The Boy Who Was Too Hard To Treat
By Ella RubeliAugust 20, 2013
How a young life was lost in the messy gaps that stretch between drug abuse, mental health and treatment.
When Rebecca Ireland was called to the Lismore morgue to identify her firstborn son, she found her handsome and broken 19-year-old lying cold. He had her long feline eyes, her high cheekbones, her rich dark hair, but he also had bruises tracking the veins of his body.
“I felt like I lost my son slowly for years, I grieved [for] him all the time,” she says.
Rebecca saw her son as having two identities. There was the little boy and there was the drug scammer. By the time of his death, Rain had been homeless and uncontrollable for almost four years. His volatile character and penchant for extreme drug use had created a monster so violent and terrifying that just before his 16th birthday, Rebecca had been forced to kick him out of her own home, where she lived with Rain’s younger brother.
“He was spiralling, just deteriorating and deteriorating, I felt like he was going to die any day,” she recalls.
Rain's Fall: Addiction Meets Mental Health
By the age of 18, Rain had advanced to such a stage of drug-dependence that his mind had collapsed into a lingering psychosis. Yet each time he was forced to see a medical officer, he would still get it together enough to adamantly refuse treatment.
As a young boy, Rain had had a fear of doctors, which evolved into an intense suspicion of anyone in the medical sector, and then a disregard for all authority. He grew wild on the street and became virtually untouchable — inaccessible to his mother, to the trail of doctors and counsellors whom she bribed him to see, resistant to advice given to him by youth workers in the nearby town of Byron Bay. Rebecca says Rain was cunning, he knew the correct answers to give during mental examinations and he managed to trick medical officer after medical officer into believing that he was perfectly well.
As a 16-year-old no longer living at home, Rain existed in a legal limbo. He was free to live independently from his parents, but if found to be at risk of serious harm, he was prevented (as a 16- to 18-year-old) by The Children and Young Persons Care and Protection Act from being forced into the care of community services. Furthermore, Rain signed privacy documents that prevented doctors and counsellors from divulging information to his mother; the current approach taken by New South Wales health services prioritises maintaining the trust of the patient. Whether or not it was his direct intention, Rain programmed the system in such a way that during the subsequent three years it was virtually impossible for health services and his family to help him or even keep track of him.
“Everyone gave up on him,” Rebecca says.
At the front of the desk of Dr Harry Freeman, the last psychiatrist to see him, Rain at 19 years of age said he had no intention of giving up drugs. He didn’t want treatment.
And that was his right.
Under current Australian law, people over 18 years of age are free to refuse treatment, provided they have the capacity to make an informed decision. Drug habits are not directly considered. Yet according to behavioural neurology professor Andrew Lawrence of The Florey Institute, drug dependence is, at its core, the behavior of a somewhat dysfunctional brain: a brain that is incapable of making informed decisions. Many of the reasons people give for refusing help are the very reasons that show they are in need of help.
“Most people wouldn't continue doing something if there were adverse consequences to it, but part of the reason that [drug addicts] do continue to [use drugs] it is that their ability to make a decision not to do it, has become impaired.” says Professor Lawrence.
Bernard Balleine is a professor at the Brain & Mind Research Institute at Sydney University.
“I would say that they'd be making decisions in a system that isn't functioning,” he says of people with a drug dependency.
“You can call them decisions in a kind of abstract way, but they're not decisions that the person’s making in a reflective sense, they're decisions that are in fact reflexive.”
Involuntary treatment is very difficult to instate. Since the days of institutionalising mentally ill patients, there has been a groundswell in support of patient rights. Currently, the New South Wales system is designed in a way that prioritises the rights of the patient. In order to detain a patient, medical officers must prove that they are ‘mentally disordered’ and a danger to themselves, or a danger to the wider public.
A patient cannot be held in hospital against their will unless two – and sometimes three – authorised medical offers agree that the person is mentally ill or mentally disordered and thus in need of assessment by a psychiatrist. This process of involuntary admission is commonly known as ‘scheduling’.
“[But] If somebody's under the influence of drugs it’s very difficult to diagnose a mental illness – because you have to wait for the drug effects to leave,” explains James Pitts, CEO of the Australian branch of Odyssey House, one of the country’s largest drug- and alcohol-rehabilitation services. “Drug effects,” he says, can last for, “sometimes two to three months.”
