Randy and Jamie Duckert, shown this March, speak of their son often, and sometimes go to the barn ... where they placed a simple wooden cross on the beam where Kyle Duckert hanged himself. SARAH HOFFMAN/THE WORLD-HERALD

Fragile Minds: Despair

People with severe mental illness struggle with the complexity of their disease and with a confusing system that doesn’t always help. The following is the first in a three-part series by Erin Grace.

By Erin Grace / World-Herald staff writer

Saturday, June 6, 2015

Kyle Duckert’s third psychotic break came like the two before it: suddenly and with frightening intensity.
The 25-year-old with severe mental illness had been sitting in his family’s southwestern Douglas County home on the Sunday after Thanksgiving in 2013 when he suddenly jumped up, ran outside and plowed into a 15-foot-tall inflatable snowman planted in the front yard. He was screaming. Kyle’s uncle told him he loved him. Kyle’s dad got him to calm down. Kyle’s mom called 911.

About the series

World-Herald columnist Erin Grace looks at the struggles of three people with severe mental illness — and the confusing health care system that isn’t always there to help them.

Part I: Despair
Sunday: Kyle had everything going for him. Except a brain he hated.

Part II: Adrift
Monday: Patricia has no permanent place to call home.

Part III: Hope
Tuesday: Nancy shows that recovery is possible.

For the third time that year, sheriff’s deputies came to restrain Kyle. For the third time, Kyle was placed in emergency protective custody.
Then, three weeks later, Kyle took his own life.
His suicide devastated his family. Randy and Jamie Duckert are still coping with their loss and trying to understand what happened to their son.
They are not angry with Kyle, a college math teacher who loved music. They don’t blame themselves. Nor do they blame the deputies, nurses, psychiatrists and counselors who tried to help Kyle.
But they do think the mental health system is not properly equipped to help people with mental illness or their families.
And they’re not alone. A recent report on Omaha’s mental health system showed a number of gaps, and a group of clinicians, professors, providers and Nebraska state officials has begun meeting to discuss what can be done about it.
Kyle Duckert wasn’t a prime candidate to fall through the cracks of a stretched system. His parents were attentive, had health insurance and could afford to pay for treatment that wasn’t covered. They lined up psychiatrists and counselors and read up on severe bipolar disorder as much as they could. For the most part, Kyle complied with his treatment.
Yet the severity of his disease was overwhelming — and the Duckerts hardly had time to regroup after each crisis, let alone plan a way forward. Such a way was murky, anyway, given the unpredictability of Kyle’s disease, the lack of clear direction and the seemingly limited number of treatment choices. And it took time before his parents were willing to consider what first seemed unthinkable: going to court to have Kyle forcibly committed for longer treatment.
The three psychotic episodes most vividly show Kyle’s turmoil and the difficulty his family had in helping him.
The first one occurred after midnight on a Saturday in April 2013. Kyle had moved back home after struggling for years with depression.

Kyle Duckert's parents Randy, left, and Jamie look at the tree they planted in the backyard in honor of Kyle at their home in Omaha. It's been a year since his death, and his parents are still reeling, still wondering what they could have done differently and how the system could have helped. SARAH HOFFMAN/THE WORLD-HERALD

A study of Omaha's mental health system

A new study of Omaha's mental health system revealed a shortage of everything: Omaha doesn't have enough psychiatrists and therapists. Omaha doesn't have enough places for people to go. Nor does the city have enough specialized kinds of treatment to deal with people suffering from mental illness and substance abuse problems.
The study, by Colorado-based TriWest Group, found that Omaha also needs to do a better job coordinating the services it does have.
TriWest counted nine gaps in total and a newly formed group of Omaha providers, clinicians and representatives of state government are looking at ways to close those gaps. Click here to read more.

Randy and Jamie were asleep when loud noises from the first floor woke them. They sprang out of bed to find their son, a month shy of his 25th birthday, running from one end of the house to the other. He screamed and shouted. He grabbed the ceiling fan.
Randy tried to stop his son, but Kyle was 2 inches taller and weighed more. Kyle hit Randy in the face. He was out of control.
This was such atypical behavior, the Duckerts thought their son must be on drugs. So did the Douglas County sheriff’s deputies who took Kyle to the nearest hospital, Lakeside, for drug testing.
That suspicion made sense to Randy Duckert, a radiation oncologist whose job involves identifying the problem and destroying it. OK, drugs, he thought. We can handle drugs.
But Kyle’s problem turned out to be something completely foreign to the Duckerts. He was diagnosed with bipolar disorder, a disease characterized by emotional highs that are too high (mania) and lows that are too low (depression).

At Lakeside, Kyle was sedated and locked in bed restraints. As he began to come out of the mania, he had no recollection of what had happened.
After about 12 hours in the hospital, Kyle was taken by ambulance to Lasting Hope Recovery Center, which provides short-term, inpatient mental health services at its facility near 25th Avenue and Harney Street. Kyle stayed there for two days and then returned home with medication.
Medication for mental disorders is an important but imperfect tool that involves time to prescribe and a lot of trial and error to assess what type and level is best for a patient. That process typically occurs as a person adjusts at home.
The medication prescribed for Kyle made him so lethargic that he spent most of his days dozing in a rocking chair. When he got up to walk, he couldn’t lift his arms. He looked like a zombie.
Kyle would say things like “I don’t know what to do with myself,” and “I hate my brain.”
He was starting to see things in his closet that weren’t there.
This was new territory for the Duckerts.

