Paragraph 47 reads: "But she did not tell them she had felt suicidal in Hartford. Neither did she speak to them about her medications, which had become more complex - in July, after the funeral, a family member found in her purse prescription bottles of two antidepressants, Prozac and Desyrel, one antipsychotic, Zyprexa, and a sleep medication, Ambien. Not until after her death did they hear the names of her medicines. They couldn't do what families routinely do to care for mentally ill loved ones: Make sure they take their medication every day, and watch closely to see if their behavior changes, always prepared to contact a psychiatrist if something seems to be going wrong."

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A MOTHER'S DEADLY STRUGGLE FOR HER SANITY

Boston Globe, The (MA) - January 5, 2003
Author: Ellen Barry, Globe Staff

A s she neared her 35th birthday, LaVeta Jackson tried to lift her spirits, writing notes to herself in her graceful, schoolteacher handwriting: "You're going to be 35 in less than 30 days," wrote Jackson, a single mother living in Mattapan. "Do something special." In a careful column, she listed her goals.

God first

Bills paid off

100-pound weight loss

Read at least 1 novel a month

Get your files organized

Come up with a daily schedule

from waking up to going to bed

But she was already in deep forest, and it was getting deeper. On a July afternoon in 2002, a man descended into a stuffy basement and found Jackson sitting on a blanket, marked with self-inflicted stab wounds, beside the bodies of her 3-year-old son and 6-year-old daughter.

She had slit both of their throats with a kitchen knife. Minutes later, she was shot to death by three police officers who described a woman leaping out of the darkness brandishing the knife and covered in blood.

Six months after she died, the story of Jackson's mental illness and treatment has never been pieced together, even for the relatives who live in the house where it happened. It wasn't that she didn't get care: During the year before she killed her children, Jackson had come under the supervision of two well-meaning families, two psychiatric hospitals, two state agencies, psychiatrists, therapists, and social workers.

A Globe investigation of all available information about Jackson's case suggests that the problem was not a lack of services, but a system that erects walls between doctors, state agencies, and caregivers in the community. In the earliest stage of her psychiatric treatment, Jackson bounced from doctor to doctor, shouldering the responsibility of taking an antipsychotic medication that made her miserable. Ashamed, or proud, or wary, she kept all details of her treatment from the relatives of her ex-boyfriend - the closest thing she had to an extended family in Boston. When those relatives tried to ask medical personnel about her illness, they were met repeatedly with silence and a recital of medical confidentiality laws. Finally, her caregivers themselves had poor lines of communication, so that none had a complete picture of her decline - and the responsibility dissipated into the space between agencies.

"The question this raises for all of us is, who was clinically in charge of the care and treatment of LaVeta Jackson?" said Marylou Sudders, the outgoing commissioner of the Department of Mental Health.

In the end, the one person who was fully responsible for her care was the person least able to handle that responsibility. For all the help she got, and all the people watching out for her, no one knew the full picture of what was happening to LaVeta Jackson except LaVeta Jackson.

An on-and-off relationship

At 34, Jackson was tinkering with her resume and daydreaming, a close friend said, about establishing a Web site selling "big ladies' lingerie." Raised outside Hartford by a single mother, she had moved to Boston in the early 1980s to attend Chamberlayne Junior College, a plan that was interrupted by her first pregnancy. By the year 2000, Jackson was caring for three children: her son Scott Murphy Jr., a bouncy 1-year-old; her 4-year-old daughter, Sydney, who wore tiny gold hoop earrings; and an 11-year-old son from an earlier relationship.

She had an on-and-off relationship with the father of Scotty and Sydney, an occasional construction worker named Scott Murphy. But with her own family two hours away in Connecticut, she had been absorbed into Murphy's warm, prosperous clan - his aunt Mable, his half-sister Michele, and his mother, Vera.

Friends thought of her as, above all, gentle: "Miss LVJ," as her friend Hermina Cooper affectionately put it, was a mother so attentive that she once snapped at Cooper for wiping Scotty's face with a dishrag. ("I said, `Girl, I'm from the South. We wash him with anything we can get him with,' " Cooper snapped back.) LaVeta was a closet smoker of Newport Lights and so tenderhearted that she wept with regret when she accidentally insulted an officemate. Insecurity nagged at her: Embarassed that neither of the boyfriends who fathered her children had wanted to marry her, she ordered a gold ring off the Home Shopping Network and wore it to work like a wedding ring, friends said.