Pitts was a professional basketball player for the Minnesota Pipers in the United States, but when an early injury forced him to leave the game as a young man, he turned to drugs and drug dealing. He was arrested and sentenced to five years in prison, but the judge saw his potential and suspended his sentence on the condition that he attend the Detroit branch of Odyssey House rehabilitation centre. Soon after that, he was sent to Melbourne to set up the program there. After 30 years working in the field in Australia, Pitts has become a leading figure in drug rehabilitation.
“It’s virtually impossible to get somebody scheduled unless they’re floridly psychotic,” he says.
“But being scheduled is a serious deprivation of liberty. If somebody's going to get scheduled, then you have to have very good reason, and I think that that's certainly a good thing.”
If a doctor finds that a patient is mentally ill, a mental-health inquiry must be referred to the Mental Health Review Tribunal. If the Tribunal finds them to be mentally ill, they can either be discharged, given an order to submit to community treatment for 12 months, or detained in hospital for a maximum of three months. If a doctor finds a patient to be ‘mentally disordered’ they can be held for up to three days.
But the process of classifying a patient as mentally ill or mentally disordered has many grey areas, and if a patient is resistant to treatment and is able to put a case as to why they do not need to be treated, as Rain Ireland did on several occasions, doctors will err on the side of caution; rather than lock them in a ward, they will refer them to a voluntary rehabilitation program.
Dr Katherine Mills, program director of the National Health and Medical Research Council (NHMRC) centre of research excellence in mental health and substance use at the National Drug and Alcohol Research Centre, is a specialist in the co-occurrence of substance abuse and mental health disorders.
“The system is set up in a way that only if you are very, very acutely ill will you get easy access to treatment, and by then it’s a bit late,” Mills says.
At the age of 16, young people in NSW are free to live independently from their parents. While living on the street at 16, Rain had many of the liberties of a functioning member of society, yet he was doing irreversible damage to his adolescent brain and hijacking his ability to make decisions. “He was ingesting anything and everything in copious amounts, with no capacity to understand the ramifications of that and the damage that [he was] causing,” Rebecca says.
“Rain would say, ‘I’m living 10,000 of your lifetimes every day, and you’re just watching from the sidelines’,” she recalls.
During his years of homelessness, Rain hung out with a revolving collection of what his mother calls “undesirables”.
“He’d be with other crazy people, people with guns, and he was still a child. They were older, scamming, mentally unwell people and they were his predators. He got beaten up, abused. He was stuck in a vicious cycle,” she says.
IT WAS JUST AFTER DARK on the night of the 4th of December, 2012 that Rain was hitchhiking back and forth along the flat grey ribbon of the Pacific highway that follows the east coast of Australia. Under a drug-spun veil of paranoia and confusion, and in the belief that he was being hunted (as drivers who picked him up have said), Rain flagged down passing cars. He would travel a little way in each one, before getting spooked and leaping out and running across the white lines to hail another vehicle heading back in the other direction. People later reported that he had been hopping about in the middle of the lane, as if fighting his own shadow.
At 8pm that night, Rain tried to call his mother from a stolen phone, but her phone was dead. Forty minutes later, he came into contact with the vehicle of an unsuspecting stranger, a 32-year-old woman behind the wheel of a blue Volkswagen Transporter. She saw Rain’s figure in the blackness ahead of her with only moments to spare. Her car collided with his body, killing him almost instantly.
It is said that the people who sat in the cars that banked up behind the accident heard the driver wailing.
When Rebecca saw the detectives who came to her work the next morning, to tell her what had happened, she says her first thought was, ‘Who has Rain killed?’.
The bitumen where Rain’s body had lain was marked out with the forensic team’s chrome-yellow paint. Pummelled by heavy subtropical rain, the paint took four months to wash out of the tiny fissures in the road. The slow-motion decline of Rain Ireland himself was to stain the community for much longer.
For Rebecca, for the youth workers who had got to know him over the years, for the local cops, the school teachers, emergency health workers, psychiatrists and counsellors, Rain Ireland was their failure. Each knew pieces of his story, no-one knew it all. Each had tried to work within a system that lacked architecture, and watched in shock as he went tearing through every flimsy safety net that was set. The question on the lips of the Byron Bay community in which he grew up was unanimous: How did it get this bad?
