By Liz Szabo, USA Today (Published on 1/17/2011)
That lunatic smile.
The eyes that look "at you and through you at the same time."
When Darlene Bobich first saw the now-infamous mug shot of Jared Loughner, she immediately recognized his expression. Although Bobich has never met Loughner, the man accused of shooting Rep. Gabrielle Giffords and 18 others, she has seen his wild-eyed look countless times - in the face of her own son.
"I know that smile," says Bobich, whose 23-year-old son, Peter, has been hospitalized seven times in five years for paranoid schizophrenia. "The dilated pupils - I call them shark eyes."
Like other parents of mentally ill children, Bobich loves her son and wants desperately to help him. But she also lives with the fear that she will one day get a call from the police, telling her about something terrible he has done.
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The first time Bobich took her son to the emergency room, at age 18, he told her that he had been forced to snap his beloved dog's neck (he hadn't) and was desperately trying to wipe imaginary blood off his clothes. He was poking at the air, explaining that "if he didn't push the buttons, we would all die."
Bobich, 46, a single mother, spent the next five years fighting: to get her son an accurate diagnosis and adequate care; to pay for his treatment and medications; to keep him out of prison; to keep her job and her own sanity.
"It was really isolating and overwhelming, knowing that every day you have to go home to that by yourself," she says.
Bobich eventually became so afraid for her safety that she moved to another state, leaving her native New England for Tennessee.
Experts say getting help for an adult child can be much harder than caring for a youngster, who can be seen by a pediatrician. Bobich's son, for example, won't allow his doctors to share any of his medical information with her, which makes it harder for his mother to help or intervene on his behalf.
In some ways, young adults are especially vulnerable to mental health crises, says Paul Ragan, associate professor of psychiatry at Vanderbilt University School of Medicine in Nashville. Although people in their early 20s are in the prime of their physical health, they're also going through huge changes - such as graduating from college, moving away, starting a new job - that can leave them without crucial support.
Ragan notes that according to the Centers for Disease Control and Prevention, the three leading causes of death for ages 15 to 24 all involve some kind of violence or trauma: unintentional injury, homicide and suicide.
Young adulthood - the late teens and early 20s - is also a time when many mentally ill people experience their first psychotic break, Ragan says.
For a loving parent, the experience is as bewildering as it is terrifying.
With a heart attack or broken arm, "everyone knows where to get services," says Michael Fitzpatrick of the National Alliance on Mental Illness (NAMI). For bipolar disorder or psychosis, "it's less clear where to get care."
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Some families first look for help through the alliance's toll-free hotline, 800-950-NAMI, which fields 6,000 calls a month.
Bobich first heard about NAMI about 18 months into her son's illness. When she finally called, she says, the man who answered said: "First, take a deep breath. I know why you're calling."
Bobich says she burst into tears.
In many cases, the best source of help is a family doctor, particularly one who knows the patient well, says David Pickar, an adjunct professor of psychiatry at Johns Hopkins University School of Medicine in Baltimore. Young adults often can be included on their parents' health plan, Fitzgerald says.
In some ways, things are getting better for people dealing with mental illness, he says. Federal law now requires that health insurance plans - many of which once provided little mental health coverage - make no distinction between medical/surgical care and mental health care, Fitzgerald says. He says he hopes that will encourage more psychiatrists, many of whom have worked on a cash-only basis, to resume taking health insurance.
But many families still struggle to get care. Across the USA, budget cuts have forced hospitals to close 4,000 inpatient psychiatric beds since 2009 - leaving them less able to take in the mentally ill. Arizona has eliminated hundreds of positions for mental health caseworkers, who help coordinate patients' care, Fitzpatrick said.
The uninsured - including Bobich's son - face additional obstacles. Bobich, an administrative assistant, says it took her two years to pay the $1,500 cost of one month's medication for her son. Eventually he qualified for disability payments, which provide him with slightly more than $600 a month. Sometimes, he steals to make ends meet. He has been arrested four times.
Like many with mental illness, he doesn't always take his medication, she says.
Bobich copes by "taking it day by day, hour by hour." And having compassion for everyone touched by the Arizona shooting. "If you pray," she says, "pray for his family, for him - and the families of those he has hurt."