Too pained to live

By the time someone diagnosed Daniel Brocchini’s mental illness as borderline personality disorder, he’d been suffering for more than a decade. Unfortunately, the diagnosis, given on June 3, did not result in the care he needed. Two weeks later, on June 17, he was found dead on his bed at a local recovery house.

There were several empty pill containers on a nearby dresser and a binder containing a suicide note at the foot of the bed. “I can’t take anymore pain,” he’d written, quoting one of his favorite bands, Social Distortion. “None of you believed me. Maybe you’ll believe me now.”

His only directives: “Bury me in Tahoe. Forget I ever lived.” He was 26 years old.

The signs of his torment had been visible for years. There were scars up and down his arms and across his chest from where he’d cut himself. He’d attempted suicide several times. He suffered from panic attacks, clinical depression and extreme anxiety. He was in almost constant emotional and physical pain. And he was deeply addicted to alcohol and drugs.

For years his mother, Evelyn Denk, had tried to get help for him. Over and over, she’d tried to sign him into public mental-health inpatient facilities here and elsewhere (they lived for many years in Lake Tahoe). Most of the time they were turned away, and when he was admitted, it was only for short stretches.

To Denk, the events surrounding Dan’s suicide were the last in a long line of encounters with a broken mental-health-care system that didn’t seem to know how to treat this terribly troubled youth. Too often, she charges, it viewed him as just an alcohol and drug addict, without recognizing the underlying mental illness that was causing his addictions.

The system, she insists, is horribly dysfunctional.

She gives this example: In mid-May, Dan was seen at Butte County Behavioral Health for an evaluation. Several medications were prescribed, and he and she were told to obtain them through his family doctor. That was Dr. Robert Roth, at the Chico Family Health Center.

At the time Dan was living at Stairways, a clean-and-sober recovery house. In his May 16 notes on Dan, obtained by Denk, Roth writes that the request to provide medications wasn’t accompanied by “any of their diagnostic or therapeutic information and … I think it would be really helpful to have a more clear idea as to what the psychiatric diagnosis is given the problems he has.”

Roth could have called BCBH, but the agency has one of the most opaque phone systems in the county. You’re more likely to get a recording than get through to someone, but the recording doesn’t take messages: Call back later, a woman’s voice says. And when you do get through and ask to be transferred to someone, you’re liable to be told—as I was this week—"We don’t transfer calls here.”

Roth’s solution? He gave Dan a note to take to BCBH “because I really professionally reached the point of exhaustion with that organization in its failed communications.”

(Roth did not return a CN&R phone message.)

On June 10, clinicians at BCBH worked up a safety plan for Dan. He was to continue residing at Stairways, and Stairways staff was “to supervise [him] and ensure [his] safety.” He was also to call the BCBH crisis line and check in when he got home, to rely on a list of anxiety-relieving techniques ("Listen to music,” “Go for a walk,” etc.), to take his meds, to call the crisis line again the next day, and to check in with various resources (group therapy, BCBH Outpatient Services, Dr. Roth) in the coming weeks.

“For someone with Dan’s disease, I can tell you this is too much,” his mother said. “Plus it’s not Stairways’ job to do that.” She also wondered why a drug regimen prescribed on June 3 wasn’t to be evaluated until July 1, nearly a month later.

His group therapy was to be via Proposition 36, the treatment-not-jail initiative voters approved in 2000. He’d gone to court on June 4 to answer to a misdemeanor drug possession charge, and Judge Steven Benson had assured everyone in court that day that they would get help if they wanted it.

Evelyn Denk was there, and for a moment she was encouraged. “You put your hope in these programs and the things you’re told, and then they’re just not there. They’re so not there.”

According to the National Association for Personality Disorder, BPD is “a disorder in which a person is unable to regulate emotions or control impulses. Their behavior can be seen as maladaptive methods of coping with constant emotional pain.”

Thus the cutting, the alcoholism, the drug addiction and the attempts at suicide, which Denk sees as cries for help.

