Michael's story: Mentally ill man attacks his family after being deserted by Pa. health care

On Jan. 23, 2012, Michael McDaniel awoke at 5 a.m. in his family's poolroom and was overcome by misery on a scale that was unique even for him. He began to cry.

Michael was 30 years old and lived with his parents and grandmother in a sprawling, cedar-planked home on the wooded fringes of the Oley Valley, just east of Reading. That night, like many others in recent years, Michael had spent sitting on a worn recliner in the far corner of the family's poolroom. The room had become something of a refuge for Michael since the onset of schizophrenia: he was now spending 16 hours a day there, writing furiously in his journal or, just as often, staring at the room's white stucco wall and letting his mind draw shapes and people and angels and demons from its cracks and craters.

At 6 a.m., his tears drying against his dark beard, Michael's misery gave way to an idea. It was an idea that Michael had long contemplated but, for a variety of logistical and moral reasons, he had repeatedly dismissed. Today felt different: Michael hoisted his 6-foot-1 frame from his chair, tightened a black hoodie around his head and lumbered through the greenhouse that connected the poolroom with the rest of the house.

Michael entered the family's darkened lounge and found his mother sprawled on the couch, wrapped in a gold quilt, watching the morning news. Nina McDaniel's presence wasn't a surprise to Michael. As he had spent more and more time in the poolroom, Nina had taken to sleeping nearby to keep an eye on him.

Michael walked past her to the stairs and said "good morning" and she said "good morning" back. Nina, a 54-year-old with silver hair and wireframe glasses, felt uneasy; she had heard her son sleep little that night, which foreshadowed a day where he would scream and cry and laugh eerily to himself even more than usual. Still, at that moment, as he ascended the stairs of their split-level home, Nina assumed he was simply heading to the kitchen to grab a cup of coffee.

Once upstairs however, Michael didn't linger in the kitchen. He walked down a carpeted hallway and toward the bedroom of his 74-year-old Ukrainian grandmother. Helen Badulak's door was open, as it was every night because she, like her daughter Nina, suffered from claustrophobia.

Michael entered a spacious, hexagonal room: To his left, difficult to see in the dim light, were shelves of more than a thousand intricately painted eggs, a Ukrainian art form called Pysanky, of which Michael's grandmother was a grandmaster. To his right, Badulak slept upright in a full-size hospital bed; Badulak's health was poor, and it was because of chronic pain that she woke easily when she heard someone enter her room.

When she made out Michael's form in the gloom, she smiled at him. The pair had always been close: Since he was old enough to talk, Michael, like his older sister Krissy, had known her as "Baba," the Ukrainian word for grandmother.

But on this particular morning, Michael didn't smile back. His face was flat and his eyes were stony and he began speaking in a deep voice in a bizarre language that confused his grandmother. Michael then stepped toward her bed, brandished one of her metal walking canes, and struck her in the head with it. Badulak cried out and tried to stand up but her legs failed and she toppled to the floor.

As she lay, Michael hit her again and again in the head, continuing to speak in his strange language. Badulak raised her hands to shield herself but Michael continued undeterred: he beat her until her fingers broke and her white bed, the white walls, the white vaulted ceiling and the pallets of white-shelled eggs that Badulak had yet to paint were splattered with blood. Between blows, still muttering, Michael would occasionally stare off into the corner of Badulak's bedroom as if someone was standing there, spurring him on.

Eighty feet away, downstairs in the lounge, Nina heard nothing and, in the couple's bedroom, neither did Michael's father, Alan.

After several minutes, Michael stopped hitting his grandmother. Badulak, barely conscious, weakly asked Michael where his mother was. He told her she was dead. "They all are dead," he added. He then walked out of her room and into the garage to look for a sledgehammer.

...

Michael's family would ultimately survive the events of Jan. 23, 2012, but it would leave them deeply traumatized and even more disillusioned with Pennsylvania's mental health care system.

The McDaniel family believes that what happened on that day could have been avoided if Michael had received the help he needed when he needed it. While the failures of the system were multiple, the most glaring, perhaps, were those that occurred when Michael was in the depths of psychosis over the preceding five years.

