Wednesday, August 3, 2011

USA Africa Dialogue Series - Teenager’s Path and a Killing Put Spotlight on Mental Care

http://www.nytimes.com/2011/08/03/us/03mental.html?_r=1&smid=fb-nytimes&pagewanted=all

Teenager's Path and a Killing Put Spotlight on Mental Care



LOWELL, Mass. — Pericles Clergeau, a tall, sturdy teenager with a troubled past, did not much like it when Kevin Allard, a radiant, sometimes manic youth, arrived at Adolescent Unit 2 at the Westborough state psychiatric hospital early last year."He was like the alpha male of the place, and I was the competition," Mr. Allard said. "It was his turf, and I was mowing the lawn."

On Feb. 3, 2010, the two 18-year-olds faced off in a basketball game called Taps, where one player can send the other's score plummeting to zero by tapping in a rebound. The game was close and tense, and the verbal sparring kept escalating, too. Mr. Clergeau was near 21 points when a swish by Mr. Allard derailed him.

Catching his breath, Mr. Allard felt Mr. Clergeau — about six inches taller — very close behind. In seconds, Mr. Allard said, Mr. Clergeau's arm was wrapped around his throat and he was dangling in a choke hold. He tried to wriggle free but passed out. Mr. Clergeau dropped him on the tarmac, and Mr. Allard came to with a deep laceration on his forehead, dripping blood, according to several accounts.

The next day, Dr. Bruce Meltzer, the unit's medical director and psychiatrist, told a state mental health department investigator that "he fears the perp could commit murder and that it could happen at any time," according to an internal document.

That concern got buried in an internal investigation. Mr. Clergeau was neither prosecuted nor placed for long in a more secure situation. And almost exactly a year later, on Jan. 29, 2011, Mr. Clergeau, homeless and adrift, was arrested in the killing of an employee at the shelter in Lowell where he had been staying. When the police arrived, Mr. Clergeau was standing behind the reception desk clutching a bloodstained knife. "I did it, I did it," he said as he was being handcuffed, according to the police report.

The killing happened nine days after a 25-year-old mental health worker named Stephanie Moulton was slain at a group home in Revere. Ms. Moulton's case spurred a statewide debate on whether budget cuts had eroded the public mental health system and endangered the safety of its workers. Indeed, in late June, a mental health safety task force issued a blistering report proclaiming the system to be in a crisis that, among other problems, created worrisome risks of violent tragedy.

The death of the shelter worker, Jose R. Roldan, 34, did not get as much attention as Ms. Moulton's. But an examination of Mr. Clergeau's case, based on interviews, confidential documents and court records, suggests that it involved an even more overt failure by the state both to help a deeply disturbed and dangerous individual and to keep the public safe.

Mr. Roldan's killing was, in a way, a death foretold. Whether it was preventable cannot be known.

But Mr. Clergeau's destructive and self-destructive path crisscrossed Massachusetts, taking him in and out of the custody of three state agencies as well as multiple treatment centers, hospitals, police departments and courts.

Over time, Mr. Clergeau established a clear pattern of lashing out violently. In turn, the government developed a pattern, too, of shuttling him from place to place until it released him to the streets and he ended up on the doorstep of a homeless shelter with little security, few resources and no knowledge of his history.

Other institutions that had treated Mr. Clergeau previously did not know his full history, either.

"No one seemingly put together a composite," his court-appointed lawyer, Michael Collora, said. "Each incident was viewed in isolation."

Those who had encountered Mr. Clergeau during his violent odyssey were saddened but not surprised by his first-degree murder charge. (He has pleaded not guilty.)

"I was only surprised it didn't happen sooner," said Christopher Casaubon, a mental health technician who suffered a shattered eye socket at Mr. Clergeau's hand.

A Troubled Path

Speaking in the leafy courtyard of a public housing complex in Cambridge, Mr. Clergeau's father said, "I knew something like that would be happening one day."

The father, Joslin Clergeau, said Pericles started exhibiting emotional and behavioral problems at 4 or 5, not long after they emigrated from western Haiti.

"When Pericles was mad, he would bang his head on the walls," said Mr. Clergeau, a taxi driver. "If you see his arm, you see the line of scars from when he'd bite, bite, bite himself."

Mr. Clergeau said Pericles was first hospitalized at 7 or 8 after "he beat a boy with a chair when the boy called him gay." He said Pericles celebrated his first communion on a psychiatric ward at Cambridge Hospital.

He also said — and Mr. Collora echoed — that no single psychiatric diagnosis was ever fixed to Pericles. Doctors speculated that Pericles had been traumatized by witnessing violence in Haiti, his father said. He did not think that was true. Even so, Pericles's behavior came to mirror that of a small but intractable population of youths who, often based on trauma in their lives, are filled with rage that turns into violence.