"All LaVeta wanted in this life was a husband and her kids and a house," said Cooper, who worked with her at Cablevision in the late 1990s.

At home, where Scott Murphy came and went intermittently, her life was moving further from that ideal. Police records describe a relationship that had become turbulent and abusive; in 1997 and 1999, Murphy - who is 6 feet 5 inches tall and 300 pounds - was charged with family abuse after three separate altercations with Jackson, once when she was seven months' pregnant with Scott Jr. After little Scotty was born, she quit her job because she could not get a pay raise and more flexible hours, Cooper said. Suddenly, she was a single mom looking for a job. But she kept her troubles to herself, Cooper said.

"LaVeta always told me, `People tell you what they want you to know,' " Cooper said. "She told me, `You won't know if I'm happy or sad.' "

In the last job she had, during the spring of 2000, her sensitivity curdled into paranoia. She began to read secret messages in innocuous lettering and see innuendo in pieces of mail. At work, entering data at the Harvard University Health Services, Jackson was so sure co-workers were talking about her that, said her supervisor, Marjorie Fisher, "no amount of reassurance . . . could ease her mind." Although Jackson was "a very, very capable employee," the distraction was so extreme that Fisher fired her after two months.

The fears proliferated through that last summer. Jackson told friends that the upstairs neighbors toyed with her water supply, so the water was too hot for her children when she bathed them, and that someone had tapped her telephone line. When she left the apartment on Cummins Highway in the morning, she would turn on a tape recorder to capture sounds of the intruders she was certain were "walking in and changing things around," according to relatives; Scott's half-sister Michele Slade, a soft-spoken accountant, remembers a strange evening when Jackson brought the cassette tapes over and asked family members to listen to them. Increasingly, she saw people following her.

Put together, these episodes look like clear indicators of mental illness. But at the time, the signs were anything but clear. As state officials would later point out, looking at a single mother with legitimate concerns about violence, it was hard to know which fears were unreasonable - and as a close friend said, low-rent apartments do have thin walls and nosy neighbors. Fearful of night intruders, Jackson had stopped sleeping in her bedroom and spent nights on the couch, with a long-bladed kitchen knife tucked between the cushions.

By the spring of 2001, she had begun to act more erratically. Overcome by terror, she would wake her sleepy children in the middle of the night and deliver them, half-dressed, to their grandmother's house. Once she took her kids to Logan Airport, trying to board a plane with vague plans and no money. She started talking about someone who wanted to kill her, even going to a police station to report it, Michele Slade said. On June 1, she got into an agitated state and told members of the Murphy family she was leaving town with the children. When they tried to prevent her from leaving, she broke her own car window with a brick.

A family member called 911, but when police arrived, they found a woman in control, Slade said.

"When they came, she stopped everything she was doing," Slade said. "They asked what was going on. She looked at me, she was as normal as ever. She said, `I don't know what she's talking about.' "

In the maze of the system

Doctors found an answer in the form of medication. On the June day when she broke the car window, police delivered Jackson to the emergency room at Beth Israel Deaconess Medical Center - where she tried to run out of the hospital, requiring staff to put her in four-point mechanical restraints, according to hospital records provided to the Globe by her family.

The medication was Risperdal, an antipsychotic frequently prescribed for the symptoms of schizophrenia, and Jackson didn't like it. LaVeta had always resisted taking medicine - her sister, Tish Jackson, remembered having to restrain her for allergy shots when she was a child. When Tish visited the hospital from Hartford, LaVeta was storing tablets of Risperdal under her tongue, then crushing them inside window sills or hiding them, wrapped in tissue, in her bra. She begged her friend Cooper to help her escape the hospital, and Cooper was sympathetic. "What I started attributing it to was the medication," Cooper said. "In the beginning, there was nothing wrong with LaVeta, nothing."

After two weeks on Risperdal, Jackson was behaving normally enough for Beth Israel Deaconess to release her, deeming her no danger to herself or others. Before releasing her though, the hospital informed the state Department of Social Services about her crisis, and the department sent a worker to determine whether Jackson was a fit parent. Vera Murphy sat with Jackson as the worker asked if she would sign a paper promising that she would take the medication. Jackson was ready to agree, but then she hesitated.