Kyle Duckert leading kids in music during Vacation Bible School when he was 15. His sister Daniela is on the left.

Kyle Duckert, when he was 21 years old, on a family trip to Canada.

By their account, Kyle had been a happy, outgoing, well-rounded young man. After graduating from Millard West High School, Kyle went to Chicago for college and graduate school. At Loyola University, he triple-majored, in math, applied math and physics. He volunteered. He loved to play guitar, sing and perform. He had a girlfriend.
Sometimes Kyle called home complaining about feeling stressed or depressed, and his parents took the complaints seriously enough to investigate. They went to Chicago or flew Kyle home. They had him meet with a psychiatrist in Omaha and with counselors in Chicago.
But Kyle had kept up his rigorous pace, and there was no sign he was experiencing anything more than the stress of a heavy course load.
Kyle finished his master’s degree in 2011 and found a teaching job at the University of Nebraska at Omaha. He moved into a rental house with old Millard West buddies. He met a new girlfriend. He played guitar.
But the roommates raised concerns about Kyle’s sloppiness, his all-nighters, his nonstop discussion of some math problem he couldn’t solve. His girlfriend echoed their complaints.
The Duckerts persuaded Kyle to see a psychiatrist, who diagnosed him with clinical depression in 2012.

Then came 2013, and Kyle’s symptoms worsened. The first manic break was in April. The second happened in October.
By then, Kyle had stopped taking his medication. He hated how it slowed him down.
On a Sunday afternoon in October — bam! The house shook. Kyle had been sitting in the rocker by the barn when he ran, full-speed, into the side of the house.
Jamie got Kyle to come inside and into his bedroom to wait. Randy called 911.
Kyle told Jamie he had a hunting knife in his closet. He told her he wanted to give it to the deputies. Jamie followed Kyle into his walk-in closet and announced that Kyle was going to hand over his knife.
But when mother and son turned around, all three deputies were facing them with guns drawn. They tackled Kyle, cuffed him and took him to Lakeside Hospital.
Kyle was locked in a room with a mattress and a blanket. He kept throwing himself against the wall and jumping off a counter.
His frantic parents could only watch helplessly as nurses and other staff started calling for a psychiatric bed somewhere in the city.
There were none. None at Immanuel Medical Center. None at Lasting Hope. None at the Douglas County Community Mental Health Center. None at the Nebraska Medical Center. None even in Lincoln. All 135 beds were full.

The Duckert family, from left: Kyle with his hand on brother Michael’s shoulder, parents Randy and Jamie, and sisters Kelly and Daniela.

Need help?

For emergency short-term inpatient stays, the following providers offer acute adult care, depending on availability:
» CHI Health Lasting Hope Recovery Center, 415 S. 25th Ave.; 50 beds
» Immanuel Medical Center, 6901 N. 72nd St.; 29 beds
» Douglas County Community Mental Health Center, 4102 Woolworth Ave.; 16 beds
» Lincoln Regional Center, 801 W. Prospector Place, Lincoln; 30 beds
» Nebraska Medical Center, 4200 Emile St.; 10 beds
Some other resources:
» Community Alliance, a nonprofit center that specializes in adult mental health, 4001 Leavenworth St., Omaha; 402-341-5128
» Kim Foundation, which serves as an information clearinghouse, 13609 California St., Omaha; 402-891-6997
» Region 6 Behavioral Healthcare, 3801 Harney St.; 402-444-6573
» CHI Health 24-hour crisis line/information and referral: 402-717-HOPE (4673)
» Nebraska Family Helpline, with calls answered at all times: 888-866-8660
» National Suicide Prevention Lifeline, 800-273-TALK (8255)

“We do sometimes have to wait for the appropriate placement to become available,” Dr. Adrian Dreessen, Lakeside emergency department medical director, said later. “Because of the limited number of psychiatric beds in the area, there isn’t always a place available right away.”
You should go home, someone told Jamie after she’d been at Lakeside for more than 24 hours straight. Get some sleep.
Jamie did. Then the hospital called, saying Kyle had left and police were searching for him.
Jamie and Randy raced back to Lakeside, where police eventually returned Kyle. He had been wandering barefoot in a parking lot nearby.