On three different occasions, Michael's family had involuntarily committed him to a psychiatric ward but, each time, Michael was released a few days later, or a few weeks later, still deeply delusional and with poor follow-up care. On many more occasions, Michael exhibited behavior that equally scared or disturbed his family but they were told repeatedly that he didn't meet Pennsylvania's commitment criteria.

Michael McDaniel's story lies at the heart of one of the most contentious debates in the mental health care field. The McDaniel family, along with a subset of police officers, mental health care advocates, and correctional officers across the country, believe that states need to either rewrite their commitment laws - or be more willing to implement their existing laws - to make it easier to mandate that mentally ill people get treatment.

National scrutiny over the criteria for involuntary commitment has intensified in recent years in the wake of several high-profile mass-killings.

James Holmes, the 27-year old schizophrenic who shot and killed a dozen people in a movie theater in Colorado in 2012, made comments that disturbed his psychiatrist but she didn't believe met the state's standard for involuntary commitment. Jared Loughner, the schizophrenic man who shot U.S. Rep. Gabbie Giffords and killed six people in Arizona in 2011, was perceived to be mentally ill and possibly dangerous by officials at his college but they also never petitioned for an evaluation for involuntary commitment.

It was once easy - arguably far too easy - to involuntarily commit a person in America. In the first half of the 20th century, the standard for involuntary commitment was simply that a person be mentally ill and needed treatment - a threshold that was so low that there are stories of families who committed unwanted relatives.

That ease of commitment, and general concerns about poor conditions within state hospitals, came under intense scrutiny in the 1960s. As the Kennedy administration began a nationwide push to close state hospitals and treat people in the community with caseworkers and psychotropic drugs, states also began to reassess their eligibility criteria for involuntary commitment.

In 1964, Washington, D.C., was the first to change its laws so that a mentally ill person could only be committed if they were "gravely disabled" or posed an imminent threat to the safety of themselves or others. One by one, states adopted similar standards, largely based around a threshold of "dangerousness."

Among the states, however, Pennsylvania's new standard, established in 1976, remains one of the strictest in the nation. In order for a mentally ill person to be committed, according to the law, it must be reasonably probable that a mentally ill person's "death, serious bodily injury or serious physical debilitation will ensue within 30 days without treatment."

Many civil liberty groups and mental health advocates are content with that standard: They believe that forcing a person into a psychiatric ward is typically the most traumatic moment in their life and should only be done under extreme circumstances.

"We think the criteria are just fine," said Sue Walther, executive director of the Mental Health Association of Pennsylvania.

Walther believes that expanding community mental health services, like caseworkers and supervised housing, is the best way to improve care for mentally ill people because, ideally, they prevent a mentally ill people from spiraling into psychosis in the first place.

State funding for many of those services has been inadequate for decades and in recent years, as in Pennsylvania in 2012, has been slashed.

But critics, like the McDaniel family, say that while they empathetically support more caseworkers and more mental health housing, they believe one of the fundamental problems with Pennsylvania's mental health care system is that it can't treat seriously mentally ill people who don't want help.

According to researchers, about half of schizophrenics and 40 percent of people with bipolar disorder don't believe they are mentally ill, a condition known as "anosognosia" in the field.

Those individuals, like Michael in the prelude to 2012, have the right to refuse therapy and medication. A family's only recourse then, under the law, is to wait for their loved one to deteriorate to a point where they're either suicidal or dangerous so they can be hospitalized.

Krissy Schaeffer, Michael's sister, believes that defies logic. "Pretty much this regulation tells loved ones that, 'I'm sorry, but your husband must die or your brother must die, or your sister must die, or your mother must die, or your grandparents must die, before we can get your family member the treatment that they need,' " she said. "I mean, does that make sense?"

On July 14, 2007 at about 4 p.m., Michael called his parents with news that was difficult for them to understand.

Up until that month, Michael's life, while rough in patches, had seemingly found its groove. At 25 years of age, Michael lived in a farmhouse-turned-apartment owned by his grandmother at the top of the Oley Valley, just 10 minutes north of his family.

