A danger to themselves or others. That’s the threshold set by Michigan law to put someone in a psychiatric hospital.
But many families with autistic children say meeting that definition doesn’t seem to be enough for their kids--and they don’t know what to do.
This is one family’s story.
“A big guy with the mind of a child”
Douglas Odisho watched as his sixteen-year-old son, Damiean, got off the elevator outside Macomb County juvenile court.
Damiean is pale, with a round, pudgy face and bright red hair. He looks like a little kid.
His father says that really, he is.
“Sixteen-years-old with the mind of a 3-year-old, watches cartoons like a little kid, they’ve got him chained up like a criminal,” Douglas said. “It’s [expletive] pathetic.”
“It’s just a big guy with the mind of a child.”
Damiean is on the autism spectrum, and has a host of other psychiatric and special needs diagnoses too. He’s on ten different medications.
But at this moment, he’s just a criminal. He was locked up at Macomb County’s Juvenile Justice Center, charged with resisting arrest.
It all started when his mom, Malinda Odisho, called police because Damiean was getting verbally and physically aggressive with her. He threatened to assault her, then went out in the garage and started smashing things. Then he left the house.
When officers arrived, Damiean was in the street several blocks away. It quickly turned into a struggle.
“At that point I wasn’t exactly worried because I knew this was something he had done in the past,” Malinda said. “Until I heard ‘I can’t breathe.’”
According to the police report, Damiean threatened the officers with a Snapple bottle. He kicked, scratched, and bit an officer. He got a broken finger in return.
Malinda has had to call the police before on Damiean. The police department in Warren, where they live, know he’s autistic and has issues with aggression. But even then, it usually ends in an altercation.
“He may sit there, or just kind of zone out into his own world, and [then] becomes a hands-on and each time there’s a fight,” Malinda said.
So when Malinda followed them to the hospital, she assumed they would do what they’d always done before--let him stay in the emergency room while she petitioned Macomb County Community Mental Health to admit him for psychiatric hospitalization.
But that’s not what happened this time.
“They were going to only medically clear him, and then transport him for their processing at their station, and then transport him again to the JJC [Macomb County’s Juvenile Justice Center],” Malinda said.
So that’s how Damiean wound up in court.
We couldn’t tape the proceedings, but the juvenile court referee seemed sympathetic. He released Damiean back into his parents’ custody with a caveat: that the Odishos take him straight back to a hospital emergency room, and get him admitted to a hospital.
Malinda Odisho says they waited there through the weekend to see a psychiatrist.
“He looked over everything, agreed also that it is very hard to get a child with autism into any hospital for inpatient services, so he said he would be better off going home with me,” Malinda said. “So that’s what we did.”
Autistic aggression is common, but little help for families
This wasn’t the first time. For about a year, the Odishos have been trying to get Damiean hospitalized for his growing aggression. But despite repeated incidents—and in this case, a judge’s order—they keep getting stonewalled somewhere in the process.
“Once it seems like it’s a behavior, they deny,” Malinda said. “So if he’s aggressive, he’s violent, any of those types of things--denied.”
That can be true, says David Pankotai, CEO of Macomb County Community Mental Health. That’s the organization the Odishos use to get mental health services for Damiean through the state Medicaid program.
“Sometimes a hospital might look at a child who’s on the autism spectrum, and think that the issues are more related to environment and behavior as opposed to a psychiatric condition,” said Pankotai.
Pankotai says community mental health has to make inpatient hospitalization recommendations based on Michigan’s mental health code. In other words, a patient has to be a threat to themselves or others to authorize hospitalization.
“Typically we’re looking at people who are an immediate danger to themselves or others,” Pankotai said.
Pankotai wouldn’t comment specifically on Damiean Odisho’s case. So he couldn’t say why the Odishos keep getting denied inpatient treatment, despite a growing series of incidents suggesting Damiean is both a threat to himself and others.
But we do know this, it’s a common situation.
“I think it’s important for people to understand just how common aggression is in autism,” said Sarah Mohiuddin, clinical director of the multi-disciplinary autism program at the University of Michigan. "But children who have these concerns with aggression have limited access to outpatient providers, and even more limited access to inpatient hospitalization and psychiatric beds. And there are very few psychiatric emergency centers that really know what to do in terms of assessing these children when they are in a psychiatric emergency.”
Mohiuddin says there are often things families can do to handle the outward aggression and self-harming behaviors autistic children often exhibit. But they often lack the guidance and support services that allow them to do that effectively.
Mohiuddin recommends psychiatric hospitalization when “there is a concern that a child is going to significantly harm themselves or someone else.” She sometimes also does so when a child is on a cocktail of psychiatric medications that isn’t working, and it’s hard to tease out what’s effective and what’s not. In that case, Mohiuddin says, hospitalization for a “medication washout”—taking patients off their meds and re-introducing drugs slowly, might be required.
“Given the degree of someone’s aggression, sometimes that’s not safe to do as an outpatient,” Mohiuddin said.
But Mohiuddin says most health providers and clinical staff lack the specialized training to properly assess and deal with aggression in autism. So many just choose not to deal with it.
The biggest fear
Given chronic understaffing problems in mental health facilities, an acute shortage of beds for all psychiatric patients in Michigan, and continued state cuts to community mental health programs, those in the autism community say it’s not a surprise that patients with aggression problems are often denied inpatient hospitalization.
And that leaves many families with the greatest needs stranded. Including, for now, the Odishos.
Malinda Odisho is scared that Damiean will end up where so many people with unmet mental health needs do, in the criminal justice system.
“My overall biggest fear is that law enforcement is going to hurt him more than just a broken finger,” she said.
Damiean was eventually ruled incompetent to stand trial, and the resisting arrest charge was dismissed.
But he turned 17 at the end of the January. That means his next brush with law enforcement won’t put him in juvenile detention. It will put him in the Macomb County Jail.
Malinda says the Odishos—who also have another son with an autism spectrum disorder—will keep advocating for Damiean.
“It’s not just like you can beat the disability out of him, or throw him in jail, and [he’s] going to stop doing those behaviors,” Malinda said. “It doesn’t work that way with autism.
“He’s going to have this disability for life. And we just work around it the best that we can.”