A frightening statistic suggests that untreated addictions derail the lives of many people in Australia: that is, according to Corrective Services NSW, three-quarters of prisoners entering custody in that state have reported a history of alcohol and/or other drug abuse, and almost 70 per cent of offenders attribute at least one of their crimes to illicit drugs or alcohol.
OUT THE BACK of the Bangalow Hotel, in the town of the same name, just inland from Byron Bay, is an abandoned railway track. Plants grow up through the wooden skeleton of the derelict railway house and vines and graffiti cover the walls. On the floor are a few telltale signs of past residents: the dead ends of hand-rolled cigarettes, a plastic bottle with a hole burned in the side, empty chip packets and scrunched-up food packages. In the centre of one room, are the backrest and seat of a dismembered faux-leather armchair, laid flat to make a bed.
Of the campsites and abandoned sheds that Rain squatted in across the Byron Bay area, this was one of his more sheltered hideouts. When he was on the move, it was a place to keep his stash.
“It’s very hard to convey how disturbed and upsetting it was to be around him,” says Rebecca.
“I couldn’t take him. In the house we had holes all over the walls and I was ringing the youth centre for advice all the time,” Rebecca says, sitting in one of several tiny fibro cottages that face the arc of a wide brown creek, a rental home that she moved to in order to escape his spontaneous visits.
‘You're just a white maggot feeding off my black carcass,’ Rebecca recalls him saying to her one night.
After she evicted him, Rain continued to visit the family home, often homeless and hungry. Rebecca lived with the implacable fear that she would one day open her front door to find his corpse in the living room, cold from an overdose.
Rain’s drug habit developed to mar nearly every aspect of his life. He relied on government welfare to partially fund his growing dependence and won the rest by scamming on the street. “He stepped right into that culture. He wanted to take it really far. He went from smoking pot, to taking liquid LSD, and by 16 he was on ice, selling drugs and scamming on the street. He had no job, no meaning in his life,” his mother says.
“He didn’t want to get better, wanted to self-destruct. But there was a little boy in there who was screaming out,” she says.
It was after Rain’s 19th birthday in April of 2012 that his drug use and mental distress began to escalate. He started travelling and was living in Sydney, where he began using heroin. “He came home with bruises all up his arms,” Rebecca says. “I knew he’d been raped and beaten. He’d prostitute himself for his habit.”
By the time his drug dependency and mental state were extreme enough for him to be detained, the pathways in his brain had been rewired and damaged and his prospects of achieving a better quality of life were severely diminished. Rain had been admitted to hospital, for overdose or drug-induced psychosis, short term, on several occasions, but was never deemed to be in need of psychiatric assessment.
In October of 2012, two months before his death, Rain’s mental condition had become so chaotic that he was deemed worthy of psychiatric assessment and he was involuntarily detained to Richmond clinic mental health unit at Lismore Base Hospital. It was there that he encountered Dr Harry Freeman. After two weeks, Rain was sent to a day-patient methadone program, but after one week on the program, he began using heroin on top of the methadone and was kicked off the program.
When The Global Mail contacted Freeman, he was taken aback to hear that Rain had died, but says, “A large number of those sort of people just don't survive for long enough to be sensible enough to stop”.
“Treating these people is not a great idea. That's just grabbing them at the bottom of the cliff- you've got to stop them from jumping and that means having different attitudes in the society”.
Rebecca wants to know why he hadn’t been detained earlier, why he didn’t receive treatment before it was too late. “He’d been kicked out of every caravan park, every house in the area. There was no shelter in the area and after two days the youth house imposed on him a life ban. He’d turned up in emergency a few times for overdosing and still he was never made to be assessed,” she says.
Di Mahoney is the director of Byron Youth Service, which Rain attended on and off over three years. “He was a very smart kid who knew how to work around things,” she says.
“We support young people to make choices and to access services and help that are out there for them and we do that to the best of our ability. Sometimes that’s really difficult. Sometimes young people don't want to access services and help.”
James Pitts explains the cycle that he sees from time to time in psychotic patients who voluntarily front up to Odyssey House.