Here, he had fallen into a comfortable routine: From Monday to Sunday, at 3 a.m., Michael would roll his 200-pound body out of bed, jump into his white Honda Prelude, pack a glass pipe with marijuana, and then drive 10 minutes north to the Kutztown Tavern in downtown Kutztown. For eight hours, before the first barflies arrived at noon, Michael swept and scrubbed and wiped the grease off the bar's wooden stools. He made $1,850 a month and largely worked alone - just how he liked it.

But Michael's routine was disrupted that July. One day, while cleaning the tavern's basement dance floor, a co-worker - a relatively new employee in his 50s - noticed the peculiar way that Michael's head swayed from side to side as he worked. The movement was an impulsive habit that Michael had developed when he was just 5 months old and, through his school years, had proved the target of merciless teasing. Michael's co-worker continued in this tradition.

At school, either in his tiny hometown of Quakertown or his teenage years in the Oley Valley, Michael's defense - as his mother had always taught him - was to ignore the teasing and walk away.

But at the Kutztown Tavern, while Michael still walked away, his co-worker's words were less easy to ignore. Since graduation and the years he spent working largely alone on a pheasant farm, Michael found relief from the abuse. His co-workers never drew attention to his head bobbing and his friends - the handful of younger boys that he drank and smoked pot with - didn't either. So, on that morning, to hear his co-worker ridicule him, unleashed a torrent of painful memories.

When Michael got home to his apartment that night he fell into an obsessive depression. Over the next few days, he called his mother and repeatedly asked her why she didn't do more to seek medical help for his head bobbing.

Nina tried to explain that she did seek help; that a neurologist studied Michael when he was 6 years old and concluded there was nothing wrong with him and that he would likely outgrow the habit, just as a child might with thumb sucking. But the explanation only angered Michael. He accused her of giving him brain damage.

The calls continued for two weeks until July 14 when Nina and Alan received a call from Michael that even they didn't expect. Michael told them he wanted to kill himself.

...

Michael's parents rushed to their son's apartment and on to Reading Hospital. He was seen be a social worker who prescribed him an antidepressant and then discharged him. But over the following days, Michael's condition didn't improve. He stopped going to work. He stopped leaving his apartment at all.

On July 22, Michael's sister, Krissy, and her husband, Billy Schaeffer, tried Michael's cellphone six times before he finally picked up. "I don't know what's wrong with me," he told her. As they talked, Michael mentioned that he hadn't eaten in five days. Krissy asked why and Michael explained that he planned to "wither away to nothing."

Krissy called Berks County's Crisis Intervention Team, a special response team that most counties in Pennsylvania have to handle emergency situations involving mentally ill people. The team helped her file a petition for involuntary commitment; Krissy argued that her brother's starvation posed a danger to himself.

A day later, on a gray morning, two police officers knocked at Michael's door, identified themselves, and led Michael to a waiting ambulance.

Watching from a distance, Krissy, Billy, and Nina found Michael's appearance barely recognizable: His black hair was wild, his face was grey, and his body looked sunken - as if someone had jabbed him with a giant syringe and sucked out 20 pounds. Tears streamed down Nina's face as they followed behind Michael's ambulance, its siren whining and its lights flashing.

Michael was committed to a psychiatric ward in Ephrata Community Hospital, about 20 miles southwest of Reading. The doctors attributed Michael's psychosis to his daily marijuana smoking - a habit he'd developed in his early 20s. On July 26, three days later, Michael was discharged to his parents.

Under Pennsylvania's involuntary commitment law, a hospital must release a person when they are no longer considered a danger to themselves or others and medical staff judge that person can be placed in the "the least restrictive" setting to achieve treatment.

Michael made an appointment with a mental health caseworker, as he was instructed by the hospital, but beyond that, Michael told his family nothing about his diagnosis.

Michael's family could also not get any information about his condition from the hospital because of privacy restrictions under the Health Insurance Portability and Accountability Act (HIPAA). With no information, the McDaniel family was left to hope that Michael's hospitalization and his first appointment with caseworker in two months time would ensure Michael was on the mend.

