Somewhere lost inside his head is the charmer, loyal brother, doting son. Now only the madness speaks.
“Everybody in the universe is able to see what I see!” Salih Mahdi roars. “You been able to see the exact same things I see since 2006 when my vision split. Don’t tell me you can’t.”
Mahdi is on day 14 of a court-imposed stay at Central State Hospital in Milledgeville, Georgia, after three days of alleged terror in June. He’s accused of fondling himself at an apartment-complex pool, assaulting a woman as she walked home from work and raping another woman twice before barricading her in a closet. During a phone interview, he calls the incidents “a consensual thing” and says everyone knows because everyone watched it all happen through his eyes -- “even dead people.”
A battery of antipsychotics -- olanzapine, Invega Sustenna and Haldol -- target his paranoid schizophrenia (6768353:US) and clearly need more time to work. Without the medicine, Mahdi is a monster, says his mother, Haleemah Rabia. And there’s the rub: Outside the hospital, nobody can get him to stay on medication.
“This is a total and complete failure because here, in this state of Georgia, they can’t seem to force him to take his drugs,” Rabia said. “This boy is sick!”
Georgia and 43 other states have laws that allow for “outpatient commitment,” by which officials can force dangerously mentally ill people to take prescribed medications, even when they’re not hospitalized. In those states, counselors or social workers can seek court orders requiring compliance.
In most states, these laws are underused or ignored, said Brian Stettin, policy director for the Treatment Advocacy Center, an Arlington, Virginia, nonprofit that supports forced medication. Salih Mahdi’s case and others show the consequences can be dangerous -- even lethal -- for patients and those around them.
Exacerbating the problem is the decades-long drop in available hospital beds for inpatient care. Fewer than 46,000 seriously mentally ill people remain in long-term care settings. There were 559,000 in 1955.
“Because of fewer beds, people can’t get into hospitals and so they’re likely to become more violent,” said D.J. Jaffe, executive director of the non-profit Mental Illness Policy Org. in New York. Outpatient commitment can be “the only thing standing between them harming themselves and others.”
The Virginia Tech shooter,Seung-Hui Cho, was ordered into involuntary outpatient treatment two years before he killed 32 people in 2007. Caregivers were never notified of the court order and it expired without him getting help, according to Mike Wade of New River Valley Community Services Board, the Blacksburg, Virginia, mental health agency that did Cho’s initial evaluation.
Out of California’s 58 counties, only one, Nevada County, has fully adopted the state’s optional outpatient treatment program known as Laura’s Law. About 150 miles away in Alameda County, Daniel Dewitt, 23, whose mother, Candy, said she watched him regularly avoid taking his schizophrenia medication as an outpatient, is accused of fatally bludgeoning a stranger in February with a ceramic planter. He hasn’t entered a plea to the charges, and was ordered to a mental hospital.
“Having a state law on the books ensures nothing,” Stettin said. “That is a tragically wasted opportunity, both to improve the lives of people with severe mental illness and to protect the public from the consequences of non-treatment.”
An exception is New York’s Kendra’s Law, which was passed in 1999 when Stettin was an assistant attorney general. The law was named for 32-year-old Kendra Webdale, a journalist and photographer, who was pushed to her death in front of a speeding New York City subway train. The man responsible had stopped taking his schizophrenia medication. The Webdale family’s lobbying efforts on behalf of the bill was followed by others, including the parents of Laura Wilcox, whose death in California at the hands of a man with schizophrenia became the catalyst for Laura’s Law.
The language Stettin drafted for Kendra’s Law makes New York unique in that all localities must establish programs. The requirement paid off, he said. Physical harm to others from those who had been treated under court order dropped 47 percent, according to a 2005 study, and the risk of arrest and hospitalization for participants fell in a 2009 study.
Pushback against outpatient commitment is constant. Ruby Moore, executive director of the Georgia Advocacy Office, a private, non-profit group funded with federal dollars and private donations, calls forced medication “a profound rights violation.” Moore and others on her staff of 32 testify, lecture and help dozens of mentally ill patients fight such orders every year.
“At the heart of recovery is the idea you can do this yourself,” Moore said. “That’s not what happens when you’re in constant threat of being rounded up, locked up and drugged.”
In Georgia, involuntary-commitment orders are “an important tool -- a tool of last resort, but a tool nonetheless,” Governor Nathan Deal said through a spokeswoman. A state manual issued two months before Mahdi went on his alleged rampage reminded social workers that they “must incorporate assertive engagement techniques” that include “legal mechanisms such as outpatient commitment.”
