(Image: Bryan Cohen for CHS)
Sean Munday said he became friends with Denny Way standoff suspect Joel Reuter who was shot and killed by police Friday morning when they both attended the University of Arizona. Munday said he knew the suspect for eight years.
Munday said the man had long suffered from mental and physical illness but he was not sure what triggered his friend to lash out early Friday morning.
“We were under the impression that he had a good lock down on things,” Munday said. “He just hit a boiling point.”
Munday gathered with a small group of other friends of the suspect, who were consoling each other one block away from the scene.
Seattle Police interim chief Jim Pugel said the 28-year-old Reuter was not allowed to have firearms in his possession due to court orders and that detectives are working to figure out how he acquired the Glock pistol seen by witnesses and recovered from Reuter’s residence. Reuter’s online accounts reveal a man suffering from mental illness with an interest in guns and the 2nd Amendment. Friends say he was diagnosed with cancer within the last year.
“We’re shocked and in pain,” Munday said. “He was gentle, very loving, very docile. He was a big teddy bear.”
Munday said the suspect had not been working due to his illness. He said his last job was with a Seattle tech startup.
The man had moved into the Marq within the past few months, according to neighbor Richard Oh, who told CHS he lives two units down from the suspect.
Oh, who has lived in the Marq since 2005, said that the man’s door was recently knocked down by an SPD crisis intervention team.
Oh also said the sign the man had posted on his door included a “666” marking and warnings to the FBI and police. “Just crazy stuff,” he said.
Julie Poliak, who has also lived in the building since 2005, said she heard what sounded like a man ranting through an amplifier yesterday evening.
“It sounded like it was related to gay marriage, but I couldn’t tell if it was hate speech or not,” she said.
Mental illness + easy access to firearms is never going to end well. This whole situation is just a big pile of suck yet we continue as a society to let this happen again and again and …
don’t you remember? People say everybody has a RIGHT to guns but no RIGHT to health care.
Until we have decent mental health care in this country we’re going to see a lot more of this.
Cops show up… this is never going to end well…
Yup.
How come they use a tranquilizer gun to rescue “dangerous” animals. But for humans they are repeated gunned down, slaughtered, murdered… I don’t get it. They are always talking about “non-lethal” weapons, but never seem to have them on hand… MURDER.
Animals don’t have guns. And tranquilizer darts often don’t work as simply and easily as they do on TV.
And I’m sure people would complain about cops injecting people with drugs.
In cases like this, some people inevitably jump on the police in a knee-jerk response. There are scant details in this post as far as what exactly happened. I think we need to wait until the facts are in before anti-police judgments are made.
My apologies. When I wrote the above, I didn’t realize that there was a previous post with extensive details of what happened.
This is really sad.
I know this guy, and it’s really sad to see him fall through the cracks of our healthcare system. He was extremely intelligent and a genuinely nice person.
it’s no secret the cracks in the system are way too big. This man’s unfortunate demise is further proof of that. Very sad.
He was locked up @ harborview multiple times in the past couple of months. This was not a sudden event.
Part of deinstitutionalizing the mentally ill in the 60s – 80s was funding cuts, true, but a lot was the result of the new ideas that most people with mental issues should be treated on an out-patient basis, and only the most severely impaired would need in-patient care.
That, plus the rise of advocates (e.g., the ACLU and others who advocated similarly) claiming that involuntary commitment should not override the mentally ill person’s legal right of self-determination whether to be treated or not. As we each have a legal, constitutional right of consenting or refusing consent for any medical treatment, the patients’ right not to be involuntarily committed trumped issues of family or neighbor concerns (except in case of a demonstrable danger to self or others, which overrides the individual’s rights in the service of public safety) and left the decision up to the patients themselves. Unfortunately, many suffering these illnesses cannot perceive their own impairment clearly. So we are left with nice sounding policies of self-determination, community based out-patient treatment, and bad consequences of ill folks wandering around unable to get it together. Probably only a tiny proportion have violent potential, but when the fit hits the shan, it ain’t good.