Unable to pay for treatment, Mr. Clergeau said, he eventually granted custody of Pericles to the Department of Children and Families, which sent him to foster homes and residential schools.

At some point — Mr. Clergeau was fuzzy about when — Pericles accused him of child abuse. An investigation was done and, the father said, the accusation was not substantiated.

That could not be confirmed. The young man's state agency files are closed, as is his juvenile criminal record. (The state's Executive Office of Health and Human Services did not respond to questions for its child welfare and mental health departments.)

At 17, though, Pericles Clergeau became an adult in the eyes of the Massachusetts criminal justice system, and from then on his bumpy path can be more clearly traced.

Into the System

The year between Mr. Clergeau's 17th and 18th birthdays was tumultuous. He was moved five times by a system that did not seem to know what to do with his increasing aggression.

Teenagers who violently challenge authority often disrupt a therapeutic environment and endanger the staff. Even though child welfare experts consider stability of placement to be beneficial and instability detrimental, these youths are the most likely to be bounced from program to program.

In early 2009, Mr. Clergeau, kicked out of his previous program because of an assault, turned 17 at a juvenile detention center. From there, he was transferred to the Hillcrest Center, a 14-acre campus in the Berkshires that specializes in youths with extreme psychiatric, emotional and behavioral disorders.

He tried to run away a few times, but his first major encounter with the police there occurred in May, when he flew into a despairing rage, destroying furniture, hitting an employee with a rock and trying to hang himself.

The following month, the police were summoned again. Arriving at the main building, Officer William C. Colvin observed broken glass and other debris littering the entrance. Inside, he saw a 6-foot-2-inch male student — Mr. Clergeau — face down on the floor with one staff member holding each of his legs and two more employees lying across his back.

Earlier that day, Mr. Clergeau had "gone AWOL," and when finally located on the property, he was hostile, screaming and wielding a four-foot-long wooden sign post, the police report said.

Swinging the stick, he had run back into the school, smashing a large glass clock and a photocopier. He charged a solid wooden door, cracking it in half and tearing it from its hinges. When the principal and others tackled him, he tore at the principal's face with the jagged post, causing what Officer Colvin described as "a long bruiser" from jaw to ear.

Mr. Clergeau was charged with assault and battery with a dangerous weapon, destruction of property and disorderly conduct. After a couple of days in jail, he was sent to the Brandon School and Residential Treatment Center in Natick.

In July, police officers reported there because Mr. Clergeau had become enraged during classroom detention. Having placed a staff member in a headlock and repeatedly punched him, Mr. Clergeau was charged again with assault and battery.

By September, he had been transferred to the Lowell Treatment Center. Not long after settling in, he was disruptive in class and ordered to return to his locked residential unit. He refused.

"He said, 'If I'm getting in trouble for nothing, I might as well do something,' " Mr. Casaubon, a staff member at the school, said. Then Mr. Clergeau started hurling wooden chairs at his teacher.

Seeking to restrain him, Mr. Casaubon, who is muscular but shorter than Mr. Clergeau, managed to pin him against the wall. Mr. Clergeau promised to calm down if released. Mr. Casaubon let him go, he said, and the young man "sucker punched" him.

Mr. Casaubon, who needed surgery to rebuild his broken eye socket, said he pursued charges reluctantly, because "I knew nothing would happen." (The case is still pending.) But, he said, "everybody was yelling at me to go to the police so that it would go on record that this guy is a violent person and shouldn't be in public. I mean, that was him on meds. Imagine when he's off meds."

Afterward, Mr. Casaubon said, staff members learned that Mr. Clergeau had a record of previous assaults with similar modes of attack. "I sure wish I had known he strikes when you let go," he said. "But it could have been worse. I'm not dead."

Mr. Clergeau's next stop was Westborough State Hospital, a hauntingly beautiful 19th-century asylum on a hilly campus overlooking a lake. The hospital has since closed because of budget cuts.

Mr. Clergeau was placed in a treatment program that served a combination of fragile, traumatized teenagers and violent juvenile offenders. It was a difficult mix.

Mr. Allard, who had a diagnosis of bipolar disorder and had been committed there after an encounter with the police, said Mr. Clergeau ruled the roost, intimidating his fellow patients and the staff, too.

During several months at the hospital, Mr. Clergeau reportedly assaulted nine staff members, sending a few out on medical leave, a person familiar with his stay there said. "You could feel the rage radiating off him," another person said.

