The State vs. Anthony Zichi -
David Cornwell - Executive Director North Carolina Mental Hope
What others have written about the Anthony Zichi case
Debra Dihoff - NAMI NC
John Tote - Mental Health Association in NC
Lorraine Ahearn - Greensboro News Record columnist
The State vs. Anthony Zichi
David Cornwell
Executive Director North Carolina Mental Hope
Tony Zichi didn't choose to have schizophrenia.
Tony Zichi didn't choose to kill 88 year old Ruth Terrell, although he stabbed her multiple times.
Indeed, Tony chose to save her - save her from the rats only he could see that were crawling over her and other elderly residents of the adult care home where state mental health workers had placed Zichi, knowing of his mental illness and his history of violence.
Tony didn't choose to be placed in an environment so unfitted to his needs that it would be fodder for a Cohen Brothers movie were it not so surrealistically real.
And certainly no one should ever forget that Ruth Terrell did not choose to die.
Tony hasn't made many choices in a very long time, well before Mrs. Terrell died in May 2005 from complications from the wounds received two weeks earlier.
A bright kid with a winning All-American look, Tony had excelled in soccer and did so well academically that he was given a scholarship to a prestigious private high school. But, a couple of years later, his world began to slowly dissolve, with the increasing aggressive outbursts and delusions that are so often symptomatic of schizophrenia.
Tony Zichi didn't choose to have a mental illness. It chooses you. It chooses you at any age, any income, any education, Christian, Atheist, Buddhist, black, white, man, woman, child.
As their son's condition deteriorated, Cathy and Mark Zichi did what all parents would do, or at least should. For years, they persistently and desperately tried to find help for their son, particularly in the form of a secure psychiatric facility that could house and treat him. They would have never chosen the adult care home in which the tragedy took place.
So who did have a choice? You could simply answer "the state" in the guise of the state's mental health system. But no more oxymoronic phrase has ever been uttered in North Carolina than "mental health system."
The one individual with a choice now is Alamance County District Attorney Rob Johnson, who could simply agree to a pretrial hearing to let a court decide if Zichi was sane at the time of the offense. The outcome of such a hearing might well mean Zichi would spend the rest of his life in the most secured portion of a state psychiatric hospital where he could receive the needed level of care for his illness, rather than prison where his condition would almost certainly deteriorate.
It would not only seem the reasonable and humane choice to make, but determining Zichi's sanity now would seem to be the fiscally responsible thing to do in terms of tax dollars. Certainly Zichi's schizophrenia is well documented and common sense would seem to dictate a sanity hearing be held.
But, perhaps afraid of the public perception of not prosecuting someone for such a heinous act, Johnson's office presses ahead in efforts to stabilize Tony and charge him with first degree murder. Tony remains in the Forensic Unit of Dorothea Dix Hospital, where he has not spoken in more than three months, the result of the trauma of his last court appearance. How long he will be warehoused in this legal limbo, perhaps only Johnson knows.
For most people, the hell, the desperation, the hopelessness of being the parent of a child with a severe mental illness are unimaginable. Imagine being Tony's mom and dad, knowing your son is too sick to ever enjoy freedom again and realizing that he needs to be separated from society for the rest of his life. But there's no mystery in their wishes that he not needlessly suffer more than necessary from his schizophrenia, and that his illness be treated and not criminalized.
Unfortunately, Tony's just a flash in the chaos that's ultimately the result of the public's choice to ignore mental illness. We can blame it on the politicians, but until enough people start caring enough about the Tony Zichis of the world, the 11-year-old spending the night in a magistrate's cell after a bipolar rage because there is nowhere else to keep her, the young adult strapped to a gurney more than 53 hours waiting for a psychiatric bed to open somewhere in the state, nothing will truly change. Until the public starts caring about the lost childhoods and the hopes and aspirations of adults just dropping away, until we choose to care and to demand humane and civil treatment for individuals with mental illness, funds for research, until we demand caring, nothing much is going to change.
If we don't care about one another, who will?
Truly, the only entity that can choose for Tony Zichi now is the state of North Carolina, most notably represented by District Attorney Johnson.