Amen, Fritz!
Well said.
Yes, excellent comment.
He seemed sane and rational in the Youtube video posted where he calls to find out if he’s allowed to own a gun. Perhaps he had an “episode”.
I’ve noticed a number of comments like this on sites discussing these (and other high profile) events.
It’s important to realize: “rational”, or at least the ability to appear rational within a specific scope of discussion, does not imply “sane”. People can be extremely ‘rational’ and even methodical in their earnest insistence that, given the ‘fact’ that they are the only person in the universe in a position to stop the great conspiracy threatening to enslave us all unless person so-and-so is killed, they need to do X-Y-Z to act before all is lost. It’s only when you get to the question of how they know about their conspiracy and their important role in preventing it that the conversation loses all semblance of rationality. Except in the discussion of their area of delusion, they may be able to appear quite organized in their thoughts and actions – but it does not mean there is not a mental illness in play.
Signed,
Your concerned neigbhorhood psychiatrist
He was not well. He was diagnosed with cancer earlier this year and after a few treatments stopped taking his medication for bipolar disorder. Watching his mental state deteriorate over the past few months and end in such a way is something I wouldn’t wish on my worst enemy. I weep thinking about how scared he must have been at the very end. He was not a gun nut, just a scared kid.
His Google+ page is online
https://plus.google.com/101940516144034628730/posts
He posted a video claiming he had been molested by a relative.
Jesus Christ
His paranoia was that strong. He believed he had been molested by a relative, he believed his family had helped the government program his mind, he honestly believed “they” were out to get him. If you ever know anyone that is on medication and they go off it, do whatever you can to get them back on it. He was my best friend for the last 11 years and watching what happened to him over the past 4 months will haunt me for the rest of my life.
He posted a video claiming he had been molested by a relative.
Jesus Christ
My heart aches at this tragic outcome for a young man and all those who cared about him.
As a psychiatrist who regularly practices at Harborview – but was never involved in the care of this particular individual – I wanted to add a few comments after noting how much confusion there seems to be about mental health law and how it may relate to this particular case.
Yes, funding for mental health care is often an issue. Yes, police treatment of the mentally ill is often extremely problematic, and at times tragic (although I have also been witness to great acts of kindness, sensitivity, generosity and caring on the part of SPD towards my patients, as well). But from the information available publicly at this point for this case, it sounds like the core of it is something else critically important for many in need of mental health treatment, but which is much less discussed in the press: the incredible difficulty involved in obtaining interventions for someone who is decompensating but has poor insight.
Washington state does, as others in some of the online discussions have mentioned, have an involuntary treatment act, and it works well in some circumstances – for people who are vocal about their suicidality, for example, or their thoughts of harming others, it can error – in my view – on the side of being too willing to detain people involuntarily, at times. But for those who are, for example, paranoid and manic, and high-functioning enough despite their mental illness to be tight lipped about any plans to hurt themselves or others in front of authority figures or those who might report them, it can be *extremely* hard to detain people for long enough for real treatment.
Similarly, for those who are not necessarily an active threat to themselves or others, but just very disorganized (generally related to a psychotic illness), the standard for involuntary evaluation and treatment can be very extreme – if you can provide for food, clothing and shelter – say, by making your way to a downtown homeless shelter for meals and a bed – you aren’t likely to be detained for treatment. If this happens to be the standard being applied to your formerly professionally employed mother who’s in the middle of a psychotic depression, that can be devastating.
In multiple other cases of publicly discussed tragic outcomes, I have followed the discussion very closely but been prohibited from commenting by patient confidentiality rules, having been a treating physician for the individual involved at some point prior to the publicly known events. It has been incredibly painful to hear an earnest discussion of what went wrong and what can be done to try to prevent it from happening again, and to know that a huge piece of the puzzle – the involuntary treatment standard (ITA standard) – was being missed… but not to be able to comment on this in any way. This time, I am finally free to comment.