Both people spoke on the condition of anonymity because they feared repercussions for exposing what had happened.

The basketball game occurred on Mr. Clergeau's 18th birthday, the day he technically aged out of the child welfare department's care.

Two days later, he smashed a dresser drawer, fashioned a weapon and threatened to impale anybody who came near him. The unit was cleared of patients, the state police were called and Mr. Clergeau, after barricading himself in his room, was persuaded to surrender peacefully. He was led away in handcuffs.

Only then did the program staff learn, through a fax sent anonymously, that Mr. Clergeau had a record of violence, with eight outstanding warrants at that time.

The hospital's human rights officer filed an internal complaint on behalf of Mr. Allard, which set off a departmental investigation that dragged on without resolution. But Mr. Clergeau was not prosecuted for anything that happened at the hospital. That was partly because the  state Department of Mental Health discourages the criminalization of its adolescent patients; staff members did not press assault charges.

The police, learning about the attack on Mr. Allard after the fact, were in the process of opening an investigation when the weapon incident occurred.

"As we responded the next day and locked up the subject on the eight outstanding warrants, the investigation into the past A & B did not go anywhere," David Procopio, a state police spokesman, said, referring to assault and battery.

Now back in his hometown, Ware, and feeling stable with an apartment and a job, Mr. Allard was stunned to learn that Mr. Clergeau had never been held accountable for, as he put it, "the attempted murder of me."

"I can't believe they let him out into a public place," he said.

Last Resort

Mr. Clergeau was discharged from Westborough with the expectation that he would be imprisoned. Hospital authorities told the state police that he was "not a psych patient," which appears to reflect a medical opinion that he belonged in a correctional setting.

At that point, Mr. Clergeau's Lowell assault case was reactivated. A judge set bail at $1,000, and after a few weeks at a juvenile detention center, he was released to his father.

The family reunion did not go well.

"When they let him out of jail, they didn't give him any medication," his father said. "A lawyer told me, 'He turned 18 now. They give him medication only if he asks.' I say, 'Stupid law.' He has mental problems."

After a month, under pressure from the Cambridge housing authority, Joslin Clergeau filed a restraining order against his son.

It was late April 2010, and Mr. Clergeau was now homeless.

In May, Mr. Clergeau was arrested on outstanding warrants while going door to door selling magazine subscriptions in Brookline. Once again taken to a juvenile detention center, he awaited the prosecution of his Berkshires case. He was found guilty of disorderly conduct and destruction of property — with no finding on the assault charge for what the judge deemed insufficient evidence — and sentenced to 30 days in jail.

In mid-August, Mr. Clergeau showed up at the Lowell Transitional Living Center. A 90-bed shelter for single adults, with limited social services and a meals program, it is often the "last resort" for people who get "shuffled around," Gary Baker, the board president, said.

Anne Marie Malavich, case management supervisor there, said Mr. Clergeau arrived empty-handed, without any identification documents much less his own case files. She said he came across as "a very, very angry young man" with a "smirk on his face" and "an air of defiance."

"Being sent to me was like being sent to the principal, and he was constantly being sent to me," Ms. Malavich said.

Mary-Anne Buhlmann, 53, the slain man's girlfriend, said, "Pericles was trouble, a troubled soul."

In a darkened apartment with "The Price is Right" on the television and a memorial photo album bound with black ribbon by her side, Ms. Buhlmann said she and Mr. Roldan met at the shelter over a decade ago. She was a former battered woman, and he had "some demons," she said; after moving into their own apartment, they remained connected to the shelter through his job there.

Last fall, Mr. Roldan came home uncharacteristically rattled, with a cut on his head, she said. He said Mr. Clergeau had whacked him, then claimed to have mistaken him for somebody else.

After that, Mr. Roldan told her that he was considering quitting his job because of Mr. Clergeau's volatility. Not long before his death, he said he had been forced to penalize Mr. Clergeau for breaking rules.

"Jose said, 'Mary-Anne, I had to kick Pericles out for a while and now he's telling me he's going to kill me,' " she said.

On Jan. 29, Mr. Roldan had been trying to calm an agitated Mr. Clergeau, who was accusing other residents of staring at him, when Mr. Clergeau stabbed him, severing his jugular vein. When the police arrived, he was still alive, barely, lying on the floor, a blood-soaked towel pressed to his neck.

Mr. Roldan was medically evacuated by helicopter. Before it was known that he had died, one officer transporting Mr. Clergeau told another that the charge was going to be "assault by means of a dangerous weapon." Mr. Clergeau interrupted.

"He looked at me and said, 'Officer, it's going to be murder,' " Officer Marisol Nobrega noted in her report. "Murder."

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