After 2½ days at Lakeside, a psychiatric placement finally opened up. Kyle was admitted back to Lasting Hope.
Two days later, a charming, lucid, compliant and medicated Kyle was let go. He returned home.
He went home because he wanted to, because he didn’t want to stay at Lasting Hope, and because no one could make him — just as Lakeside could not hold him against his will.
The mental health system, by design, is mostly voluntary. Emergency commitments generally don’t last longer than a couple of days. A longer commitment involves the legal system — and it doesn’t happen overnight.
That option was on the table. Kyle’s psychiatrist told Jamie and Randy about an inpatient treatment center in Kansas City where Kyle could go for a month or longer as he adjusted to a new medication regimen. It was an agonizing but seemingly inevitable prospect, and the Duckerts figured they would have to consider the Kansas City option soon.
But Kyle was never hospitalized long enough for his family to prepare to deal with his illness. His sister Kelly, now 24, said the family didn’t get enough time to regroup — or enough direction about what to do. She remembers getting a brochure. Meanwhile, Randy called for some backup. He asked his sister and her husband to come stay with them over the Thanksgiving holiday.
The relatives did, and they witnessed Kyle’s third manic break on Dec. 1, when Kyle tackled that snowman yard decoration.
This time the deputies took Kyle straight to Lasting Hope. Two days later, Kyle returned home.
By law, Kyle was free to go, even though a doctor told Jamie her son needed longer inpatient care.
“We had no way to keep him admitted without his compliance,” Jamie said.
As Christmas approached, Jamie felt the family could use a change of scenery. She proposed that they all go to Florida to visit her father.
Randy worried that Kyle might have another episode while traveling. He couldn’t imagine what might happen at an airport or on an airplane. He volunteered to stay home with Kyle. Jamie was nervous but agreed.
She and the other kids left Dec. 21, a Saturday. Randy worked that morning at Methodist Hospital and told Kyle to go for a run. Jamie kept in touch with Kyle until takeoff.
How’s it going, she’d text. I love you! We’ll be home soon!
Randy got home around lunchtime. He was exhausted. Kyle seemed particularly eager about going Christmas shopping. Randy seized on the idea and suggested they grab a bite afterward at a new taco place. But first, he needed a quick nap.
Randy stretched out on the couch.
He awoke around 3. Kyle? Kyle?
Randy started looking for his son. He walked around the house. The yard. He entered the barn.
And there, oh God, was Kyle.

Because their mathematics-oriented son loved the symbol for infinity, dad Randy got an infinity tattoo, altered so that it also resembles a heart. Mom Jamie wears a silver infinity pendant on a chain around her neck. SARAH HOFFMAN/THE WORLD-HERALD

The funeral was held after Christmas. Peace Presbyterian Church in the Elkhorn area was packed.
Friends filled the Duckert home. Family came and called often.
The Duckerts themselves entered counseling. Jamie found refuge in yoga. Randy threw himself into work. Kelly somehow finished her last semester of college and graduated. It was a relief to focus on school. Kyle’s sister Daniela, 17 at the time, went to a grief support group at Millard West in addition to counseling. His brother Michael, then 12, continues to see a counselor.
They placed a simple wooden cross on the beam where Kyle had hanged himself. They seized on an image that their mathematics-oriented son loved: the symbol for infinity.
Jamie wears a tiny silver infinity pendant on a thin silver chain around her neck. Randy had an infinity tattoo made, altering the symbol so it also looks like a heart.
They talk of Kyle often. Sometimes they go to the barn where he died.
By speaking out, they hope to raise awareness about mental illness and about the shortcomings of a fractured system.
They couldn’t save Kyle. But maybe the Duckerts can save someone else.
Contact the writer: 402-444-1136, erin.grace@owh.com, twitter.com/ErinGraceOWH

* * * * *

Kyle Duckert on vacation in Canada. Kyle suffered three psychotic breaks before he killed himself on Dec. 21, 2013, in the barn at his parents’ home in southwest Douglas County.

Lessons from Kyle’s story

The World-Herald asked psychologists who studied Omaha’s mental health system to respond to the story of Kyle Duckert’s mental illness and discuss how it relates to the bigger picture.

The suffering of those with mental illness and their caregivers
“It’s invisible to us most of the time,” said James Zahniser, a psychologist and consultant for Colorado-based TriWest Group, which has studied Omaha’s mental health system.

The need for “first-episode psychosis care”
This is an intensive, team-based response following the first time someone experiences psychotic symptoms or a psychotic episode, according to the Yale School of Medicine. The goal is to reduce the negative aftershocks that disrupt work, studies and personal relationships. Those disruptions, in turn, can lead to unemployment, depression and substance abuse. In its recent evaluation of Omaha’s mental health system, TriWest calls for this kind of crisis care plus a longer-term, team-based approach called “assertive community therapy.” Region 6, which manages behavioral health care for a five-county region including Omaha, has a federal grant to launch first-episode psychosis care.

More and better transition support
Andrew Keller, a psychologist and TriWest consultant who studied Omaha, said hospitalizations might provide short-term stability, but they don’t focus on continuing treatment. “People need intensive treatment for years,” he said. This often includes substance abuse treatment, job help and other assistance.

Better psychiatric training for pediatricians and general practitioners
Keller and Zahniser say half of mental disorders are in place by age 14, and the vast majority appear between ages 15 and 25. Pediatricians and family doctors need to be better at recognizing symptoms and referring families early to more specialized help, they say.

Improved support and education for families
Families need a lifeline in learning how to navigate the complex, fractured system, how to advocate within it and how to support loved ones “more skillfully,” Zahniser said.

— Erin Grace

Share your thoughts