Maria Rathbun always knew a tendency toward mental illness was locked in her son’s genes.
But the change in him happened almost overnight.
He was 15, the lead singer in an Eagle River grunge rock band. He started hearing voices talking to him through speakers and amplifiers. One night before a gig, he became convinced that the people in the audience were threatening him.
The diagnosis was schizophrenia -- the same illness from which his biological father and grandmother suffered.
Medication helped him, but he struggled with the side effects. Rathbun did what she could to keep her son safe. But when he turned 18, Mark Bolus was free to make his own way.
Off his medication, his thinking grew confused. He couldn’t keep a job or a permanent place to stay. There was nothing she could do but watch his decline and worry. Eventually, his strange behavior caused him to tangle with the law. By the time he was 19, he had been convicted of a felony.
The conviction was, in a strange way, a relief. Until he died this May, it seemed that jail was safer than the unknown for Rathbun’s mentally ill son.
“When incarceration is the best a parent can hope for, something is very wrong,” she said. “We all failed Mark.”
A growing problem
There have never been more people with serious mental illnesses living in Alaska’s jails and prisons than there are today.
There are three times as many beds designated for mentally ill Alaskans in jails as there are at the state psychiatric hospital.
In many cases, as with Bolus, mental illness contributed to the crimes that put them there.
Forty-two percent of the people imprisoned in Alaska have a diagnosable mental illness or cognitive disability, Department of Corrections officials told the Legislature in February. One in five is considered “severely and persistently” mentally ill.
Diagnoses of psychotic disorders, like the one Mark Bolus had, are up 60 percent among inmates.
Medical experts agree that jail is far from an ideal setting for people with mental illness.
“No, it is not a therapeutic environment,” said Steve Williams, chief operating officer of the Alaska Mental Health Trust Authority.
But the Department of Corrections has no choice but to care for the mentally ill people increasingly being ordered into its facilities.
Department officials say they are doing the best they can. This year, it is expanding clinical services, including adding a third unit for mentally ill prisoners at the Anchorage Correctional Complex, to keep up with the influx.
Still, two young men with mental illnesses have died after being held in isolation cells at the Anchorage jail in recent months.
The first was Davon Mosley, a 20-year-old from Bakersfield, Calif., who died of bleeding ulcers, usually a treatable condition, in April.
The second was Maria Rathbun’s son, Mark Bolus.
He hung himself in his cell early on the morning of Mother’s Day.
“I wonder if he thought he was giving me a gift,” Rathbun said. “The end of 10 years of his suffering.”
If any family had the tools to conquer mental illness, it was the Rathbuns.
Mark Bolus grew up at the end of Eagle River Road with an older brother and two stepbrothers. Later, a younger sister joined the family. His stepdad worked for the state parks division and his mom went back to school to become a medical office manager. Rathbun hoped a happy, stable childhood would ward off the sickness she saw in Mark’s father. There were Teenage Mutant Ninja Turtle birthday cakes and fishing trips.
After Mark was diagnosed with schizophrenia, the family sent him to a residential treatment center in Idaho for eight months. They hoped he’d learn to accept his illness as a chronic condition that could be managed with medication and didn’t have to define his life.
“Like diabetes,” Rathbun said.
Like many families of mentally ill children, they dreaded Mark’s 18th birthday. Once he became a legal adult, they would have no control over their son.
When Mark graduated from Chugiak High School, the friends and bandmates who had given shape to his teenage years moved on with their lives.
He clung to old routines and began a familiar cycle that Francine Harbour, the executive director of the National Alliance on Mental Illness’ Anchorage chapter, calls the “downward drift.”
Mark, handsome and “outlandishly funny,” according to his friends, disliked the way anti-psychotics made him feel flat and dull. He’d stop taking them and then smoke marijuana to compensate for the symptoms of his disease. High and unmedicated, he’d act strangely and lose whatever temporary job or living situation he’d found. He began to show manic symptoms of bipolar disorder.