Even though Mahdi was in and out of the county jail 10 times on various charges related to violence or threats over the past five years -- bouncing between incarceration and the hospital -- no one ever sought an outpatient commitment order for him.
“I don’t really know about that kind of court order,” said Joan Malone, who supervised a team of social workers that was assigned to try to keep Mahdi on his medication in late 2011. Such teams, called Assertive Community Treatment, or ACT, care for outpatients statewide. Over the four months that she and her ACT team worked with Mahdi, “he kept refusing” to take the drugs, Malone said.
The state Department of Behavioral Health and Developmental Disabilities interprets the language in its manual as a voluntary guideline, said Kristie Swink, an agency spokeswoman. She declined to comment on Mahdi’s case, citing medical privacy laws.
“Each ACT team is encouraged to develop relationships with its consumers that build trust and support independence through partnership, not force,” Swink said in an e-mail.
When Mahdi was released from jail the last time, on May 14, he wasn’t assigned to any ACT team. Nobody monitored him. He fell off the system’s radar until police say he committed a series of increasingly violent acts carried out in the early summer heat.
While Mahdi denied committing any crimes during an interview from his hospital, he has yet to enter a plea in connection with charges that include two counts of rape. He’s being held at the hospital so that doctors can attempt to restore his competency.
When he’s on medicine, a gentle young man emerges in place of the monster, according to Mahdi’s mother, Rabia. He’s five-foot-eight, 160 pounds -- an African-American Brad Pitt, his sisters joke. Rabia once believed her son’s winning personality and athleticism would take him far -- as a pro football player or senator.
“He’ll stay out of issues as long as he’s taking his meds,” said Captain Samuel Smith, who, as commander of the guards at Clayton County Jail in Jonesboro, has known Mahdi for six years.
“But once he’s off the meds, he’ll do things that aren’t acceptable to society,” he said.
Up to 60 percent of the 11.4 million adults in the U.S. with serious mental illness take antipsychotic medicine, the latest government numbers show. Last year, 41 million prescriptions for antipsychotics worth $15.1 billion were dispensed in the U.S., according to data compiled by Bloomberg. Only 35 percent of patients prescribed the drugs are still on them after a year, according to a 2009 survey by Indianapolis-based WellPoint Inc. (WLP:US)
Mahdi goes off his antipsychotics because he doesn’t believe he’s mentally ill, a condition called anosognosia that’s experienced by half of those with schizophrenia, according to the National Alliance on Mental Illness. “I haven’t had a doctor who can diagnose what I have,” he says.
Salih Talih Mahdi was born Jan. 18, 1988, the fifth of seven children, the youngest of two boys. His first name means “a fine courage,” his mother said.
Despite having three different fathers, the children were raised together south of Atlanta in the suburbs of Riverdale and then Morrow. Rabia, their mother, is a part-time mathematics instructor at Clayton State University in Morrow who made education a priority for her children. Three of her daughters are college graduates; the two others are going now.
Mahdi was a jokester. He’d spin a dead squirrel in the air just to hear his sisters squeal. His speed made him a star on the football field. At 11, he was named Most Valuable Player at a banquet where his mother caught a glimpse of his potential.
“He’s working the room,” she said. “He’s literally going to every table, shaking hands with every adult. I thought, wow, this boy’s going to be a sports person then maybe a newscaster and then senator.”
The dreams faded in his early teens. He took up with a new crowd and marijuana. He was arrested for possession and put on probation. He dropped out of high school at the start of his junior year.
He’d walk the house naked. Some nights he’d sleep in a park two blocks away. He’d burn toast until it was black -- saying he was baking out the poison -- then crumble it into a bowl with milk and slurp the dark mush with a spoon. His mother knew his behavior was more than just teen-age rebellion when he started showing up in her bedroom late at night, loudly accusing her of sending him telepathic messages: “Stop it, I’m trying to sleep!”
In April 2007, he was diagnosed with schizophrenia. Two months later, his sister, Makeeta, was ironing in the kitchen when he came up behind her, grabbed her hard by the throat and whispered, “It’s Judgment Day.” She couldn’t breathe and nearly blacked out. He falsely believed she’d touched his toast with hands contaminated by fecal matter.
For Rabia and her daughters, the incident marked the end of feeling safe. For Mahdi, it kicked off four years marked by long stretches in the Clayton County Jail -- mostly unmedicated -- waiting for a bed to open at Georgia Regional Hospital. Twice, he waited nine months; once, he waited a year.
