By the time Isaiah Kalebu was sixteen, the state had intervened in his troubled family life in three distinct ways. It had deemed his parental supervision “adequate” after his mother brought him to the emergency room, at two months of age, with a cigarette burn near his eye that she said was an accident. It had expressed concern, in the form of repeated attempts at intervention by Isaiah’s public elementary and middle-school teachers, but none of those attempts at intervention had been successful. Finally, the state had appeared at Kalebu’s homes and at his private Adventist school in Kirkland, in the form of summoned police officers, for incidents of domestic violence and for the fight Kalebu had with another student.

There had been repeated nights in jail for Kalebu’s abusive father and, once, a Thanksgiving night in juvenile detention for Isaiah. But none of these incidents ever resulted in anyone’s pursuing formal charges in court.

Then, in September 2002, something called Family Court got involved in the ongoing dispute between Kalebu’s parents. It’s a department of King County Superior Court designed to assist families going through difficult proceedings and, in doing so, perhaps save on court costs — and, by extension, taxpayer money — while better protecting the interests of children. Family Court was asked to investigate the domestic violence allegations coming from each of Isaiah’s parents and, after that, to recommend a course of action to the judge handling their divorce. A social worker was assigned to help in the investigating.

“Missed opportunity”

By the end of October, the social worker had a completed report. It noted that Kalebu’s father admitted to being arrested twice for incidents involving his son. “This behavior,” she wrote, “appears to indicate a lack of empathy on the part of the father toward his children, in addition to a lack of consideration for the mother’s wishes. These behaviors, viewed in totality, are indicative of a pattern of control and violence that exemplifies domestic violence.” She recommended that Kalebu’s father “complete a domestic violence treatment program, and a respectful parenting course.” She suggested that Kalebu’s mother “would benefit from mental health counseling to assist her in learning how to remove herself from violent situations rather than respond in an aggressive manner.”

Finally, she singled out Isaiah, then just over two months past his seventeenth birthday, for special consideration. “It appears that the oldest son has endured a great deal of the father’s abusive behavior,” the social worker wrote. “This son would also benefit from mental health counseling.”

This never happened. “A major missed opportunity,” wrote Dr. Maria Lymberis, a forensic psychiatrist at the University of California, Los Angeles, who was hired by King County Superior Court to evaluate Isaiah after he was charged with the murder of Teresa Butz.

Had someone tried, at public expense, to get Isaiah Kalebu into mental health counseling at the time, it’s possible the system itself would have missed the opportunity, too. “A patchwork relic” is how a presidential commission, established just a few months earlier, described the nation’s mental-health apparatus. In any event, the legal battle between the teen’s divorcing parents dragged on, in a local court system that, like others around the nation, was itself suffering from neglect. A major issue was inadequate funding. Soon, current and former Washington State Supreme Court justices would launch a campaign for more money called Justice in Jeopardy.

Community treatment

The problems in the public mental health system had deep roots. In 1955, more than half a million Americans were housed in mental hospitals. Many of them were there for no particular reason, other than that someone with a certain amount of power found them strange, or inconvenient, or of the wrong skin color. Conditions in these institutions could be hideous, and protesting one’s confinement could be taken as proof of one’s instability. It was an open question as to whether this system was creating more insanity than it was purportedly treating, and at the urging of reform-minded psychiatrists, President John F. Kennedy closed the question by, effectively, closing down the institutions.

The community-treatment movement began, with promises of increased respect for individual rights and an emphasis on tailored outpatient therapies whenever possible, all of it to be backed by the latest science and huge increases in federal spending. Mental hospital populations began falling, helped along by a 1975 Supreme Court ruling that declared it unconstitutional to involuntarily commit “a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.” This, over time, evolved into a commonplace legal standard that, with some variations from state to state, prohibited involuntary psychiatric detention of any individual unless that individual posed “danger to self or others.”

Unfulfilled promises

By 1980, the population of American mental institutions was down sharply to around 155,000 people. The problem was that new treatments weren’t as much of a breakthrough as thought, and in any case federal funding sufficient to the challenge of community treatment never materialized. The Vietnam War intervened, requiring attention and money. An oil crisis came, requiring attention and money.

In the decades since President Kennedy signed his 1963 Community Mental Health Act, whenever crises arrived, whenever budgets had to be cut, expensive programs designed to help a marginalized and stigmatized population, now dispersed throughout many communities and possessing little political clout, tended to be the first to get the knife.

Dreams of widespread education about psychological instability did not materialize, either. Nor did dreams of services capable of responding rapidly to any individual in crisis. By 2008, when Kalebu found himself in crisis, multiple presidents had been warned that the system was failing because of neglect and was riddled with disparities and limitations. The same presidential commission that had described America’s “patchwork relic” of a mental-health-care system had, in its final report in 2003, called for a “fundamental transformation” of the country’s entire approach to people in psychological distress. It imagined a system in which, “at the first sign of difficulties, preventive interventions will be started to keep problems from escalating.” This commission, the New Freedom Commission on Mental Health, had the misfortune of competing for attention with the aftermath of September 11, 2001.