Tony Zichi likely wouldn't have chosen to be at the crux of any civil or human rights issues. He probably would have chosen to go to college, start a career, marry, be a dad and kick a soccer ball around the back yard with his kids on Sunday afternoons.
But Tony Zichi didn't have a choice.
We do.
You Can Help
Please consider writing or calling NC Attorney General Roy Cooper, Alamance County District Attorney Rob Johnson, Alamance County legislators, the Burlington Times-News and other area newspapers with the contact information at the bottom of this column.
Both NAMI executive director Debra Dihoff and Mental Health Association executive director John Tote have spoken out on this issue, and the prosecution of individuals with mental illness for acts committed while experincing psychosis is a national issue that the Zichi case brings home. Please speak out and speak out often.
Individuals wishing to help the Zichis with the enormous expenses of attorneys, pscychiatrists and other specialists can send contribtuions to:
Mark and Cathy Zichi
7060 Chapsworth Drive
Trinity, NC 27370
or call 336-475-2342.
Anyone who might donate a fairly current computer or funds to be used for it and a high-speed Internet connection are also encouraged. Certianly more up-to-date technology would be an asset to the Zichis and their efforts.
While emails can be effective, as effective is a phone call or letter registering your opinion with lawmakers and public servants.
Attorney General Roy Cooper
(919) 716-6400
9001 Mail Service Center
Raleigh, NC 27699-9001.
Email link from web here
(Click on names below for other email links)
Alamance County District Attorney Rob Johnson
(336) 438-1015
212 West Elm Street, #200
Graham, NC 27253
Alamance Assemblymen
Rep. Alice Gordsen
919-733-5820
NC House
300 N. Salisbury Street, Room 530
Raleigh, NC 27603-5925
Rep. Cary Alred
NC House
919-733-5905
300 N. Salisbury Street, Room 606
Raleigh, NC 27603-5925
Sen. Tony Foriest
(919) 301-1446
NC. Senate
300 N. Salisbury Street, Room 332
Raleigh, NC 27603-5925
Letters to the editor:
Please note that letters to the Burlington paper are likely most effective.
Burlington Times-News
Greensboro News Record
Raleigh News & Observer
We must provide proper mental health treatment - May 12, 2008 - Burlington Times-News
By John Tote,
Executive director, Mental Health Association N.C
I am writing this letter during May, which is Mental Health Month. That is significant since mental health issues don't usually get the general support that they should get, especially when it comes to issues that can be easily stigmatized and stigmatizing. One such event, and its aftermath, concerns the case of Tony Zichi.
The tragic case of Tony Zichi of Alamance County is one that needs to be discussed. The number of victims in this case has been ignored. Tony Zichi was a young man, most likely inappropriately placed in a setting with people that were older and did not have mental illnesses. Unfortunately, he did not receive the care that he should have. Tragically, he took someone else's life. Clearly, the lady and her family are victims. However, Tony and his family are victims as well. First, they were victims because they did not receive the services that were so desperately needed for an individual suffering from schizophrenia. Now they are victims of politics as Tony sits silently in a state hospital until he can get "well enough" to be put on trial for this event. There is no doubt that Tony should be confined; however, his confinement should be within the state psychiatric hospital system not in the prison system. From all indications, Tony was not legally responsible for his tragic actions. This does not excuse nor take away the pain from the family that lost a loved one. It must be clearly stated that Tony needs psychiatric care and should receive it in a proper manner even after an event such as this. Politics and public perception are difficult to overcome, but we must overcome them in order to do the right thing. Late in many ways? Absolutely! Too late? Not at all.
In closing, we must not consider this case in isolation. We must have appropriate and timely care and treatment for individuals with mental illness. If we do that, this May is Mental Health Month will be the start of something truly special.
Mental health reform flaws, laid bare - April 14 - Greensboro News Record
By Lorraine Ahearn
Staff Columnist
ELON — These days, Tony Zichi is finally where his doctors and his family argued he should have been all along: in a maximum security state psychiatric ward, for treatment of severe schizophrenia.
The irony?
It took a homicide to get him there.
It took the brutal stabbing in 2005 of 84-year-old Ruth Terrell, a resident of a small, quiet elder care home where mental health authorities placed Zichi, then 25, despite his well-documented history of violence.