On any given day, the jail has 10 to 20 people waiting for psychiatric beds. The average wait time is one year, said Sheriff Kemuel Kimbrough.
“It is inhumane to allow somebody to sit there literally in their own muck, overly psychotic and maybe a threat to others,” said William P. Kissel, president of Georgia’s chapter of the National Alliance on Mental Illness.
After that first nine-month wait in jail on a charge of simple battery, Mahdi got to the hospital on March 10, 2008, “mostly mute and uncooperative” and “hearing voices and refusing meds,” according to the hospital records. Medicine was injected over objection. By the end of his stay, he was taking the antipsychotic Risperdal twice a day orally and voluntarily. He was sent back to jail and released on July 17, 2008; the state dropped the charge against him.
As soon as he was out, he stopped taking his medicine, his mother said. He lived with his older brother for a few weeks, then showed up at her house in September, angrily demanding money. (She had secured guardianship of her adult son, which meant she controlled his $674 monthly disability check under the federal Supplemental Security Income program.)
He held a baseball bat to a visiting aunt and told his mother: “I will hurt you, shorty.”
Then it was back to jail for another nine-month wait: 270 days without medicine. He pleaded guilty to two counts each of aggravated assault and terroristic threatening, and received suspended sentences of three years for each, records show. He got to the hospital in June 2009 and was discharged a month later.
His cycle might have repeated, save one detail: The group home where he was ordered to live made sure he took the prescribed Haldol by insisting he show staff he’d swallowed it, his mother said.
He got his hair cut. He brought a date to the family’s Thanksgiving dinner. He was doing so well that the group home rewarded him with the worst thing it could have done, his mother said. It dropped the pill monitoring.
He grew unruly and refused to stay. By Dec. 12, 2009, he was sleeping outside. His mother helped him get an apartment as his condition deteriorated.
On Jan. 1, 2010, he was arrested after masturbating behind a rack of clothing at a Macy’s (M:US) department store in Morrow, according to a police report. The next month, he walked up behind a woman working the cosmetics section at a Wal-Mart store and said “Can you feel this?” as he pressed his exposed penis against her back, a police report said.
He returned to jail on charges of sexual battery, public indecency and marijuana possession of an ounce or less. This time, he waited a year for a psychiatric bed. By February 2011, he’d lost 30 pounds in jail, his hair was in tangles and he stunk, his mother recalled.
“I cried to the guard, ‘He is dying. You must get him to the hospital,’” she wrote in a diary she began to keep in 2007. “Salih’s Journal” is filled with e-mails and phone calls to counselors, doctors, nurses and jail staffers -- all of whom she contacted to try to keep her son on medicine.
She sent e-mails this time to the sheriff, the guard captain and Mahdi’s public defender. Two days later, on Feb. 14, 2011, he was transferred to the hospital, so delusional that when asked his name, he mumbled repeatedly, “Peter Piper pick a pepper.”
That May, he injured a doctor and a pregnant nurse, sending them to the hospital. Still -- after Mahdi received an extended regimen of Haldol injections and oral doses -- a judge released him into a residential program in July 2011. He was placed on 12 months’ probation. With no medication order in writing, Rabia remembered fearing the worst as she sat in the courtroom.
He ran off from his group the next month, and eventually called his mother from a police lockup. He’d been arrested for shoplifting. When he was released again Dec. 7, 2011, there was a sliver of hope: His public defender had assigned him to an ACT team -- a group that would take charge of trying to ensure he received outpatient treatment.
Mahdi still refused to take his medication, and the ACT team didn’t seek a court order to require him to, despite Georgia’s law. Malone, the team’s supervisor, said she didn’t know about such court orders. Mahdi’s ACT team was part of Assertive Community Recovery LLC, a Stone Mountain, Georgia, company that works with the state. Ann Brown, the company’s director, didn’t return telephone messages seeking comment.
It’s not unusual for people in mental health and the justice system to be unfamiliar with outpatient-commitment laws, said Clarke County Probate Judge Susan Tate.
“I daresay in many counties, maybe some whole regions, there are never any petitions filed,” said Tate, who said she rules on about a half-dozen such requests each year.
Social workers “do their damndest” to avoid court orders, said Maureen Mayer, who works on an ACT team with a different company, Renaissance Counseling Services in Decatur, Georgia. She wasn’t involved in Mahdi’s case.
“It’s not what our job is,” she said. “Our job is to help people cope with life on life’s terms. If they fall flat on their face, they fall flat on their face but it’s still their choice.”