No “fundamental transformation” ever occurred. Instead, the burden of handling psychologically distressed people like Kalebu fell increasingly on families without the capacity to help and, when those families inevitably reached their limit, onto local police, emergency rooms, courts, and, finally, prisons, which had effectively become the new mental institutions, except without the mission to provide restorative treatment.

It has been pointed out that there’s strong irony to these developments. It was the shameful confinement of psychologically distressed Americans to prisons that, after being exposed in the 1840s by a woman named Dorothea Dix, led to the creation of mental hospitals and institutions in the first place. According to the Treatment Advocacy Center, which has highlighted this irony, the mentally ill population of America’s jails and prisons now far outnumbers the population of its surviving mental hospitals.

At the time when Kalebu found himself in need of help, the vast majority of Americans facing psychological distress were, as always, nonviolent, far more likely to be victims of crimes than perpetrators, far more likely to harm themselves than anyone else. But whether they were among the vast, nonviolent majority or in the small minority with violent tendencies, if they were poor, like Kalebu, they found themselves encountering a public mental health system that was in a state of collapse. If they were African American, like Kalebu, they were “unlikely to receive treatment” from this system at all, another federal report found, and in the event they did receive treatment were “more likely to be incorrectly diagnosed.”

Delusions and chaos

Then came the financial collapse of 2008 and, consequently, even more cuts to programs that might help people like Isaiah Kalebu.

He continued to deteriorate that year and, eventually, his older half-sister Deborah kicked him out. Not long thereafter he left his mom’s apartment, too, announcing he had a place of his own. His mother got in her minivan with him and his pit bull, and her son directed her to a large house on Capitol Hill, not far from downtown. It was a huge, two-story Craftsman with a finished attic, bigger than any place the Kalebu family had ever lived. They arrived at around 10:30 a.m., but the house was already occupied, by a small financial-services business.

Isaiah walked into the business with his dog, announced that he owned the place, and began firing people. He looked around, opened cupboards, peered in crannies. He explained that he was an African king and that the home had been stolen from him during the sugar trade of the nineteenth century.

When the police arrived, Kalebu’s mother begged them to take her son to the hospital instead of jail. She explained that several members of her own family had serious mental disorders and that Isaiah’s sister had recently kicked him out because of his sudden personality changes. Isaiah’s mother now believed her son had what her own mother had: schizophrenia.

However, she also told the police what was true: up to this point, her son had never been diagnosed with anything. In fact, he had never seen a psychiatric professional of any sort. The police escorted him to Harborview Medical Center, where emergency psychiatric evaluations are conducted.

“And here we go,” said Dr. Lymberis, the forensic psychiatrist who years later examined Kalebu’s trajectory. “When the family turned to the system, the system had the same dynamic as the family.” The system was under financial stress. It was under time pressures. No one could pay enough attention. Which was all well-known to people within this system. For decades, commissions at the state level, just like their counterparts at the federal level, had presented papers urging change, action, bigger fixes, more funds.

In Washington state, 2008 brought the elimination of a thirty-bed ward at Western State Hospital, the largest publicly financed psychiatric hospital in the region, which had already shrunk considerably in recent years. Money saved by the ward closure was supposed to be invested in better community-treatment programs, but that investment was effectively canceled out by recession-spurred cuts to those same programs.

“An imminent risk”

This contributed to an ongoing problem in which the system for handling people in acute mental distress was essentially locking up. Many other states faced, and still face, this problem. Like a number of those states, Washington addressed it by “boarding” — that is, strapping to gurneys in local emergency rooms — people deemed in need of psychiatric commitment but for whom there were no rooms available in any psychiatric hospital.

In 2008, more than eight hundred people were held in this manner in King County, kept in hallways or empty rooms in hospitals like Harborview, for various and unpredictable periods, waiting, often untreated, in a purgatory that local officials considered inhumane.

The month Isaiah was brought to Harborview, March 2008, saw forty-three people being boarded. That number means that on March 28, 2008, when Kalebu was brought in, there were likely one or two people already strapped to gurneys at Harborview, in urgent need of involuntary commitment but waiting, in states from untreated to insufficiently treated, until a psychiatric bed opened up somewhere.

But Kalebu’s older sister Deborah, who was called during the evaluation by a Harborview doctor, said she begged the doctor not to release Isaiah, explaining that his family had become scared of him.

“During the evaluation,” court evaluator Dr. Lymberis would later write, “Isaiah actively tried to present himself as sane.” He denied “any depressive or psychotic symptoms, admitting only that, in the last two months, he has become more enlightened. He was ‘being in the zone.’ He refused to discuss any of the details of what actually brought him to the hospital.”