Michael would never make that appointment because, as soon as he returned to his apartment, he ignored his medication and descended into a deeper psychosis. He developed an obsessive infatuation with a married co-worker at the Kutztown Tavern.

One day, after hearing a song play on a local radio station, Michael interpreted it as a message from God to head to town and find her. The woman soon filed a restraining order against him and Michael was fired from the Kutztown Tavern.

Michael's family desperately tried to get help for Michael but, beyond pleading with him, there was no way to compel him to take his medication or see a doctor unless he chose to - and Michael had no interest in either. Eventually, as before, Michael stopped eating. He told a crisis intervention worker that he wanted to "die in the name of love" because his former coworker had spurned him. "I'm dead without her," he added.

On Aug 28, barely a month after his last hospitalization, Nina McDaniel filed a new petition for involuntary commitment and argued, as Krissy had, that Michael's starvation was a danger to himself.

Once admitted to the hospital, the degree of Michael's deterioration was on full display. He told medical staff that he thought he was god and, while watching television that afternoon in a waiting area, claimed responsibility for a series of car crashes that appeared on the screen. Michael got a new diagnosis: major depressive disorder with recurrent, severe psychotic features. He was released five days later.

Shortly after he was released from the hospital, Michael asked his parents if he could move in with them at his grandmother's cedar-planked home. Nina and Alan agreed, hoping that a change of scenery might make life easier for their son.

But Michael's mind was undergoing changes that couldn't be easily halted.

It was a bright summer day in 2008 when Michael's world took on new dimensions. Michael was cutting the 20-acre lawn at his former apartment, which was owned by his grandmother, as a favor to her.

It was then, sitting atop a John Deere mower, that he heard something just beneath the mower's diesel roar. Michael stopped and listened. It was the voice of one of his former neighbors - a heavyset, blond woman who used to talk openly to Michael about her depression.

Over the weeks that followed, the voice of Michael's former neighbor grew louder and was joined by other voices. He heard his mother, his father, and his sister; sometimes offering warnings, sometimes offering instructions, sometimes saying little more than "Mike" or "Michael."

Soon, sitting in his bedroom or his family's living room in the middle of the night, Michael heard wholly new voices: God, Satan and a succubus that Michael would come to call "Mohinee." The voices fascinated him. Michael secluded himself in his family's poolroom to listen to them more closely.

The voices were eventually joined by visual hallucinations. Michael started seeing orbs - red ones and blue ones and black ones - floating in hallways and tucked in corners of rooms.

They made him chuckle.

Meanwhile, he discovered that if he took his glasses off and stared at the white stucco wall in the poolroom, he could see translucent spiders - bigger than tarantulas - crawling across its surface. Other hallucinations came in time and Michael took all of them as affirmation that God and Satan were communicating with him.

His reverence for his hallucinations was such that, in November, upon the advice of the voices, Michael swallowed a random assortment of antidepressants and painkillers in Krissy's bathroom and he was rushed to the emergency room.

Michael's family were struggling to adjust to Michael's increasingly bizarre behavior. Michael was often awake at all hours of the night and constantly wore a pair of dark aviators, even when he slept.

His mood was often unpredictable and he would grow angry quickly. Michael's grandmother, who grew up in Ukraine in the midst of World War II, knew little about mental illness and had particular difficulty understanding what was happening to her grandson.

She was fearful she would say the wrong thing and upset him, so she spent most of her days secluded in her room, painting her beloved Pysanka eggs, and making little more than polite conversation with Michael at dinner. Alan, a global IT manager for a construction management firm in New Jersey, felt mounting stress during the day knowing that his son was deteriorating at home.

But no one experienced the toll of Michael's transformation quite like Michael's mother.

Nina was her mother's sole caretaker and spent most of her days at home in close proximity to Michael. As his hallucinations mounted and his emotions became more unpredictable, Nina became his verbal punching bag: he yelled at her frequently, blaming him for his mental illness and his side-to-side bobbing.

He also told her things that were seemingly designed to disturb her, like the time he told her he had envisioned her body swinging from a noose in the poolroom.