"No; this is my body. Nobody can make me do anything with my body," she said, recalled Murphy and her daughter, who was also present. Jackson crossed her signature out with stabbing strokes of the pen.

That decision flipped a switch in the system. Based on her refusal, DSS approached a family court judge on June 14, arguing that Jackson's children were "in danger as a result of her paranoia. Mother refuses to take her medication prescribed to alleviate psychoses, and this results in her behaving in erratic ways. . . . The patient's five-year-old daughter reportedly told her grandparents that the patient sleeps with a knife under her bed because of paranoid feelings." The children were placed in the custody of Scott's half-sister, Michele.

For Jackson, the loss felt catastrophic. Days later, she was back at Beth Israel Deaconess, again brought by the Murphy family, according to the hospital record:

"She, on initial intake interview, believed that she was afraid of something but she would not reveal the nature of this fear or its contents," read the hospital discharge papers, which drew on the accounts of Scott Murphy's family. "In a state of fear and anxiety the patient flew to New York to visit a friend. She lost all of her money at LaGuardia airport under uncertain circumstances. She tried to buy plane tickets from airline companies to reportedly go to Bermuda or Florida. The airline company would not allow her to buy a ticket nor board any airplane because of the odd erratic behavior she was displaying in the airport."

The doctors took her case seriously, and another switch was flipped. The state of Massachusetts grants its citizens the right to refuse antipsychotic medication up to a point, and then those rights are stripped: In a guardianship hearing, hospital personnel must argue their case before a district judge, proving that a patient is "not capable of making informed decisions" about his or her treatment. On July 5, a judge came to this conclusion about Jackson, granting her doctors a six-month monitoring period.

In the end, the hospital kept her for more than a month - an extraordinary duration in the age of managed care. With the right to force treatment, Jackson's doctors opted for an older antipsychotic, Haldol, presumably because it could be injected into her muscles, giving Jackson no option but to take it. The medication worked: "She was noted to be less guarded, less suspicious and more open with staff and peers," the hospital's discharge papers read. "She gained moderate insight into her illness and the need for treatment medication." Her diagnosis was "psychosis not otherwise specified," meaning she had hallucinations and delusional thinking, but did not yet meet the criteria for major mental illnesses, such as schizophrenia and bipolar disorder.

On July 19, Jackson was released into the custody of her mother, Ava Marie Lyle, who lives in Hartford. Among her papers were instructions for a bewildering new life. From her new medications, they said, she could expect to experience any or all of the following side effects: weight gain, blurred vision, drowsiness, shuffling walk and jerky movements of the head, face and neck. She had been given an "Emotion Regulation Handout" that suggested that she "do what [she was] afraid of doing over and over again"; a "Discharge Care Plan" advised her to "notify your doctor if: depressed, suicidal." Her next Haldol shot was due to come from Dr. Angelo Carrabba, a gynecologist who employed Mrs. Lyle as a medical technician.

But the follow-up plan apparently did not go as planned. It was a matter of weeks before LaVeta Jackson found a hunting knife. She was back in the hospital for a third time.

A long masking

The day an ambulance came to get her at her mother's Hartford apartment, Jackson seemed to understand the dangers inside her.

It was early September 2001, and she had been in Connecticut for about a month when she confessed to family members that she had found a knife in her stepfather's car and she felt like killing herself. Already, she had "threatened herself plenty of times," said her sister, Tish. "She said she was going to run in front of a bus." She was asking for help, they say: Rosa Valdez, who lives with Jackson's sister in Hartford, remembers waiting for the ambulance while Jackson lay on a couch, almost motionless. She whispered that she was glad they were coming for her, Valdez said. Jackson spent about a week in the Institute of Living, a psychiatric hospital in Hartford.

But as she improved, she told the people around her less and less about her illness.

As Christmas approached, she moved back to Boston suddenly, without getting medical referrals and without even telling her sister, Tish Jackson said. With her Mattapan apartment gone, she asked if she could stay with her ex-boyfriend's relatives - his half-sister Michele Slade, who had temporary custody of Scott and Sydney, and his mother, Vera. The family took her in willingly, and even helped her to find a counselor. They thought she had recovered.

