless team the second I get to work today. Thank you for calling attention to this potentially preventable tragedy.

  • I got up this morning and read this.

    I would have done something to get this stinking repulsive woman some help, (no matter what her physical condition a human has precious life that is to be protected) I have to think that and know it otherwise I would rather have died than not insist that she get help, I have been in the trenches with mental illness for over 2 decades.

    Last night we had yet another episode with my 26 yr old son who is anything but mentally stable.
    Doctors say PDD/NOS Asberger’s Autism BiPolar Schizophrenia
    Yet alot of the time he is calm sweet interested in life and pleasant
    The Good times far outweigh the bad times.
    He seems to wax and wane
    He is on the “meds” and now weighs 390 lbs and 5’10”.
    two of his meds have class action lawsuits against them because of severe weight gain ,,,,,,, but what do we do? I have lived with him not taking them and it is unbearable.

    Life is a bitch and then you die.

    Sometimes it just seems it can’t get any worse ,,,,,, and then it does.

    Fortunately most people don’t have to be bothered with mental illness
    My son has ostracized my wife and I from almost everybody.

    He has been in the State Nuthouse,,, HORRIBLE they overdosed him and warehoused himn nearly killed him with a misdosing of his dangerous meds

    our state Alabama spend more $ on the State Fair than it does on mental health

    Now on the horizon I have this fear that Obama has the answer
    (just like Hitler thought he had the answer)

    What is Hell? is it here on earth a mentally ill person? for me ?
    When I croak can I be sent to a place worse than this ?

    But on the bright side when I croak I won’t have to be bothered by such things as “mental health” aka the disease that described best by the statement of Scarlett O`hara “We’ll think about it tomorrow”

    • Marthamoet

      Hi Frank, Your honest description of Mental Illness. My son has suffered from Sz. for 10 years. He seldom takes his meds. He lives with me but I fear what will happen when I pass on. I pray for compassion.

    • Marthamoet

      Hi Frank, Your honest description of Mental Illness. My son has suffered from Sz. for 10 years. He seldom takes his meds. He lives with me but I fear what will happen when I pass on. I pray for compassion.

  • Djjaffe

    Once again, you highlighted an issue as no one else can. Congrats.

  • Luvhd

    It breaks my heart. My mother, brother and daughter all are bi-polar/schizophrenic. My mother has lived in state hospitals most of her life, my brother has been missing for 17 years, we believe he is homeless in Florida and my daughter is 24 and is now struggling with living with the disease daily. Even though she is meds compliant, I am so afraid that she will stop treatment and go missing too. It is a fear that I live with. I am her favorite stalker, constantly trying to keep tabs on her to make sure she is OK. It can be frustrating for the both of us. What else is a mother supposed to do?

  • Mark

    Very well put Pete. I am Susan McDonough’s brother. It makes me so angry to go outside in this cold weather and think of my sister and now Paulette and the many others that cannot take care of themselves because of not being in the right frame of mind because of their mental illness. How can we see them and just ignore them or not reach out in some way. The laws must change so we can do more for them. Everyone keep up the fight.

  • denise

    keep the discussion going
    I visited a church in Toronto Canada and in the front they kept a record of who dies on the street homeless each month. There were a lot of John Does

  • advocate4change

    Of all of the options that Pete mentions, the only one that would make a real difference is changing our Mental Health Procedures Act through assisted outpatient treatment legislation (AOT) so that an individual such as Paulette would receive the treatment she desperately needed. Our current treatment law requires the same criteria for inpatient and outpatient treatment, “clear and present danger to self and others” and the AOT legislation that has been proposed would change just the outpatient treatment to “likely to be a clear and present danger to self or others.” More importantly, the court order would assign a mental health provider agency to be responsible for following-up on an individual who was so seriously ill and lacked the insight (anosognosia) to seek and remain in treatment.

    Someone did drop the ball and it is true that the mental health agency’s hands were tied because our outdated treatment law doesn’t require them to intervene unless an individual is dangerous. However, our Office of Mental Health (OMHSAS) and PA Providers Association oppose changing our treatment law which would then allow them to intervene when someone as ill as Paulette desperately needed their help.

    It would be very difficult to open a group home where residents who have a serious mental illness and are psychotic and refuse treatment because there would be many opponents with the “nimby” (not in my back yard) mentality. A Housing Committee in our area has worked hard on improving the housing situation in our county but it has been an uphill battle to find affordable housing.

    We have assertive community treatment (ACT) programs in our state but admission is completely voluntary. If an individual decides that they do not wish to participate in an ACT program, the team does not continuously reach out to them to try to persuade them to join.