For Mahdi, it was back to jail in March 2012 for violating his probation. Among other things, he threatened to kill his brother, his mother said. By April, with his release imminent, Rabia made one final plea in an e-mail to Judge John C. Carbo and 11 other officials to help her son get long-term treatment with proper medication.
On May 14, Carbo released him. The judge didn’t respond to two e-mailed requests for comment. His law clerk, Jennifer Caldwell, said the judge had to release Mahdi because he’d served the maximum sentence of two years -- either in jail or on probation -- on the 2010 charges of indecency and sexual battery.
The court’s authority was at an end and there was no way for the judge to impose further conditions, such as assigning an ACT team, Caldwell said.
With few other options, Rabia helped her son move into an extended-stay hotel in Jonesboro. As she drove him from jail, she was overwhelmed, she recalls.
“I thought to myself I can’t do this all my life ’cause I’m going to die,” she said.
She improvised, falsely telling Mahdi he needed to see a psychiatrist to restart the disability checks that stop whenever he’s in jail. The doctor wrote him a four-month prescription for Risperdal. It was never filled.
June 2 was hot and Sherri Faye Bill was suspicious. She spied the stranger in a lawn chair at the pool of her apartment complex, Magnolia Woods, in Morrow, Georgia. He was wearing jeans and a hoodie. “Damn!” she remembered thinking. “It’s 100 degrees and the boy’s dressed like that?”
He went into the nearby laundry room, emerging moments later in nothing but white boxers. A quick dip in the pool, and he began to masturbate, his eyes trained on a woman playing with her child, Bill remembered in an interview.
She called 911. Fearing the stranger would leave before the police arrived, she walked toward him.
“Hey!” she shouted. He turned and she snapped his picture. His eyes like cold black marbles, he disappeared down a path. Police later identified him as Mahdi.
The next day, Cindy Rogers, 34, was walking home from work at Folks Southern Kitchen, a family restaurant on busy Tara Boulevard. She was halfway to her house when she noticed a stranger.
“He’d be behind me for a little while then he’d run up beside me and say, excuse me, you got a cigarette? And I’d say no,” she recalled.
She turned off the main road. He appeared again and pinned her against his body and began beating her on the right side of her head, she said. Less than 100 yards from home, she screamed. No one came.
“He kept beating me and I’m screaming, screaming, screaming and he’s like shut up, shut up, shut up, and he was like I’m going to rape you,” she remembered. He pulled her to the ground, ripped open her shirt and pulled down her pants.
“Give me your damn cell phone because I know you’re going to call the cops,” he said.
Rogers refused. He groped and pushed until finally he just stopped and stood. “If I find out that you’ve called the police I’ll come back and finish what I started.”
Her collarbone was broken. Blood streamed from her right ear where he ripped off an earring. An ambulance took her to Piedmont Henry Hospital in nearby Stockbridge. Days later, she picked out her assailant from a photo lineup: Mahdi.
Two days after that attack, on June 5, Mahdi showed up again at the same apartment complex, Magnolia Woods, according to a police warrant. He told a woman in the rental office he wanted to see an apartment. She took him to vacant unit D-9.
Mahdi punched her, fracturing an eye socket, and raped her twice, before forcing her into a closet and barricading the door with a dresser, according to the warrant.
A maintenance man confronted Mahdi on his way out and chased him into the woods, according to the police warrant. Standing on her back porch, Sherri Faye Bill, who had taken the photograph days earlier, recognized Mahdi. “I screamed, ‘Oh my God that’s him!’” she said in an interview.
He was apprehended a short time later and confessed, according to the warrant.
“I’m pleading not guilty,” Mahdi says of the rape charges in an interview from Central State Hospital in Milledgeville.
“The girl, she knew what we was getting into before we went there, and once we got into it, I made a comment about how she smelled. She got offended and we got into an altercation,” he said.
His denials come sprinkled between the bizarre. He communicates telepathically with Rihanna, Beyonce and other musical performers, he says. He’s conceived children since “the day I was born,” six each day until 1998.
His next scheduled court date is in January, according to the court’s website. He could be found insane at the time of the crimes and sentenced to a state hospital. His mother, Rabia, said she hopes for the best but isn’t encouraged.
“There’s such a break in knowledge,” she said. “They don’t know. Even the police, the social workers. They don’t know the law. So many people who are hands-on with the mentally ill don’t even know what they can do.”
To contact the reporter on this story: Tom Moroney in Boston at firstname.lastname@example.org
To contact the editor responsible for this story: Gary Putka at email@example.com