It was during one of these episodes that Mark first crossed paths with the criminal justice system, his mother said. He had driven to Tok alone on a whim and then was arrested after he tried to fill up with gas and had no money on his debit card to pay.
In September of 2009, Mark was 19 and living in a hotel in Palmer. According to a police report, he rode his bike to a Dairy Queen, walked in, began talking to a teenage cashier and squeezed her buttock. He left. He pedaled to Carrs Safeway, where he grabbed a cashier’s breast. Then, at Fred Meyer, he told a worker she was “very attractive” and “pulled her into a hug,” the police report said.
He was arrested and charged with second-degree sexual assault.
Rathbun said no one -- least of all Mark himself -- excused the behavior.
His previous case involving the gas theft had been handled through one of Alaska’s mental health courts, which are supposed to look at the root causes of illegal behavior and divert mentally ill people away from the criminal justice system into more appropriate treatment. Alaska was one of the first states in the nation to use such courts to address the burgeoning population of mentally ill offenders.
Mark’s new case, a felony sex offense, did not qualify for mental health court.
A Palmer judge sentenced Mark to seven years in jail with five suspended.
“I’ve never really felt this guilty or horrible in my life,” Mark said at his court sentencing.
The 18 months Mark served in prison offered his mother an uncomfortable sense of relief.
Now that her son was in jail, he was stable and on his medication. The guards liked him. He was occasionally allowed to play his beloved guitar.
Rathbun could visit him. She knew where he was sleeping, which was more than she could expect when he was out.
When Mark was released early for good behavior, he faced the necessity of meeting strict probation requirements coupled with a powerful new stigma.
Mark was now a sex offender and felon, attributes not at the top of any landlord or employer’s list of desired characteristics. Doors closed.
“Add a felony conviction on your record -- just a felony straight up, not to mention the sex offense aspect -- and you have barriers related to housing and employment,” said the Mental Health Trust Authority’s Williams. Without a home or a job, it’s difficult to meet probation requirements. Recidivism rates go up.
Mark’s brother and friends tried to help out. He did odd jobs and stayed on couches. He was always being kicked out by landlords, his friends say.
Mark occupied a no man’s land of mental illness: sick but not sick enough. Courts can mandate that people with severe mental illness take medication if they are an immediate threat to their own safety or the safety of others, but Mark’s mental illness didn’t meet that standard.
Mark was neatly dressed. He wasn’t talking to himself on street corners or attracting the attention of police. But his thinking wasn’t rational.
“He wasn’t crazy-crazy,” said his friend and former bandmate Zane Miller.
His parents had no legal authority to force him into treatment or to ensure that he was sticking to a medication regimen. They could only watch the decline.
Even if they could have forced him into treatment, Alaska Psychiatric Institute is designed as a short-term placement for people who are acutely sick and in crisis. Only 50 beds are designated for that purpose.
Providence’s psychiatric wing is also intended for emergencies only.
That’s by design, said Melissa Ring, head of the Alaska Psychiatric Institute.
“Alaska’s history, traditions and culture have long placed a strong emphasis on individual liberties and individual rights,” she said, in an email. “There has been a conscious decision within state government to uphold those rights and not have institutionalization in hospitals and nursing homes. Therefore few of such placements are available. And the laws are very stringent regarding rights of persons with mental illness to choose whether to receive treatment, take medication, stay in a hospital or live in shelters or on the street.”
He could have gotten case management services with Anchorage Community Mental Health Services or one of the other nonprofits that try to help people with mental illness create stable lives.
It fell on Mark, a young man who wanted more than anything to feel normal like his friends, to seek out those services.
To do that, a person must have the presence of mind and tenacity to navigate a complicated system that can be daunting in the best of circumstances, said Harbour, the NAMI-Anchorage director.
He did have one case management appointment with a local nonprofit but was turned away because he was too “high-functioning,” according to his mother.
Mark spent the last years of his life bouncing around. He made music. He drew elaborate scenes of dragons and flowers for his younger sister. He painted and gave the work away to his friends.