    Inpatient hospital stays are generally less than a week and, even if Paulette had been involuntarily hospitalized last week she would have already been discharged and the temperatures are once again at the freezing mark.

    Yes, someone definitely did drop the ball and the ones such as our OMHSAS office and provider agencies who should pick up that ball by joining the advocacy effort to change our treatment laws don’t want to change the status quo. It is therefore up to everyone else in PA who wants to have a compassionate intervention treatment law in place so that individuals such as Paulette Wilkie of Morrisville, PA and Susan McDonough of Reading, PA do not need to meet such a tragic fate to contact their legislators and demand effective AOT legislation.

  • brational

    In demanding effective Assisted Outpatient treatment we are speaking for Paulette Wilkie and Susan McDonough and all of the other victims of mental illness who cannot speak well for themselves due to their illness. We need to demand this legislation in order to stop these tragedies and begin to bring people “in from the cold”. No one with good mental health and ability would choose to stay outside and freeze to death. It is the illness that makes the choice and those who think that civil rights are being violated by simply helping people to make more sane choices simply don’t understand this legislation. People with severe mental illlness would be protected from their illness within a community of professionals providing them a road to sanity. To prevent this road to sanity or to sit by and let it happen is cruel since severely mentally ill people cannot be expected to make good decisions about their health. It is their illness speaking!

  • Timbeshore

    I have to believe that when the state hospital were severely cut back somewhere around the 50’s, society was unprepared for the unpredictable. I think a large part of it has to do with how exactly someone goes about having a non family member involuntarily commited.

  • Timbeshore

    I have to believe that when the state hospital were severely cut back somewhere around the 50’s, society was unprepared for the unpredictable. I think a large part of it has to do with how exactly someone goes about having a non family member involuntarily commited.

  • Guest

    No one should be forced to take medication if they don’t want it. I’d rather freeze to death outside than be forced into a hospital and shot full of drugs. That’s my right. This woman said she didn’t want help so people listened to her and she got what she wanted. That’s no one’s fault. That’s called freedom.

    • Mark

      To Guest,
      Your comment is sure to anger alot of people as it did me. You have alot to learn about the mentally ill. The condidtion of schizephrenia has many factors to it and one of them is that 50% of them don’t know or believe they are ill. They are not in there right mind to make decisions for themselves. I take great offense to you thinking that my sister Sue or Paulette saw themselves freezing to death as a way to show we have freedom in this country. I’m sure in the right state of mind they would have been in a warm bed somewhere.

      • Cindy

        I was glad to read your comment to the person who called sick people’s right to die freedom. How ridiculous! He obviously has no understanding of mental illness.

      • Spanishindiangirl

        Mark,
        Your sister’s loss, absolutely could have been prevented, I am truly so sorry.

        One thing that helped me, i learned in group counseling was “a contract” with my loved one, medication compliance or else leave my property, kind of like reprimanding a child to go to their room, it is sensitive since none of us wants our ill person to become homeless but it worked for me. My son is doing Great, He is the Joy of My Life…for almost one full year no episodes at all..and he is med compliant almost completely, he knows it upsets me if he gets off kilter,,very sensitive on how to manage this. There were times I did not think he would come back around from his break as he was so far gone….but my son is super humorous, loves animals, this has been a big help (horse, llama, and goats therapy) very healing. We have success; it is so GREAT. Now my son’s father, not sure how he is doing …in a medical/jail? not sure what this is about…but it is on my heart to find out..we split about 24 years ago, when our son was 2…NEVER GIVE UP ..IT GETS BETTER..I CAN ATTEST TO THIS..WE ARE IN THE TOP 20% OF SUCCESS..some stories are even way better than mine..never give up hope..ANY OF YOU who may read this. Even the most tragic case of seeing the ill person can turn around to great success…never give up hope.

        Mark, I am so sorry …and thank you for being a positive, light, a voice in this often bleak and dark place…we..You ..us must always be hopeful and never give up Love.

        one thing that helped

      • Spanishindiangirl

        Mark,
        Your sister’s loss, absolutely could have been prevented, I am truly so sorry.