There was no discussion of danger. Vera Murphy even remembers laughing with Jackson when she looked back on things that she did when she was sick, like dash into houses to escape imaginary enemies. She remembers long conversations the two of them had during the trial of Andrea Yates, the Texas mother who drowned her five children.

"I told her, you'll probably end up like the lady down in Texas who killed her children," Murphy said. "She said, `Nothing could make me do that . . . She said, `No, no, no.' "

But she did not tell them she had felt suicidal in Hartford. Neither did she speak to them about her medications, which had become more complex - in July, after the funeral, a family member found in her purse prescription bottles of two antidepressants, Prozac and Desyrel, one antipsychotic, Zyprexa, and a sleep medication, Ambien. Not until after her death did they hear the names of her medicines. They couldn't do what families routinely do to care for mentally ill loved ones: Make sure they take their medication every day, and watch closely to see if their behavior changes, always prepared to contact a psychiatrist if something seems to be going wrong.

In fact, there were laws that allowed her to keep her treatment to herself. Every time Scott's relatives asked medical personnel about her mental condition - at Beth Israel Deaconess and later at Dimock Community Health Center - they had been told the information was confidential. As far as they knew, Jackson's problem was that she was "moody," said Slade, who allowed Jackson and her children to live in her house. It did not occur to them to monitor her medication.

"The whole time she was living with me, I never saw her take a pill," she said.

Jackson was not the only one who held back medical information. In the spring, when Jackson appealed for custody of her children, DSS began to investigate her mental state, contacting her past caregivers: Aside from the six weeks she spent at Beth Israel Deaconess, she was seen regularly at Hartford Behavioral Health, a nonprofit clinic funded by the Connecticut Department of Mental Health and Substance Abuse. And for the six months after she returned to Boston, she had weekly therapy at the Dimock Community Health Center. DSS was assured that Jackson was keeping her appointments, taking her medication, and "lacked homicidal or suicidal ideation," said Harry Spence, commissioner of the Department of Social Services.

But in the investigation, a key fact never came to light, according to Spence - DSS never knew Jackson had been hospitalized a third time, or that she had threatened her own life. The only reference to that incident, he said, was a "cryptic reference" on handwritten discharge notes from the Institute of Living that Jackson herself had supplied. "We didn't know it," he said. "Certainly it would have added a cautionary note that was not there for us."

Spokespeople for Hartford Behavioral Health, Dimock, Beth Israel Deaconess, and the Institute of Living declined to comment to the Globe on any aspect of Jackson's case, saying confidentiality laws prohibited them.

On June 4, confident that Jackson's mental state was stable, DSS closed the case and returned the custody of Scott and Sydney Murphy to their mother.

Until toxicology tests are completed, it will be unclear whether Jackson stopped taking her medications after that, or whether they had been suddenly changed, as she told Scott's relatives. For her part, Tish Jackson speculates that her sister stopped taking her pills as soon as she had what she wanted: "They drilled it into her head, you take your medications and we'll give your kids back," she said.

Whatever the reason, Jackson changed faster than anyone could have imagined.

In the weeks before her death, she had become painfully self-conscious about a new set of side effects: Her beautiful, luminous skin suddenly turned spotty and rough; she gained so much weight that she was ashamed to see her mother and sister in Hartford. After an upsetting visit, during which she got into a fistfight with Tish, LaVeta Jackson seemed to drop down a well: She slept during the day, openly chain-smoked Newports, stopped eating. She began to walk around Michele Slade's house with a scarf around her neck, complaining of stiffness, Slade said. She was vacant, wordless, stared straight through people.

When Vera Murphy asked about her strange behavior, she said it was a new medication. Murphy remembers her saying: "I've got so I can't even think. My mind's running away with me. I got so I can't sleep."

Mable Graham, the 74-year-old matriarch and problem-solver-in-chief of the Murphy family, took matters into her own hands. Graham's knowledge of mental illness was patchy, but better than many of those around her; 25 years ago, after moving to Boston from North Carolina, she received training as an auxiliary police officer and learned, as she puts it, the three types of mentally ill people: Those who sit and stare; those who kill themselves; and those who kill other people. And long experience had taught her that psychiatrists could pose a danger to the civil rights of black people - once, she urged an ill sister-in-law to drive all night from North Carolina to Boston for psychiatric care, because "people in the South, if you have a nervous breakdown, that was the end of you."