The same funny, warm, hyperactive Mark was always there, his friends say.
But he seemed to struggling to stay afloat in a sea of court-ordered obligations, with his illness tugging him down.
Repeatedly, Mark violated his probation.
Once, he impulsively went to Soldotna to fish without permission.
Another time he failed a drug screening for smoking marijuana.
He’d end up in a cell for weeks or months. His mother began to expect it.
When a person enters the correctional system it’s like getting caught in a briar patch, said Harbour, the mental health advocate. Once you’re in, thorns claw at you from all directions: “It’s almost impossible to get yourself free.”
At the end of March, Mark slid into a manic state.
Rathbun offered him a choice: Go to the hospital, or go to your probation officer’s office and be arrested.
“Either way, you’re going to get back on your medication,” she told him.
He chose Providence hospital’s psychiatric emergency room. He was released after a day.
The next week Mark showed up at a court-ordered sex offender treatment class, again in a manic state. He was back on his medication but it hadn’t fully kicked in, Rathbun said.
Mark wasn’t allowed in, which made him technically absent. For missing the class, Rathbun said, his probation officer sent him back to jail.
It would be the last time.
The Anchorage jail was undergoing renovations when Mark arrived in April, and he was among a group of prisoners temporarily displaced to Spring Creek, the maximum security prison in Seward.
Rathbun doesn’t know what happened during her son’s 11 days in the Seward prison. But when he returned he seemed distressed. He told her prison medical staff had put him on lithium, an inexpensive and widely-used drug used to treat bipolar disorder, in addition to his usual anti-psychotic medication. In the past, lithium had brought out Mark’s paranoia, his mother said.
For privacy reasons, the Department of Corrections won’t comment on individual inmates’ medical treatment.
Then Mark asked to be put into “segregation.” He was afraid of other inmates, his mother said.
In his isolation cell, Mark was alone 23 hours a day. Researchers have found that isolation can exacerbate mental illness.
At some point, Rathbun says, Mark wanted out.
On May 5, Mark told his mother he had asked to see a doctor.
“This medicine isn’t working,” he told her. “It makes me paranoid.”
Each day that week, he sounded worse.
On Saturday, May 10, they spoke on the phone one final time. He still hadn’t seen a doctor, he told her. He thought the guards were looking at him strangely and they were out to hurt him.
“I need help,” he told her.
“Just hold on until Wednesday,” she told him. He’d have a court hearing that day. He could be released, and together they could work on a new medication plan.
Rathbun could have bailed him out for $250, but she was calculating, weighing the fear she heard in her son’s voice against her own feeling of helplessness.
If Mark got out, where would he go? In the odds game between bad and worse, jail still seemed like the better option.
On May 11 at 6 a.m., a nurse and a guard delivering medication found Mark unconscious in his cell.
Mark had hung himself with a bedsheet.
He had never talked about suicide before, his mother said.
Mark Bolus was not on suicide watch or in a cell with camera surveillance at the time of his death, said Department of Corrections spokeswoman Sherrie Daigle.
“There was no indication that he needed to be in a camera cell,” Daigle said.
After lingering in the hospital for three days, Mark died on May 14 with his family by his side.
Mark’s family held a memorial service for him at a log church in Palmer.
More than 100 people showed up. There were songs by his old band and cupcakes topped by guitar picks printed with Mark’s face.
On a recent day, Maria Rathbun was alone at her Lazy Mountain house, just her and pigs and the chickens. Her daughter was at a friend’s house, and her husband was off fighting the Funny River Fire.
The sympathy bouquets were wilting, and the family members who’d flown in after Mark’s death had gone home.
If jails are going to be where society puts its mentally ill, she said, staff need better training in how to deal with depressed, psychotic, manic or paranoid prisoners. If someone asks for help, as Rathbun believes her son did, they need to get it right away.
“I thought he was safe,” she said. “Now I have to go pick up his ashes tomorrow.”
Reach Michelle Theriault Boots at firstname.lastname@example.org or 257-4344.