So far, Zichi has been unable to face a first-degree murder charge, with experts split on whether he is competent to stand trial. After an attempt to pick a jury in February, an Alamance judge ordered Zichi taken back to Dorothea Dix hospital.
But in the meantime, two massive civil actions by the elderly victim's survivors — one against local authorities, the other against the N.C. Industrial Commission — are beginning to grind their way through the courts.
Laying bare the inner workings of mental health "reform" — North Carolina's attempt to close state facilities and send the mentally ill back to the community — the lawsuits could accomplish the very thing that no amount of advocacy or newspaper articles have so far: Force a change.
"This is the worst case the state has seen," said James Roane, a nursing home attorney who filed the lawsuits for the victim's son and daughter.
"Everybody knows the system is broken. It's my intention to bring this to the public, and bring it to the legislature. That's all we want to do."
At the heart of the case is an ongoing practice the state calls "mixed populations" — a euphemism for placing mentally ill people in facilities that are instead designed to care for the elderly.
In the Zichi case, that would be the Evans Forever Young Family Care Home. The brick house in the country, two doors down from a horse farm near Western Alamance High School, was home to four elderly women when Zichi was placed there.
"Exhibit A" in the case is the admitting form that Alamance-Caswell Mental Health officials filled out for the home's operator. Though Zichi's diagnosis is listed — "schizoaffective disorder, polysubstance abuse, antisocial personality" — none of the boxes to indicate "inappropriate behavior" are checked off. Those boxes, left blank, included, "injurious to others."
In fact, Zichi had a history of violence, his criminal record shows. He had been placed — and kicked out of — seven group homes in four years, including one in Guilford County where in 2002 he stabbed a younger male resident in the neck with a pencil, according to court records.
In Burlington, he punched a female group home resident in the face and held her down, records show. He was also convicted of stealing a revolver and pointing it at someone.
The Alamance-Caswell physician who signed the form, Dr. Julia Snow Knerr, has declined through her attorney to explain the omission, citing patient confidentiality.
Zichi, who allegedly became increasingly paranoid and delusional because he was vomiting up the medication used to stabilize him, had been at the home near Elon for three months when the stabbing occurred.
On the night Terrell was stabbed with a knife from the kitchen, she had been asleep. In the two weeks that she was later hospitalized before dying of complications, police said she told witnesses that Zichi had jumped on top of her and tried to strangle her before stabbing her multiple times.
Nursing home operator Erma Evans, a defendant in one of the lawsuits, denied in court filings Zichi had posed immediate problems and threatened her staff. Evans conceded that Zichi had "some adjustment problems," but maintained that she "met all her legal responsibilities and was not negligent in any way."
Although Zichi is also named in the lawsuit, the attorney for the victim recently let both Zichi's mother and the Alamance Department of Social Services out of the action, which alleges negligence, medical malpractice, wrongful death, assault and battery, and fraud. Attorney Roane said DSS workers had been "desperate" to have Zichi moved from the nursing home.
And after a deposition with Zichi's mother, Catherine, Roane concluded the mother had searched exhaustively to find him a proper placement when they could no longer manage him at home.
"She complained to everybody she could think of, she wrote letters," Roane said. "But nobody wanted him. Not the ER, not the 'supervisory unit,' not the jail, not the group homes. So they put a 25-year-old man with a history of violence in a home with elderly women. What do you think is going to happen?"
The Zichis declined to comment because of the pending murder trial, but a mental health advocate who led their family support group described the family's unsuccessful efforts to have their son, who was diagnosed as schizophrenic at age 20, confined to a state hospital.
Support group leader Eileen Silber, past state president of the National Alliance on Mental Illness, said because of the thrust to close mental hospitals, Zichi didn't qualify for the limited bed space.
"This system is so broken and fragmented, there was no room to put him in a state hospital," Silber said. "But when you deliberately put someone like Tony in a residence like (the Evans rest home), you are not concerned with the public safety."
Zichi, after running a mile from the house on the night of the stabbing, allegedly told sheriff's deputies he was seeing "rats."
He frequently suffered delusions that the CIA and the Mafia were after him, according to court records, and during a court hearing in February, he sobbed when he saw his parents in the courtroom, then stopped talking completely.