The question of when to involuntarily detain and treat someone with a mental illness is incredibly, incredibly hard. But the process by which we decide and apply the standards has been, I think, much too secretive and hidden from the public here in Washington state. How many people reading this know we have one of the most conservative systems in the country in this regard? This is something we should be working together to think through and make decisions about. It desperately needs honest, open, informed discussion.
Again, my most sincere condolences to those grieving this young man’s death. I read this story and immediately see both patients and my own loved ones in his place and can hardly bear it.
Thank you for your professional insight into this case as it applies to the general issue of involuntary commitment. Another post (above) states that this person had been “locked up” at Harborview quite a few times recently…if this is true, would that not in itself be a good reason to send him to longer-term inpatient treatment? I would much rather mental health professionals err on the side of committing someone…otherwise, we will have more episodes like this one. Perhaps some state laws need to be changed.
A major problem is that seriously mentally ill people stop taking the medicines which would help them, and perhaps this poor fellow is an example of this. There needs to be better follow-up once a patient is discharged from Harborview…at least daily for awhile…and, if a patient admits to not taking medication, they should then be involuntarily committed….to protect the public as well as themselves.
You hit the nail on the head with the last paragraph.
Yes, I saw these mentions too – and in the phone call someone linked to where he calls to ask about whether he can own a gun, he refers to having seen a judge as part of a mental health court hearing.
In our system, there is a whole hierarchy of involuntary treatment, and the further you get in the hierarchy, the higher the bar is for detainment. The lowest bar is to be detained for evaluation – a policeman or ER doc can make this determination themselves, and can tell someone that they are not allowed to leave until they’ve been evaluated by a psychiatrist. Sometimes, when people say they were eg “detained at harborview”, this is actually what they mean – although MDs wouldn’t generally use the words that way.
If someone is evaluated by an MD and felt to be an imminent (ie, within a matter of weeks – “this person is bound to kill someone in the next year or two” doesn’t go anywhere in our system) danger to themselves or others, or is “gravely disabled” (ie, unable to provide for their own food / shelter / basic safety), then in our state the next step is to refer to a “county designated mental health professional” or “CD-MHP” (often called “MHP” for shorthand). This person is NOT an MD, although some are LCSWs – it is someone who has been hired and trained by the government to come out and make an independent assessment of whether the legal criteria for involuntary detainment – ie, risk of imminent harm or grave disability – are met. If the CD-MHP agrees, then the person is detained for 72h on those grounds. Of those 72h, the person can be forcibly given certain – but not all – medications for 48 of them – but not the last 24h, because you are at every step allowed to refuse all medications for the 24h before a commitment hearing.
And that’s what happens next, at the end of the 72h (not including weekends/holidays) – a mental health court hearing with a judge, who decides whether you can be placed on a “14 day hold”. Finally, when this expires, the next step is by default a hearing about a “90 day hold”, although more often than not if it looks like someone will be held, their lawyer and the court will instead do an agreed extension that’s less than 90 days. At any point during these holds, if the patient’s MDs decide the patient doesn’t need to still be there, the hold is lifted – so a “72 hour hold” or “14 day hold” are referring to the maximum times the hold can last, not the minimums / defaults.
The things that are relevant here are that the bar for keeping someone goes up at each hearing – so it’s not uncommon to have someone detained for 72h, but then released at that hearing. And if someone’s really in trouble with a mental health crisis, it’s a rare case where 72 hours – of which 48 can require compelled treatment, and that’s if you magically know what’s going to be best for the patient from the moment the hold starts and start it right away – are going to make much of a dent. On the other hand, a week or two of treatment CAN make a huge difference for many people, although of course not everyone.
Another thing that’s unusual about our system here in this state is what happens when someone is discharged. Almost everywhere there is something that lets people extent some aspect of compelled treatment into the outpatient stage after an involuntary treatment stay – here, it’s called an “LRO” for “least restrictive option”. So, if someone is decided by their providers (in discussion, of course, with the patient, the patient’s family, outpatient providers, etc, of course!) to be ready for discharge and they still have time left on their hold (eg, they’re one week into a 14 day hold), then their hold can be converted to an LRO – where, if you can find an outpatient mental health facility willing to manage the legal aspects of it all, there will be stipulations written up for what the patient needs to do to keep up with outpatient treatment – and if they don’t, then the bar for re-detaining them for the rest of their original hold is lower than it would be to detain them anew.