“When a patient is in treatment, their situation is not so dire that you can have them scheduled, then when they leave, there is nobody to monitor their behavior and the next time they visit they have deteriorated significantly. Assuming that they respond well to treatment, they recover.” He says, “so there’s never a situation where someone is able to see them at their worst in the community, when they might say, ‘Look, we need to put you in the hospital for 30 days.’”
“Certainly I have on rare occasions had people who, no matter what you did, their condition was so chaotic that you could keep them for a while, but as they started to function better they would make a decision to leave, and you couldn't do anything about it”.
Towards the end of his life, when Rain was travelling the east coast of Australia, every now and then, when his psychosis got too strong to bear, he would check himself into a treatment facility in pursuit of methadone to calm himself. His mother believes he was admitted to hospitals both in Brisbane and Sydney, and had been to other mental-health and drug centres within the 1,000 or so kilometres that separate the two cities. But how often he visited, where he visited and how he was advised is unknown.
The chain between drug-and-alcohol and mental-health services in Australia is weak and in some parts broken: availability of care is varied and the most effective treatment is available at only a few private pioneering institutions in the big cities.
“At the moment, the system relies on individual clinicians talking to each other. There is no broader infrastructure system or approach to how it should happen, which would be more helpful but there's just not the resources there at the moment. So it relies on an individual clinician making those links and following up with people and monitoring them over time. But often that’s not people’s jobs and their workload is so huge that they can't do that,” Dr Katherine Mills says.
Rebecca wonders whether – had a strong communication and monitoring system been in place – the cumulative reports of Rain’s illness would have led to an earlier assessment.
She found the lack of knowledge about her son’s whereabouts and mental state maddening.
“I know everyone means well, but services need to talk to each other and they need to work with families to create a safety net,” she says.
The Department of Health and Ageing is currently rolling out a program across Australia called Partners in Recovery, which aims to provide a system to help existing mental-illness-support services work in a more “collaborative, co-ordinated and integrated way”. They plan to develop strong networks between sectors and services to assist “individuals … reported too often fall through the system gaps and require more intensive support to meet the complexity of their needs”.
But the majority of addiction services remain separate from mental-health services and continue to lack the infrastructure that is needed to track often itinerant substance abusers.
Rebecca knew that, since he was a boy, her firstborn son had an unusual mind. At school Rain’s teachers reported that he had a remarkable intellect, but found friendships difficult and had trouble with sequencing (remembering sequences of information or actions). His kindergarten teacher suggested that he should be checked for ADHD. He also reported hearing voices from a young age, and there had been cases of both schizophrenia and bipolar disorder in his family history, but he himself was never diagnosed with a mental illness.
Some children like Rain may now benefit from an early-intervention program being introduced in NSW and Victoria. The new school-based drug and alcohol-education program, run by the National Drug and Alcohol Research Centre (NDARC), is currently targeting 3,000 children who have personality traits that put them at risk of substance addiction. According to NDARC, around 40 per cent of Year 8 students display one of these personality traits: sensation seeking, impulsivity, anxiety or negative thinking. In addition, children with mental or psychiatric disorders, such as Attention Deficit Hyperactivity Disorder (ADHD) are deemed at much greater risk of drug addiction than others.
Dr Nicola Newton who heads the prevention program says: “Drug and alcohol problems cost our community dearly; not only financially, but in the functioning and future life options of our young people. Our early intervention research is aimed at giving young people the tools to best manage personality traits which make them vulnerable, and to help them to make the right decisions in any given situation.”
It is late in the afternoon; Rebecca comes inside from the verandah to sit on the couch. Rain’s 10-year-old brother Jack races around, leaping over couches and shooting at her with an empty water gun. She holds in her hands a necklace made from a guitar string.
During his time detained in hospital in November 2012, Rain had been sedated and was swimming in an induced lethargy. “He’s prescribed 10 valium a day and on methadone and he was so out of it, he could barely keep his eyes open,” Rebecca says.
“He’d so broken down in a lot of ways that I could really see the real him coming out. The little boy got bigger in a way.” It was there that he made his mother the necklace, with 19 coloured beads threaded either side of a stone. “It was something that he would have done when he was five,” she says. Rain had been a young boy on the cusp of adolescence when he began experimenting with drugs.
“He was a child when it happened to him and he never got to grow up,” she says.