        One thing that helped me, i learned in group counseling was “a contract” with my loved one, medication compliance or else leave my property, kind of like reprimanding a child to go to their room, it is sensitive since none of us wants our ill person to become homeless but it worked for me. My son is doing Great, He is the Joy of My Life…for almost one full year no episodes at all..and he is med compliant almost completely, he knows it upsets me if he gets off kilter,,very sensitive on how to manage this. There were times I did not think he would come back around from his break as he was so far gone….but my son is super humorous, loves animals, this has been a big help (horse, llama, and goats therapy) very healing. We have success; it is so GREAT. Now my son’s father, not sure how he is doing …in a medical/jail? not sure what this is about…but it is on my heart to find out..we split about 24 years ago, when our son was 2…NEVER GIVE UP ..IT GETS BETTER..I CAN ATTEST TO THIS..WE ARE IN THE TOP 20% OF SUCCESS..some stories are even way better than mine..never give up hope..ANY OF YOU who may read this. Even the most tragic case of seeing the ill person can turn around to great success…never give up hope.

        Mark, I am so sorry …and thank you for being a positive, light, a voice in this often bleak and dark place…we..You ..us must always be hopeful and never give up Love.

        one thing that helped

  • Pedge

    This is a real tragedy. My heart aches with the thought of this poor woman in her last hours. The fact that she was sitting in below freezing temperatures without shoes and socks shoes she was not in her right mind. “Anosognosia”—is very clear in this story! The legislation to change our laws and provide AOT (assisted outpatient treatment) is the only thing I think would have helped in this case. Let this women be a loved one of ANY of our lawmakers and this would have never happened because AOT would be a law by now in our state. When are they going to open up their eyes and their hearts and do the humane thing. The way this woman died is a disgrace to us as a society!

  • Thankyou for adding my name in the login.
    I just wanted to respond to what happen to this woman and say that it is a tragedy that we, as a community and society do not realize when people need help, and this was very obvious. Where I have helped dozens of people myself. Families that could not afford daycare, or live without certain means where they depended on the state for their children to have daycare. I had one family that I worked with for three years, where the mother of the child couldnt afford my daycare without my help, let alone find decent housing. She eventually was placed on section 8, and on the HUD system, and was able to be on her own.
    One time I had a student who was homeless come to my door because he had no place to live. I was living out of state at the time. I wanted to offer him to stay with us, however, my husband, at the time, didnt want me to have him stay. Many people get the idea that some of these people would harm or hurt the family that they are living with, and that may be why so many do not wish to help. What if he/she has a weapon? What if they try to steal my items, etc. There is society fears, and some could be correct in that thought, however it must be balanced in our thinking, when someone is without, they are in need, and to be helpful, just to help one person in your life, you are helping many. I am one of those people. As a person who is also in nursing, I have seen many people with issues and problems. I have been through some difficulties myself. I have a kind heart, and so very willing to give. However I have been stepped on in various ways, and severed from the very things I have loved doing most. I was raised with the belief that you dont cut off communication or help because you are taking away the very foundation of love, spirit, joy and especially life that a person needs. If your’e filled it is easy to give. To give love, you must have love to give.
    For four years I was bleeding harshly, and believed that I would bleed to death. It wouldnt stop, no matter how many surgeries that I had. I knew what it was like to come close to dying I believed it was work related. Not necessarily stress, because I didnt have many stresses towards the end of my working period there. For the time that I was there it became my secondary home, and I gave because I was receiving love from one person in my life. Therefore I could give love back to the others there that I cared for there. However, when someone is in trouble, I would not be the one to say “what do you want me to do about it” It becomes the responsibilty of someone that the person loves and trusts to become that other person.To do so basically gets the problem off their back and not help the one in need or say that you can go here or there or somewhere else to get your help is alot of bologna. You can say maybe “why dont you go to your doctor, and well you have your life with your family, etc, but what about giving supportive words that can do alot and this is especially when the love that you entrusted in needs to give it back.” Many people tell me hurts and stories of needing help, and some I hardly know, but I offer them advice, Im not their doctor, or anything else. I just notice it, and offer it. As long as I can give it, it is there to give. but it is hard when your not getting what you need back. I received a phone call today as when he called he thought I had called after 4:00pm, but I think he called me because he wanted to know how I was doing. I get diplomatic and sometimes too business like on the phone, as I tried to sort through my feelings to tell him how I felt. No, father, I didnt call you, but I am glad you called me. I wish I could take you to church, and take you out to dinner afterwards; and I wish you wouldnt say anything negative, but because I love you, I look at your needs first, and that is more important to me. Like opening the door of the church so that you can get to your car or just to see you, and at the same time I would like to take care of you at assisted living, like I did before. I often think about those things, and what people talk about regarding you and me. I often think of many things as I think of my marriage to you, I think of love, I think about alot of things My caring for you would be basically that, as taking care of your basic needs. And unlike what most people think sex is not the priority. But love is. It what keeps life, love, happiness, and good spirit.