A sacrificed life’s legacy

By Robert Landauer – editorial columnist for The Oregonian, October 10, 1998. Not available elsewhere online.

Ideas are most stirring when they serve people. A Washington County conference this week on “Violence and Mental Disorders” makes the point.

Attendees’ eyes are drawn to a photo in the program of a serene young woman and to a declaration:

“This conference is presented in memory of Monica Cuenca, a loving daughter, valued friend and dedicated clinician. Monica was murdered while working at a respite facility for consumers with mental illness.”

On Dec. 20, 1994, Howard Allen Bethea, a Hillsboro man with a history of mental illness, walked into the Banyan Tree mental -health facility where he had lived and shot Cuenca, 28, with a handgun while she played a board game. Bethea thought she had gotten him in trouble with his parole officer.

Until now, this story only has had victims. Certainly, Cuenca and her family. Possibly Bethea, sent to prison for life. He might have avoided this dismal end if we could spot those stumbling toward violence and step in before they fall into the pit.

Those who serve the mentally ill are traumatized, too. They and their families wonder each day how risky it is to be helpers.

Every death like this also shocks the mentally ill. They dread being stigmatized by someone else’s behavior. They fear that they, too, might do fatal damage to others or to themselves if they are ignored when their diseases knock them into tailspins.

The Washington County Health & Human Services program aims to turn Cuenca’s legacy from sadness and paralyzing fright to healing and sustained help.

About 230 social workers, mental -health specialists, police, paramedics, parole and probation officers, drug/alcohol specialists and other professionals received two days of training at the conference. It acknowledged the risk of violence but put it into perspective as infrequent or occasional. It suggested team-based case-management tools and relapse prevention that cut risks to the clients, the people who help them and the public.

A guest is left with strong impressions:

The relationship between mental disorder and violence is very weak; mental disorder makes a very minor contribution to violence in society. Victims are rarely strangers.

It is unfair and hurtful to label all people with mental illnesses as dangerous. Very few are violent and then only when experiencing particular symptoms that usually can be spotted and help offered.

But no checklist ensures that professionals, family and friends will make the right decisions all the time.

And the high school shooting last May in Springfield, where two students were killed and 22 wounded, testifies that spectacular failures will occur. They dominate the attention of press and public, while thousands of success stories, modest though they might be, go unsung and unappreciated.

It was astonishing to learn how accurate mentally ill persons are in reporting their own violent tendencies and how important it is to include them in decisions about their treatment. Police and hospital reports and people in regular contact with patients add little to the patients’ self-reports.

People, the mentally ill included, usually have a purpose for behavior, said Joel Dvoskin, New York state’s former acting commissioner of mental health. “Threats are the alternative to violence; they’re usually statements that they want you to change something. Ask them what it would take to change their mind and they usually will.”

The mentally ill often have reason to be agitated. Predators often steal their money and belongings. Yet society is more ready to view them as offenders than as victims, and to shun them.

The lessons can be reduced to this:

A lot of concerned public workers are trying to improve the odds that everyone will be able to live safely with mental illness.