At the same time, Michael was extremely aloof. When Nina first heard him screaming or crying in the poolroom, Nina would run to her son and ask him what was wrong. But, every time, Michael would tell her, "Don't worry about it."

Those words became a daily catch-cry and somehow epitomized for Nina just how much her son had changed. Michael was no longer the boy she knew - the happy-go-lucky child with the black mop of hair who preferred to play with the family's pots and pans than his own toys. He was someone else.

Despite her despair and frustration, Nina had little choice but to persevere. With a caseworker who only visited Michael briefly each month, with a family doctor that could do little but prescribe medication that he refused to take, and with weekly therapy visits that seemed to make no difference to his condition, Nina was all Michael had. She was, for better or worse, Michael's one-woman mental health team.

Which is why on Dec. 15, 2008, around 6 a.m., as Nina and her husband slept in their bedroom, she bolted awake when she heard a whimpering cry from Michael's bedroom.

Nina grabbed her glasses and ran to his door where, through a crack between the doorframe, she could see her son sobbing on his bed. Nina asked Michael what was wrong and he screamed back, "Leave me alone or I will kill you and dad."

Nina was chilled. Despite all the times she had been rebuffed or abused by Michael, it was the first that her son had threatened to harm her and Alan. Nina's nerves had already been rattled by an incident a few days earlier: Michael had woken her at 2 a.m. and asked where the family's guns were because, he told her at the time, "God wants to know where they are."

Nina called the crisis intervention team and Michael was taken to Reading Hospital that morning and involuntarily committed for the third time in his life. Nina cried in the waiting area. The accumulation of a year's worth of anguish and stress was now compounded by a new realization for her: She no longer felt safe living with her own son.

Inside the hospital, Michael initially downplayed his symptoms to medical staff. As a nurse asked him questions, Michael stared back at her through his black aviators and told her he didn't have visual or auditory hallucinations. He added that he had never said he wanted to harm his mother. On the contrary, he told the nurse, he believed his mother wanted to harm him.

While Michael was hospitalized, Nina tried to arrange for Michael to be transferred to county-funded housing for mentally ill people.

The program offered 24/7 supervision. But staff at Reading Hospital didn't believe that a residential treatment program was appropriate for Michael. They wanted instead for Michael to return to his family's home and partake in a program called Assertive Community Treatment, or ACT, which would mean he would be visited each week by a social worker and psychiatrist.

The hospital staff also told Nina that Michael's preference was to return home rather than go to a residential treatment program.

The hospital and the McDaniel family were at loggerheads, but as the days wore on, Nina and Alan were forced to relent. It became clear to the couple that the hospital would release Michael to a local homeless shelter if they didn't take him. So, on Jan 9, 2009, after 20 days of hospitalization, Michael's family reluctantly welcomed him back to their Oley Valley home.

Unknown to Nina or Alan however, their concerns may have had more validity than even they realized. In a psychological evaluation conducted by Dr. Anna Czipri, a psychology intern, and reviewed by Dr. Michael Magdalinski, a licensed psychologist, Czipri noted Michael's potential for dangerousness. The report concluded: "Mr. McDaniel currently experiences distressing hallucinations and delusions but has increased amounts of resistant to treatment. He also exhibits homicidal ideation towards his parents. He has extremely poor insight and minimizes both his homicidally and psychotic symptoms."

The report continued that the results of his psychological test "indicate a risk of dangerousness to others given his impaired ability to tolerate stress, difficulty modulating emotions, impaired reality testing and mistrust towards others." But that report, like all of Michael's federally protected medical records, was not shared with the McDaniel family.

...

Even without seeing Michael's psychological report, Nina and Alan were so nervous about their son's return home that they notified the Exeter Police Department that they were living with someone who had a serious mental illness.

Meanwhile, Nina began sleeping in the TV room, adjacent to the poolroom, so she could keep an eye on Michael's movements. And Alan, who continued to sleep in the couple's bedroom, began locking the door at night.

Michael, for his part, asked his parents to hide all the serrated knives in the house. Nina and Alan complied.

Two months after his release, Michael got his first visit from the ACT team - the intensive case management team arranged by Reading Hospital - but Nina and Alan found the program less intensive than they had imagined.