The hospital recorded Isaiah’s family history of schizophrenia, but it diagnosed him with something different. It said he was in a manic state of bipolar disorder. A hospital psychiatrist wrote that Isaiah’s behavior “strongly suggests he is not capable of being in behavioral control due to his mania, that his decision-making is extremely poor,” and that “his impulsivity creates an imminent risk.”

Civil liberties

Kalebu had bothered other patients, been combative with the hospital staff, and claimed that people there were going to hurt him. Lithium was recommended should he be hospitalized against his will. However, the decision as to whether he would be held for a 72-hour evaluation was not the hospital psychiatrist’s to make.

Like other states, Washington uses a system of Designated Mental Health Professionals (DMHPs) who are called to evaluate whether people like Kalebu — people brought to emergency psychiatric centers because of concerns about their behavior but who express profound disagreement with their diagnosis — should actually lose their civil liberties by being involuntarily committed.

These professionals have a hard job, balancing individual rights against community safety and applying a static law to dynamic mental disorders, often with little background information about the individual in question, all with the knowledge that in either direction, hold or release, there will be challenges in getting the individual care.

Sent on his way

In Kalebu’s case, the DMHP determined that Kalebu did not meet the state’s criteria for involuntary commitment, which had been loosened and fine-tuned several times over the years but still revolved around the idea of danger to self or others. During the events that had brought Kalebu to Harborview, he had not described or evinced any intent to imminently harm himself or anyone else. He’d just falsely claimed to be an African king with the power to fire strangers from their jobs and had been a handful for hospital staff who he believed were wrongly detaining him.

So he was sent on his way. As Isaiah’s own public defenders later described it, “Ten hours after arriving at Harborview, Isaiah was released without medication, without prescription, and without follow-up aftercare.”

The day after his release from Harborview, Kalebu was at his mother’s apartment in Burien when she told him she wanted him to take medication. Isaiah told her to get out. Of her own home. He told her, “You’re dead to me.”

His mother asked him what he was talking about.

“Just leave,” Isaiah told her. “Enjoy your last day on earth.”

His mother became scared, grabbed a pair of scissors to defend herself.

“You’re no match for me,” Isaiah told her, according to a police report of the incident.

His half-sister Deborah, present for this altercation, fled with Isaiah’s mother and Isaiah’s two younger siblings to the minivan.

Someone told Isaiah to be out by the next day. In response, he grabbed a backpack and his dog and left, walking past the minivan — and flashing a knife with a six-inch blade as he did so.

Epilogue

In 2011, Kalebu was convicted of murder for his crimes against Teresa Butz and Jennifer Hopper, given a life sentence, and imprisoned. He’s now at Clallam Bay Correctional.

In 2015, under continued pressure from mental health care advocates, the legislature began to make some repairs to the state’s long-neglected mental health care apparatus, which is itself a microcosm of what the Obama administration recently described as “a crisis in America’s mental health system.” Lawmakers in Olympia passed Joel’s Law, named after Joel Reuter, a young, bipolar software engineer who was killed by Seattle police in 2013 after he shot at officers, thinking they were malevolent zombies. Joel’s parents, who feel their son should have been detained by mental health officials before the shooting, had lobbied for the new law. It allows family members to appeal to a judge for a second opinion if a disturbed loved one has been evaluated, deemed not a threat to self or others, and released.

Washington’s legislature also amended its involuntary commitment law in 2015, adding some language that made it easier for someone already diagnosed with mental illness and a history of noncompliance to be ordered into “assisted outpatient treatment.” If properly funded and implemented, “AOT” involves close community supervision, and had it existed in the summer of 2009, Washington’s new AOT language could also have been used to try to halt Kalebu’s slide. However, it’s worth noting that when they created the state’s new AOT program in 2015, lawmakers declined to fund it at recommended levels. When Washington lawmakers passed Joel’s Law, they also declined to fund it at a level certain to meet the potential need. Mental-health advocates in Washington state remain concerned about its still-frayed system for dealing with people in serious psychological distress, as well as its perpetually underfunded court system.

Jennifer Hopper, who testified against Kalebu at trial, moved out of the South Park home where she and her partner Teresa Butz were assaulted. She still lives in Seattle and has, in recent years, found a growing sense of forgiveness for her attacker. She doesn’t think about Kalebu a lot these days.

“I really don’t,” she said. “And that gives me freedom. That’s massive freedom, considering what happened. And yeah, there were people who said to me, ‘Man, I hope he gets his own when he gets to prison.’ To me, that for sure doesn’t bring Teresa back. For sure, it doesn’t make me feel whole, and it just has me participating in the same kind of way that created the violence that had him hurt me.”

From “While the City Slept: A Love Lost to Violence and a Young Man’s Descent into Madness” by Eli Sanders. Published by arrangement from Viking, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2016 by Eli Sanders. On Twitter @elijsanders

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