Review: Couple Found Slain: After a Family Murder

Couple Found Slain: After a Family Murder by Mikita Brottman
My rating: 4 of 5 stars

This true crime, non-fiction account of the forensic mental health system over several decades was incredibly accurate and disturbing. This is the story of Brian Bechtold, a 22-year-old man who wandered into a police department in Port St. Joe, Florida and confessed to killing both of his parents. This crime was occurred in Maryland where the family was living and therefore Brian was arrested and tried in Maryland. He was found guilty by reason of insanity or what was called "not criminally responsible". He was sentenced to "treatment and incarceration" in a state mental facility for the "criminally insane". The system at the time was one of maximum security with step down units based on good behavior. A problem with this approach is that it is incredibly subjective. In addition to this, there is very little true review of a case. In other words, the history and documentation that is in place from the beginning remains an active part of the chart throughout the sentence. When new doctors and nurses assume care for the individual, they often adopt the previous diagnoses rather than "start over" and formulate their own diagnosis. Therefore, Brian, who was highly intelligent and educated, was stuck in a monotonous loop of mediocre or poor treatment and lack of new ideas.
From my personal experience having worked in the forensic unit of a psychiatric state hospital, I can absolutely see both sides of this situation. From the caregiver side, it would be difficult to have the resources and time to fully review and rediagnose every person you care for when taking over from a previous provider. In addition, resources for treatment options are limited as is staffing. This can lead to less than stellar care. However, I can absolutely see that the person who is admitted to a facility may feel as though they have done everything right after they are admitted and yet are no closer to discharge and feel like there is no hope.
I believe that the other issue is that mental healthcare has gone to a rehabilitation model, where the expectation, on both sides, is for functional improvement and ultimately the ability to resume as normal a life as possible. The ability to control impulses and take care of activities of daily living is a goal that may be obtainable or not. The decision that someone is at risk to themselves or others is a vital consideration as well. I have seen people who do rehabilitate and can be safely discharged to a forensic group home and then some do return to their homes. I have also seen the opposite situation, where the mental health issue is intractable and the likelihood of fully returning to society outside of a psychiatric institution is low.
This book brings up some excellent points and was a great read. I was allowed an early release of the audiobook. I flew through it, knowing many of the places and the situations. It gives a fantastic look at how this system works, or doesn't work, and is highly worth the time. The narrator, Christina Delaine, did a great job with this as well.
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