The team's social worker and psychiatrist visited Michael for only about five minutes each week, asked him whether he was taking his medication, asked him whether he was harboring dangerous thoughts, and then left.

After six months, to Nina and Alan's surprise, Michael was discharged from the ACT program because the team believed that his behavior was due to prior alcohol and marijuana use.

The program concluded that if Michael was still behaving strangely after six months, then it was likely Michael had a mental illness and he could rejoin the ACT program. Nina and Alan felt stranded.

As Michael's family felt that the community mental health system had abandoned them, they felt equally deserted by the hospital system. It was on Sept. 25, 2010, his grandmother's birthday, when Michael asked his parents to drive him to the hospital because he was feeling suicidal. "I have no purpose in life," he told them.

Michael was admitted to St Joseph Medical Center in Reading just before 11 a.m. but, after waiting 13 hours, he still hadn't been seen by a psychiatrist. In frustration, Michael approached the desk of the unit's intake coordinator and asked her if he could go outside to smoke a cigarette, but the woman told her he couldn't leave the hospital.

Michael became angry and knocked computer monitors off her desk. "I'm gonna snap!" he yelled.

The woman offered Michael a nicotine patch and medication to help him relax but he refused both. "I would rather be arrested," Michael told her, before threatening the hospital's security personnel. Just before midnight, police officers arrived and gave Michael a choice: calm down or leave. At 1 a.m., confused and emotionally exhausted, Nina and Alan picked up their son.

While Michael's condition had been precarious over the past five years, that September marked the beginning of a new downward spiral. That was no clearer than on Valentine's Day 2011. The day had started promisingly: Nina had convinced Michael, ever reclusive, to come out bowling with the family that evening. B

Soon after the game began, Michael retreated to the restroom and wouldn't leave. Nina persuaded Michael to come out and let her drive him home.

The pair winded their way back to Oley in the family's gold Chrysler Pacifica, sitting in silence, when Michael gently grabbed Nina's right hand from the steering wheel and placed it over his heart. "Mom," he said. "Please take a gun and shoot me." Michael explained that he now knew he didn't have the courage to kill himself. "You can do it," he said. "I just can't take it anymore - living like this."

As he spoke, tears welled up in Nina's eyes. Michael told her that he couldn't stand not knowing what was real and what wasn't anymore. "I don't know if you are real," he said. "I think I am living in a matrix."

When they arrived home, Nina immediately called the county's crisis intervention team. A woman in her late 20s arrived and Michael told her he didn't want to go to hospital. He spoke frankly with her, a rarity for him, and promised he would be more open about his feelings. Despite Nina's reservations, Michael convinced the crisis worker that he didn't need to be committed and she left.

Over the following days, however, Michael closed up completely: He spent longer and longer periods in the poolroom, stopped talking to his family, stopped coming to the table for dinner, and stopped watching television. When he did speak with his father or mother, he now called them by their first names, insisting that they weren't his real parents.

The screams from the poolroom became more frequent and increasingly pained - as if Michael was being tortured. The screams ripped Nina apart but, every time she ran to ask Michael what was wrong, he replied with his standard refrain: "Don't worry about it."

By this stage, Nina and Alan had completely lost what little faith they had in the commitment process. At age 29, Michael had been hospitalized, both voluntarily and involuntarily, six times, and he never seemed to be treated long enough to instill lasting change.

On more than 20 other occasions, by Nina's count, the family were told by crisis intervention staff that either it wasn't worth pushing for a commitment or that Michael didn't meet the criteria.

On Oct. 3, however, Michael exhibited behavior that even Nina and Alan, as jaded as they were, felt certain would meet the threshold for involuntary commitment.

That morning, Nina sat down to her computer to check her email account and found Michael had left his own account open. Her eyes were drawn to one of Michael's emails: "Bud's Gun Shop." Nina opened it.

The email read: "We welcome you to BudsGunShop.com. You can now take part in the various services we have to offer you." Nina checked the browser's history and found that Michael had also been looking at a website for another gun shop.