Though Zichi had been a bright, athletic student before the onset of his illness, Silber said Zichi's parents had long resigned themselves to the idea their son could not function in the community, but might well have to spend the rest of his life hospitalized.
For the first time, Zichi is where his psychiatrists recommended — a locked facility with mental health staff and doctors to monitor his powerful psychotropic medication.
"But it took this," attorney James Roane said, tapping his finger on a photograph of Ruth Terrell, who spent her 85th birthday in the hospital, just before her death.
Roane concluded there were "two victims" in the case — one a sick young man needing treatment, the other, an elderly woman who needed protection from harm.
"We are literally dumping mentally ill people in with the elderly, and for the foreseeable future, it's not going to change. We need state-run facilities. That's it. They're going to have to find the money.
"Because this," Roane said, tapping the photograph, "is not working.
Decline of mental health system - March 6, 2008 - Burlington Times-News
By Debra Dihoff
Executive Director National Alliance on Mental Health, North Carolina
There are many victims in the events that led to the death of Mrs. Ruth Terrell, an 88-year-old woman in 2005 at the hands of a young man with full blown psychosis. The National Alliance on Mental Illness North Carolina extends its deepest sympathies to the family of the victim and to the whole community.
But there are other victims here, too. Anthony Zichi is a victim of the failure of the mental health system to provide the right level of treatment to protect both him and others. His story mirrors the decline of the mental health system in N.C.
He was diagnosed with schizophrenia in l999 when he was 20 years old, which is typical. He then was placed in nine different homes from 2001 to 2005. He had seven short-term hospitalizations in a three-year period, and attempted during that time to get long-term help but was turned down. Most recently he was placed in the family care home near Elon (in March 2005) until his time in the hospital forensic unit following the tragedy.
Schizophrenia is a neurobiological disease affecting about l percent of the population; it is a thought disorder — reasoning, memory, and judgment are affected. Often it causes delusions, where certain people or events take on unusual or threatening significance which was the case with Mr. Zichi on the day of the tragedy. Voices told him to attack rats, so that is what he did. Even the most irrational delusions seem absolutely real to the person experiencing them.
Research clearly demonstrates that people with schizophrenia have differences in their brain structure and brain function. In that way it is a disease, like any other. At times schizophrenia may cause overly aggressive, hostile, or violent behavior, and at these times hospitalization is needed to prevent self injury or harm to others. Mr. Zichi and Mrs. Terrell and their families are all victims of the lack of appropriate treatment — hospitalization — for this illness.
Is justice served by putting Mr. Zichi in prison for the rest of his life? One has to wonder if the action caused by the disease and by the lack of appropriate treatment for that disease should count for something. Society must be protected, and Mr. Zichi must get the right treatment. Treatment in a secure hospital setting, which would result in both of these objectives, would be the right choice.
What else can be done to prevent tragedies like this from happening? No young person should be placed with elderly people in a care setting where there is no specialized training for recognition of the signs and symptoms of a worsening condition. Unfortunately there are not enough of these facilities. And there are insufficient crisis response systems as well.
North Carolina ranks 43rd per capita in funding for people with severe mental illnesses, and this is where it shows, where a 28-year-old man is placed in a home with elderly female individuals because there is no other place.
Alamance County is working to begin to make some changes to put into place things that work, like the start of a jail diversion program called Crisis Intervention Training. Kudos to everyone involved in this effective program that trains first responders — law enforcement — to recognize mental illness and get people to treatment, rather than to jail. People with mental illness do not make progress in their treatment for their disease while they are in jail. In Memphis, Tenn., where this program has been in place for many years, the result of the encounters with people living with mental illness has changed significantly — previously 20 percent of the time it resulted in arrest, post training, down to l percent.
North Carolina has experienced a decrease in psychiatric bed availability, and a decline in community mental health services. Mr. Zichi is a victim of this decrease, as are many others with mental illness who are living in jails, prisons, homeless shelters, and inappropriate or non-supportive housing. While 6 percent of the general population has a serious mental illness, these same individuals are over-represented in our jails and prisons, 21 percent and 24 percent respectively.
Let’s get the right services in place in the community to prevent this from ever happening again. And let’s remember there is more than one victim in this scenario, and let’s do our best to make that right.