Monday, March 12, 2018

Nikolas Cruz's Psychiatric Treatment

The system failed. It failed the children of Parkland, FL and it failed Nikolas Cruz. We know that the FBI was asleep, that the sheriff’s office was derelict in its duty and that no one has yet to take responsibility for the failure. If Sheriff Scott Israel had any sense of decency he would long since have resigned his position. Instead, he is hunkering down and defending himself… because he wasn’t on the scene. Of course, he is still responsible for his department. But apparently, he does not feel that way. And our morally twisted culture refuses to hold him accountable in the court of public opinion.

Today, we have another piece of the puzzle. It turns out that Nikolas Cruz consulted with several psychiatrists and therapists over a two year period. He was taking psychiatric medication… though I do not know which one. Now, the Miami Herald has gained access to the psychiatric files and reports on them.

The signs were clear enough, and the psychiatrists did everything short of having Cruz committed. They saw his paranoid and violent tendencies. They knew that he was threat. They seemed to believe that he was responding to treatment. But they had not seen him in two years. Between then and now, his violent and erratic and paranoid behavior had gotten worse. The sheriff’s department was called to his home dozens of time. And yet, no one thought to send him back to treatment… or to have evaluated.

Cruz was a problem in 2014, when he was attending what is called an “alternative school.” He had confided in a psychiatrist that he wanted to kill people, but he told the therapist that he didn’t really mean it. The therapist wanted Cruz to talk it out— the old talking cure, don’t you know— which the Miami Herald disparages:

A May 3, 2014, notation in a Broward County schools psychiatric file said Cruz “reported [a dream] last week of him killing people and covered in blood. He smiled and told the therapist that sometimes he says things for shock value.”

After Cruz’s disclosure to his therapist at the alternative Cross Creek School, administrators developed a “safety plan” to ensure the welfare of Cruz and others while the teen was on summer vacation. The plan included provisions for removing “all sharp objects from the home,” and encouraging the youth to “verbalize what the problem is.”

If talking about “the problem” was seen as a solution to Cruz’s volatile behavior — and, in the short term, it may have been — it did not last. 

What did the treating therapists see?

Cruz alternated between periods of good behavior and periods of paranoia during which he acted out at school and at home, making fun of his peers, cursing at school staff and making threats, according to notes from his period at Cross Creek. The records obtained by The Herald documented weekly therapy sessions between February 2014 and December of 2015.

Cruz wanted to own a gun. One therapist was concerned:

School administrators spoke with Lynda Cruz in the months that followed about their mutual concerns about Cruz’s desire to own a gun and take shooting lessons. The therapist, a Sept. 23, 2014, notation said, “shared concerns with parent about his obsession with guns/military and his poor anger control. The note also cited concerns over the possibility that Cruz would “deploy aggressive behaviors at home.”

Another therapist recommended that Cruz be allowed to have a gun if he could earn it:

At the time, Lynda Cruz was considering buying the teen a pellet gun for his birthday. A different therapist who appears to have been visited the family at their home suggested the mom develop a “plan” in which the youth would be allowed to buy a gun if he was able to “earn it” with good behavior. There was “a plan in place at home in order to control his use of the pellet gun.”

Another therapist was opposed:

Cruz’s school therapist, however, expressed reservations. “Parent was advised against getting him a gun (pellet) or classes for his birthday,” the September notation said. “Parent advised to restrict access to any weapon.”

Another therapist tried role-playing as a way to ease Cruz’s transition into the more normal high school, Marjorie Stoneman Douglas High:

In some sessions, the therapist described Cruz as “receptive,” or noted that he’d had “positive” behavior at school. The therapist role-played with Cruz to teach him how to interact with his peers and avoid conflict. But following other sessions, the therapist noted troubling behavior at school and at home.

In one April 2014 session, the therapist discussed Cruz’s “aggressive behavior at home due to his not getting his way.” Cruz responded by saying that he saw the therapist as a threat. The therapist noted that Cruz was “very paranoid.”

Before the 2014 summer vacation, Cruz’s therapist and psychiatrist wrote to another of the boy’s psychiatrists, to express their serious concerns:

In preparation for a summer 2014 recess, Cruz’s school therapist and psychiatrist jointly wrote a letter to another one of the teen’s psychiatrists articulating a host of serious concerns. “At home, he continues to be aggressive and destructive with minimal provocation,” the letter said. “For instance, he destroyed his television after losing a video game that he was playing. Nikolas has a hatchet that he uses to chop up a dead tree in his backyard. Mom has not been able to locate that hatchet as of lately.

“When upset he punches holes in the walls and has used sharp tools to cut up the upholstery on the furniture and carve holes in the walls of the bathroom,” the letter added.

One notes that Cruz was treated by multiple therapists. And that some of them were clearly alarmed.

But then, they seemed to believe that Cruz had improved significantly. We do not know whether this had anything to do with his medication and we do not know what the medication was. We do not know whether he continued to take his medication after entering Stoneman Douglas. We suspect that he did not:

By the following April, though, after Cruz had shown “tremendous progress” in his behavior, Cross Creek began efforts to move him to a traditional school.

Psychiatric notes from that period describe a significantly less erratic youth. His mother reported that he was making friends and had exhibited no signs of inappropriate behavior “in the community. She is happy that he has been doing better,” an April 28, 2015, notation said.

Cruz had been able to “control” his behavior, both in school and at home, the April 28, 2015 notation said. He was noticeably less aggressive. Teachers did not report having to place him in “time outs.”

“Parent has requested student to be mainstreamed,” the report added.

In discussions about Cruz’s desire to attend a “regular” school, psychiatric progress notes said he was encouraged to continue mental health medication, therapy and social work case-management at home, and was discouraged from becoming a cadet: “Interested in ROTC?,” the report said. “Not advised,” it added.

One does not know whether Cruz received any treatment after he enrolled in his new high school. We suspect that he responded well to medication, but then stopped taking it. Within the scope of their influence the psychiatrists do seem to have done as well as they could by Nikolas Cruz… but then he stopped treatment and the problem became the sheriff’s and the FBI’s.


Jack Fisher said...

In some states, like California, a psychiatrist has a duty to warn (that is, breaching psych - client confidentiality) if there is a threat to third parties. Patient confidentiality is a matter of huge, huge importance.

In other states like Florida, this isn't a duty, but the decision is left to the psych. Here is part of the Florida statute allowing disclosure:

"(2) Such patient has made an actual threat to physically harm an identifiable victim or victims; and

(3) The treating psychiatrist makes a clinical judgment that the patient has the apparent capability to commit such an act and that it is more likely than not that in the near future the patient will carry out that threat, the psychiatrist may disclose patient communications to the extent necessary to warn any potential victim or to communicate the threat to a law enforcement agency."

From what I've read, the threats were too vague and distant in time to allow the psychs to inform LEO. The failure is in how the law is written. There have been efforts to change this.

Fla. Statutes Title XXIII 456.059

Ares Olympus said...
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Ares Olympus said...
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