With Graham as her advocate, Jackson's final interactions with the mental health system ticked away one by one. A week before the murder , Graham made a call to Jackson's therapist at Dimock to alert her to the strange new behavior. She was told that Jackson's case was confidential, and was offered a contact number for the Boston Emergency Services Team, a mobile psychiatric emergency unit, Graham said. Not realizing Jackson was dangerous, Graham didn't call.

Five days before the murder , Jackson's DSS caseworker visited for the last time to say goodbye before leaving Boston, Slade said.

Four days before the murders , on Friday, Graham walked with Jackson into Beth Israel Deaconess Medical Center. The two women were directed to the psychiatric ward and told that her former psychiatrist was no longer practicing there, but they were allowed to leave a message for another doctor, Graham said. Jackson refused to go to the emergency room. "I said, `LaVeta needs help. I said, `Give her a shot. Just give her a shot,' " Graham said.

The two women then went back home. There, Jackson dipped into the same dark silence.

Six-year-old Sydney knew something was wrong, said Slade. She would look up at her mother, asking, "Are you thinking again, Mama?"

`I didn't do nothing'

She was thinking. The night before she killed her children, Jackson asked Mable Graham to drive her to Wal-Mart, where, Graham now believes, she bought a large bottle of cough syrup.

These are the details that Graham goes over and over these days, sitting in her kitchen over cups of tea. The wailing and the falling of mourners are finished in her house now, replaced by a ceaseless repetition of details. Jackson had begun to clutch her children even closer, so that relatives had to persuade Jackson to allow them to leave the house for a street fair.

Now, when she remembers the peculiarities of that Monday, Graham shakes her head slowly. How Jackson left Wal-Mart with the cough syrup and told Graham to pick her up for a therapy appointment at 10:30. How she said, "I'll need some help with little Scotty in the morning." How she left $6 - probably the last money she had - balled up on the seat of Graham's car.

The rest is known in snapshots. At 7:30 in the morning, Michele Slade passed by Jackson's room, and noticed something odd: Jackson and her children were all sleeping in the same small bed. Slade moved to prepare strawberry milk for Scotty, as she did every morning, but Jackson said, from the bed, that she had already given it to him. Slade peered down at the child and noticed another strange thing: normally chirpy, he was so groggy he could barely raise his head.

Jackson asked Slade if anyone was home, and Slade said she wasn't sure. It was the last thing she said before she left for work.

We know that Jackson took her children - Slade believes she carried them, drugged with the cough medicine - out the kitchen door and into the basement.

Donald Moore, Slade's boyfriend, is a meat manager at Stop 'n' Shop and still bears the faint accent of the North Carolina farm where he grew up. He can describe the scene in the basement so calmly, he figures, because he "cuts meat for a living." He climbed down the winding stairs into the basement at a few minutes before 4. She was sitting on a blanket that had been spread on the concrete floor, with a kitchen knife in her hand, he said. The children were lying behind her, their throats cut. There was very little blood.

As far as Moore could tell, she had been there all day - he suspects she spent the day trying to kill herself. She had filled a sink with water, Moore said, and placed an electric carpet shampooer in it, and plugged it in, but the water apparently kept draining out of the sink. She had stabbed herself in the side with the knife, but "I don't think anyone could kill themselves that way," he said. When he walked in, she looked up at him strangely.

"I didn't do nothing," she said, when he asked her what she had done. He climbed the stairs and called the police, and when they arrived, they stood at the top of the stairs, hollering out: "Police coming down, police coming down." When they reached the bottom of the stairs, she appeared, wielding a knife, police have said. The officers opened fire, fatally injuring her. Upstairs, Moore listened as round after round of ammunition exploded in the basement.

"It sounded like a war," Moore said.

`You have to bare your soul'

Unlike Andrea Yates, LaVeta Jackson's crime never became a national news story, and the reactions stirred by it have been quiet ones: At the funeral, where relatives waved fans and moaned in anguish, pastor Karen Bryant got cries of assent when she said only Satan could be at fault.

Scott Murphy, who would not comment for this article, is exploring a wrongful-death suit on behalf of his children against the psychiatrists who treated Jackson, and Jackson's sister is considering her own legal action. Scott's Aunt Mable thinks idly about returning to the reception desk at Beth Israel Deaconess and "making sure those three young ladies that sit at that desk be removed."