The disease, according to the NAPD, is a “biologically based disorder of the emotional regulation system that may be due to genetics factors, the environment or a combination of the two.” It tends to run in families with a history of mental illness, depression, ADHD or addiction, and often is characterized by abnormal levels of the neurotransmitters serotonin and dopamine in the brain.

It’s a difficult illness to treat. There’s no one-size-fits-all medication, and medications must be closely monitored and adjusted over time, as BPD symptoms often change. The best course is to combine such regimens with both individual cognitive behavioral therapy and group training that teaches emotional regulation skills, distress tolerance, improved interpersonal relationship behaviors and self-awareness, or mindfulness.

Needless to say, such a sophisticated treatment program was not available for Dan Brocchini. “He was work, hard, hard work,” Denk said, “and nobody wanted to invest that much.”

Laurie Feldman is the BCBH family nurse practitioner who diagnosed Dan Brocchini as having borderline personality disorder. In a phone conversation, she addressed a number of the issues raised by Evelyn Denk, while endeavoring not to talk specifically about her son because of confidentiality concerns.

The fact that someone is suicidal doesn’t necessarily mean he or she is a candidate for inpatient care, Feldman said. “Most people are not permanently suicidal,” she explained. “It tends to be off and on.”

So when is a suicidal person admitted? When that person is “being suicidal and is also unable to contract for his or her own safety,” Feldman responded. Signing what is known as a “no harm” contract, in which a person promises not to commit suicide and to stick to a safety plan, “is considered an adequate alternative to hospitalization.”

She agreed that BCBH’s communication is “a problem—oh yeah.” When she arrived at the agency six years ago, she wanted to make the system more accessible, she said. For a while she served on a health-care coordinating committee, which came up with the idea of having a central phone number and even went so far as to get a number, but “it never went anywhere.”

And she agreed that the entire mental-health-care system is broken. “We’re using our jails as inpatient units,” she said. “Taxpayers’ money is going to prisons, not health care. … The system fails people on a daily basis.”

In recent weeks, the county department had to lay off nearly 30 clinicians due to state-imposed budget cuts. A few have been rehired using money from the Mental Health Services Act, the initiative that taxes millionaires slightly for mental-health services, but the money must be used for new services, not existing ones, so the impact of the layoffs remains heavy, Feldman said.

(A phone message left for BCBH Assistant Director Lisa Cox was not returned.)

Dan Brocchini is the second of Evelyn Denk’s five children to die. She lost a 5-month-old baby boy to sudden-infant-death syndrome 23 years ago.

Her response then was to get involved in a national SIDS awareness chapter in her town and become a trained counselor to other parents who lost children. “They called me whenever they brought in a baby,” she said. She did that for three years, until it became too much emotionally. She shifted to other charitable work and is especially good at marketing, she said.

She intends to take a similar approach this time and has contacted the NAPD seeking to volunteer to raise BPD awareness in the Chico area. It’s the most stigmatized and least understood mental illness, she said, and too often its sufferers are dismissed as merely substance abusers.

In the meantime, she’s trying to obtain her son’s medical records from BCBH so she can find out what really happened to him there. The agency has insisted, however, that to get the records she must go through probate to become the executor of his estate, which she said amounts to “the $5 he had in his wallet and his comic books.”

All she has left of him now are some photos of a cute little boy, his many poems—some of them splattered with blood—and various documents and notes he obtained or made in the days before his death. They don’t take up much space in her north Chico apartment.

She’s convinced he didn’t really want to die. For one thing, the suicide note had no message for her, the person he loved most in the world. “He would have said goodbye if he meant to die,” she said. And it also contained a list of the meds he’d taken, as if he wanted whoever found him to save him.

“I believe he was trying to force them to treat him by taking himself to the edge,” Denk said, tears in her eyes. “He miscalculated, perhaps because he was clean and sober and his tolerances weren’t where he thought they were. An attempt to be taken seriously cost him his life.”