Pastor Brandan Thomas had just stepped away from the homeless shelter he runs when his buzzing phone signaled another mental health crisis. That week in late August he had already sought help for one resident who suffered a psychotic break so severe she could not remember her name, and another who bit his own arm and then swallowed a bottle of pills.
Now texts were telling Thomas his most challenging client was out of control. He raced back to find David Austin Rowe pacing the shelter. The 18-year-old threatened to shoot one staffer, Thomas said, and to choke another. He rambled about blowing up the Winchester Rescue Mission.
The pandemic has sparked a second epidemic of despair and the mission is on the front lines. Death and isolation associated with the coronavirus created an uptick in people needing counseling, while degrading the ability of the mental health system to provide it.
Normally, 40 percent of the mission’s residents have a diagnosed mental illness but that number shot to 90 percent at times over the last six months. Virginia’s hospitals were struggling to find beds for the mentally ill, amid a surge in patients and a staffing shortage exacerbated by the pandemic. Problems in the state mirrored those nationwide.
Rowe, who suffers such profound autism and mental illness that he had been in the care of the local county since age 11, had a history of violent outbursts. On that August day, Thomas desperately tried to get Rowe an emergency hospital commitment, but was stunned when Rowe was turned away. Then the teen tested positive for the coronavirus.
Sick and suffering a mental breakdown, Rowe could not return to the shelter so he turned to the one person he had left: Dianna Swaner — who had been one of the few constants in her grandson’s tumultuous life.
Though he had been accused of assaulting her, she took him in. On Aug. 28, Swaner stopped Rowe as he tried to take a can of beans from her home, authorities said. Rowe allegedly smashed her head through a TV, before fatally bludgeoning her with a jarred candle. He was charged with murder.
Thomas said he was deeply shaken, but not surprised. Rowe was a worst-case scenario, a collision between a new American crisis and an old one — the pandemic and a frayed mental health system — that was ripping many families apart.
“This is almost the perfect storm,” Thomas said.
The most challenging case
Thomas first met Rowe in July at a visiting room in a local jail. A guardian with the Frederick County, Va., Department of Social Services had asked the pastor if he could help her client, who was incarcerated for allegedly attacking his grandmother.
Rowe, wearing a navy colored jail jumpsuit, seemed childlike, Thomas said, and it quickly became clear he didn’t fully grasp why he was there. The young man wanted to talk about his phone and girls.
Thomas, who has tattoos running up his arms and once rode a Harley cross-country to raise money for the homeless, said the encounter nearly moved him to tears. He suspected the alleged attack was a product of unmanaged mental health issues rather than malice.
“How can jail be the answer for a young man who is mentally ill?” Thomas asked. “It’s heartbreaking.”
Thomas called a meeting of the staff at the mission and proposed Rowe come live at the shelter. Thomas told staff Rowe would present unique issues, but staff agreed they were up to it. And the courts allowed it.
Rowe was born drug exposed and his mother was in and out of jail during his early years, according to a court assessment. When his mother was around, Rowe told the evaluator she left him “in a room all day.”
COVID-19 costs for the uninsured worries local health
federal program that has given tens of millions of dollars to Missouri providers to defray the cost of COVID-19 testing and treatment for the uninsured came to an end Wednesday, leaving clinics and hospitals worried about the impact on tight budgets and continuing efforts to contain the spread of the deadly coronavirus.
“From a public health and a community health perspective, anything that puts a damper on testing and treatment is really a bad idea because the consequences are increased (infection) rates and higher degree of transmission,” said BJC HealthCare’s Dr. Clay Dunagan, speaking on behalf of the St. Louis Metropolitan Pandemic Task Force, which includes all the major hospital systems in the region.
Hospital leaders fear uninsured patients may not seek testing and treatment when exposed or sick because they are worried about the cost, miss the window for prevention therapies or end up requiring more costly care in the emergency room.
“The health systems, as always, will do what’s clinically appropriate for the patient sitting in front of us,” Dunagan said. “It will become just another unfunded mandate on the health system for taking care of uninsured patients.”
The end of the funding for the uninsured is the first casualty in a budget impasse between Congress and President Joe Biden’s administration over its request for an additional $22.5 billion for the ongoing response to the virus.
The uninsured program has been in place since May 2020. It reimburses hospital, clinics, doctors, laboratories and other service providers for COVID-19 care of the nation’s uninsured population, which totals about 28 million people. In Missouri, the latest federal census data shows 12% of those under the age of 65 are uninsured — or about 612,000 Missourians.
The program is run by the federal Health Resources and Services Administration, which warns on its website that it stopped accepting claims at midnight Wednesday for testing and treatment. After April 5, the program will no longer be able to accept claims for vaccination costs.
A White House fact sheet says other COVID-related efforts also will soon be in danger without new funding, such as the development of new vaccines and maintaining a robust capacity for testing.
The federal government also has no more funding for additional monoclonal antibody treatments for high-risk individuals who get COVID-19. Starting Monday, state allocations of the treatments will be cut by more than 30% to spread out the existing supply.
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