This is useful for many people. There are barriers to its use, though – and, in addition, it’s definitely weaker in its power than what’s used in many other states – eg, where I practiced previously, the stipulations could include that if someone were required to show up and receive medications, and they didn’t do so, the police could show up at their house and give them the choice of going to their provider or the hospital.
Again, there are good and bad things about almost every way of doing things – and I am not advocating a particular change, here (although I have plenty I would push for myself…). But I do think it helps people to know what the situation is and how it compares to other places when they think about what happened in a tragic situation like this.
– Your concerned neighborhood psychitrist
Thank you for your insightful comments. What would be, in your opinion, the two or three most useful amendments to the involuntary commitment process in Washington? Perhaps there are some measures that could be undertaken to improve the laws.
I am by no means an expert, and there are many who are very involved in trying to reform these laws – although there is also concern that if they are “opened up” so to speak that they will end up moving away from involuntary treatment being allowed at all, rather than in a direction that seems likely to benefit patient care in the long run.
From what I know just on the practicing end, the biggest areas I fantasize about being able to make changes would be:
1) More oversight and joint reviews of the CD-MHP training, resources and decisions. I have worked with CD-MHPs who are AMAZING. Who work so hard to come up with a plan that will have the best possible outcome. And then I have worked with CD-MHPs who show up and say “well, I know you have half a dozen people with signed affidavits saying this person is paranoid, extremely depressed, and has spent the last 3 weeks researching effective means of suicide – but I just talked with him for a few minutes and he just told me he’ll be fine, so…. *shrug*… I’m gonna let him go. Have a good night!” I know there are internal reviews that happen within their department but the MDs who work so closely with them are never privy to any of that. In addition, at this point they are *massively* overworked – which means that they don’t have enough time to do a careful job, often, and people are at times released even when everyone agrees they could/should have been held just because the CD-MHPs couldn’t get there within the amount of time the law allows for an evaluation.
2) There are not enough inpatient facilities willing to care for detained patients. This means that there are often patients “boarding” in the ER for long periods of time – which is AWFUL. Harborview is an amazing place with really dedicated, caring people, and it does a ton with little resources, but its facilities for psych are not luxurious, and its ER is not meant for people to stay in for days at a time. It’s psych ER is full of small, windowless concrete rooms with giant locking doors and metal gurneys. The doctors who run the psych ER are really good at being psych ER doctors – and are not set up to do the care required once a patient has been “admitted” – ditto for the nursing staff. It’s just not a therapeutic environment, there’s no continuity if care, etc. The consequence of which is that often people who are detained spend much of their initial hold hanging out in this miserable situation that’s NOT contributing as much to their very acute care needs as an admission to the floor would – but there’s just no space for them upstairs. And actually, at least at Harborview they are being cared for by psychiatrists – when they are boarded at small community hospitals, which often happens as well, often it’s just the local general ER doc making care decisions! The solutions to this are manyfold, but one of the most obvious is to decrease the waitlist for longterm patients to go to Western State Hospital, which would free up shorter term inpatient beds immediately. Much of this backlog started within the last couple of years when Western lost funding and closed a bunch of beds, because it couldn’t afford to staff them.
3) Personally, I would like to see the standards for involuntary treatment altered to allow for less emphasis on “imminence” (ie, if you can demonstrate there’s a good chance someone’s going to kill a random person on the street in the next year, that ought to count for dangerousness!!) and on direct harm, and more weight given to a collapse of function and decision making ability (so, the previously totally functional person who’s now completely disorganized and incoherent – but not actively suicidal – would be easier to get help for). But I would love to see this paired with true implementation of psychiatric advanced directives – where when someone with a chronic serious mental disorder is doing well, they can give directions about what they want to have happen or not have happen during any future episode that may occur, and to have that have some teeth behind it (at this point, a watered down system does exist, but it’s hard to use and often ignored, for a variety of reasons).