No public agency has found wrongdoing in the case. Last week, the Police Department completed its internal investigation of Jackson's shooting, said David Meier, chief of the homicide unit at the Suffolk district attorney's office. The office will review the investigation and decide whether the shooting should be investigated by a grand jury, which has the authority to issue criminal charges. Within five to seven weeks, special toxicology tests will determine whether LaVeta Jackson was taking her medication at the time of her death, Meier said.

In November, Spence, the DSS commissioner, announced that an internal review board found the social worker had not made any errors, since she had relied on the testimony of psychiatrists. In an interview, he said he was grateful that neither Jackson nor any caregiver had been scapegoated after the three deaths.

"Could LaVeta Jackson's case have been averted if, if, if . . . Those ifs could go all the way to the federal government," he said. "It is important to acknowledge the existence of tragedy."

But to relatives of LaVeta Jackson and her children, this is not a satisfying conclusion.

Thirty years after America's leaders began a great push to empty mental institutions, their frustration should stand as a warning. Centuries ago, a patient such as Jackson would likely have been cared for in the same small community where she became ill. Fifty years ago, the same patient would likely have been sedated and locked away for many years in a crowded state hospital. Today, the mental health care system treats seriously mentally ill people with the optimism that arrived with modern antipsychotic medications - once a patient has been stabilized on medication, the hope is, she can be allowed to return to a normal life.

There is one problem with that: Once released from the hospital, LaVeta Jackson found herself too often alone with the burden of her illness. Alone to gain weight, to sprout blemishes, to develop tremors and tics, to face old parking tickets and calls from a bill collector, to watch her 3-year-old bond with another woman, and finally, to apply for Section 8 housing supplements and disability payments and food stamps and to coordinate her own medical care.

This is a difficult task for the most able person; for Jackson, it was impossible, said Sudders.

"She got good pieces of care," the mental health commissioner said. "There were pockets of really excellent care. But who was clinically in charge to make sure that all these pieces came together and the family caring for her was involved and her kids got good services? Basically, we said she is responsible for her care. A good treatment requires a strong alliance. It should not be a singular responsibility on one person. It should be a shared responsibility."

"When something this awful happens, you have to stop and literally rethink everything you do," Sudders said. "When LaVeta Jackson kills her children and then is killed, you have to bare your soul and examine yourself."

Charles Baker, health care adviser to Governor Mitt Romney, would not comment on the particulars of the Jackson case. But he said he sees it as "one of the fundamental challeges of the next few years" to gather together the diverse strands of a person's needs into a single, ongoing relationship, so that there are fewer botched handoffs, and fewer people lost in them.

LaVeta Jackson's friends and relatives knew she was not the kind of person who asked for the help she needed. On the day before she killed her children, Vera Murphy took her to the supermarket and offered to pay for groceries for her family. Knowing her children were hungry, Jackson wandered through aisles full of food with a wire shopping cart for half an hour and came back, miserably, with a single loaf of bread.

The same thing happened with the crowd of psychiatrists and social workers and counselors and outreach workers who got to know her during the last year of her life: In fact the helpers were there. Jackson wanted to get better, too. But they missed each other in the dark.

Ellen Barry can be reached at barry@globe.com.

SIDEBAR:
WARNING SIGNS
PLEASE REFER TO MICROFILM FOR CHART DATA.
Caption: PHOTO CHART

1. LaVeta Jackson, her son Scotty Jr., 3 (center), and daughter Sydney, 6, in a photo taken last March.
2. `JUST GIVE HER A SHOT' - Mable Graham, above, marched Jackson into a psychiatric ward four days before the murders , but they went home without seeing a doctor.
3. A COLD HOUSE - Michele Slade, who cared for Scott and Sydney during their mother's illness, tried to ignore Christmas this year. she has considered selling the house where all three died.
Edition: THIRD
Section: Metro/Region
Page: A1
Index Terms: MET; DEATH HEALTH CARE MENTAL NAME-JACKSON
Record Number: 0301050382
Copyright (c) 2003 Globe Newspaper Company
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A MOTHER'S DEADLY STRUGGLE FOR HER SANITY