I hope it’s ok to be talking about this here. I absolutely don’t want to detract from the focus on this individual person’s awful loss. I just can’t help but read this and think of all of my patients – and loved ones – who risk similar events. I read the comments about how desperately people were trying to get him care, and I *KNOW* that this happens over and over and over and yet we haven’t fixed it – the fact that so many people can see something like this coming and try EVERYTHING to avoid it and still end up with no options and then a tragic end – it just makes me feel desperate to find a way to change the situation.
So, thanks for listening / thinking about this with me…..
— Your concerned neighborhood psychiatrist
Thanks again for your detailed remarks on the detaining process. I am amazed that, after an MD psychiatrist has determined that a patient should be detained, a lesser-trained “MHP” can overrule the psychiatrist’s professional judgment. Shouldn’t it be the other way around? And, if a person is seriously ill enough to be admitted on a 72-hour hold, is that really adequate time to diagnose, begin treatment, and stabilize such a patient? When patients are discharged after that short time period, it seems likely that many of them will still be out-of-control and that public safety would be compromised.
Also, it seems quite clear that outpatient follow-up needs to be significantly improved….otherwise any improvement while in-hospital will be quickly negated, especially since many of these persons will stop taking their medicine. Even if a hold is converted into a LRO to compel outpatient treatment, it sounds like the LRO would expire within a fairly short period of time (say, for example, one week if a 14-day hold was converted into an LRO after 7 days)….so, the obvious question is “What happens to that patient after that happens?” Wouldn’t it be better if most of these patients were compelled to continue outpatient treatment for weeks or months, at a minimum?
My condolences to this young man’s family and friends.
I have to wonder at the use of lethal force (once again) by law enforcement. I have read accounts of this matter in various news sources and apparently, there were police snipers stationed in positions whereby they had visual contact with the victim. Why weren’t nonlethal means of stopping this young man used before killing him? Listening to the radio broadcasts during the day, it came out that this individual had a history of medical aide intervention of which the SPD was a part. I’m wondering when the decision is made that a person such as this becomes “expendable?”
What non-lethal means would you have suggested? He had barricaded himself in his apartment, making it rather difficult to deploy any such means.
I doubt that any of the police considered him expendable, but when he started endangering the lives of others by shooting out through the window, it was considered necessary to use lethal force to end that danger.
“Why weren’t nonlethal means of stopping this young man used before killing him?”
They presumably tried. For 8 hours. Until the young man fired his gun. It’s not like they just showed up and immediately shot him.
Maybe it would have turned out better if he’d only had a knife, rather than a weapon that can kill from a distance.
To this man’s family and friends: My utmost condolences. I never met Joel, but he was my neighbor and I’m sure that we passed each other on the street at least once. I wish that he had been able to get the help he so badly needed. Yesterday was a very sad day for a lot of people.
RK, thank you for your insights. As someone who has had to grapple with the system while trying to involuntarily commit a loved one, to little avail, I too would like to know what changes you suggest to make WA’s involuntary commitment policies more progressive.
The least we can do for all those impacted by this terrible situation, and folks who are marginalized by mental illness in general, is reflect on how to prevent others from hitting rock bottom as well.
It’s appalling that such a wealthy, progressive city has gaping holes in the safety net designed for those who need it the most.
“It’s appalling that such a wealthy, progressive city has gaping holes in the safety net designed for those who need it the most.”
—-> That’s because its not near as progressive as our reputation suggests. Think critically about that for awhile. Peace.
[…] shocked and in pain,” a friend told CHS. “He was gentle, very loving, very docile. He was a big teddy […]
[…] standoff. In the wake of the shooting, the man’s friends told CHS about Reuter’s battle with mental illness. This week, the Stranger talks with the people who knew Reuter about his life and what happened to […]
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