Because Michael had been involuntarily committed he would have failed a background check to purchase a firearm, but still, that he was trying to get one was alarming in itself.

When Michael awoke that morning, Nina and Alan called him into the family's office and sat in a circle around a desk. Michael absent-mindedly wrapped Scotch tape around index cards - the cards, covered in his handwriting, were part of Michael's ongoing documentation of his thoughts and the tape was intended as a sort of laminate.

The couple asked Michael about the email from Bud's Gun Shop and he explained that he needed a gun for protection because he believed someone was going to shoot him in the head. Alan and Nina told Michael that he didn't need a gun and that they could protect him - but Michael became enraged. He said that they didn't understand what was going on and that if they stood in his way he would "blow their heads off."

Nina called the county's crisis intervention team. Two police officers and a crisis intervention worker arrived. The police officers told the couple that they could file charges against Michael for terroristic threats - but Nina said they didn't want their son jailed. They wanted him treated.

Nina filled out an involuntary commitment petition and the police officers took Michael to St Joseph Medical Center at 11 a.m. Two hours later, to their disbelief, Nina and Alan received a call from Michael. The hospital had determined that their son didn't meet the commitment criteria and Michael asked for a ride home. His voice was casual, as if nothing had happened that day. Frustrated, and again frightened of their own son, Nina and Alan brought Michael home.

It would be two months later, a chilly winter morning, when the police would next receive a call from the McDaniel household.

It's not entirely clear why, on Jan 23, 2012, after beating his grandmother with her own metal cane, Michael told her he had killed his parents. Nina still lay on the couch downstairs, very much alive, and Alan still slept peacefully in the couple's bedroom.

Nevertheless, the effect on Badulak, lying in a bloody heap on her bedroom's beige carpet, was devastating: She no longer felt like living.

After their brief conversation, Michael exited Badulak's room and walked to the family's two-car garage to search for a sledgehammer or another weapon to continue his attack. He was frustrated that she wasn't dead.

But Michael struggled to find a new weapon in the garage. He searched for knives in the kitchen but also came up empty. After one more search of the garage he walked to his bedroom and called 911 from his cellphone. He calmly told a dispatcher that he had killed his grandmother and to "please send the police out to shoot me."

Meanwhile, back in his grandmother's bedroom, severely injured but still conscious, Badulak used her broken fingers to grab the dangling loop of her phone charger cable. She pulled her cellphone down from her nightstand and, only two minutes after Michael called 911, she placed her own call.

Speaking in a hurried whisper, Badulak told a different dispatcher that her grandson had killed his mother and father.

Badulak completed her call only moments before Michael reappeared in her doorway. He held a new metal cane and again struck Badulak in the head. By this point, numb with shock and adrenaline, Michael's grandmother could feel little.

She made a renewed attempt to communicate with her grandson. "I love you, Michael," Badulak cried. "Why are you hitting me?" Michael struck her again but Badulak kept pleading: "I love you, Michael. I love you." Michael struck her a third time and then, for whatever reason, walked out of the room.

Michael headed back downstairs towards the poolroom. On his way, he passed his mother again in the living room. He mumbled something to her and Nina caught the words "police" and "Baba."

Confused, Nina hurried to her bedroom to wake Alan up and then ran to her mother's bedroom. Nina entered a room that looked like something out of a horror film: it was drenched in blood. Next to the bed, her mother laid like a rag doll, motionless. Nina screamed.

Michael was sitting on his favorite worn chair, smoking a cigarette, a candle lit next to him, when he saw the flash of red and blue lights down the driveway. A dozen police officers, their guns drawn, circled the house.

Michael's plan, he would say later, was to charge at the officers so that they would shoot him - suicide by cop - but Michael changed his mind when he realized they had a police dog. He feared the German shepherd would maul him. Instead, Michael walked calmly onto the wooden porch outside the poolroom and, as the officers directed, he lay on the ground and was calmly arrested.

Badulak was rushed to the hospital and Nina and Alan were taken to the police station to make statements. The pair wouldn't see Michael again until they turned on their television that evening to watch the news on WFMZ, a local TV station.

Handcuffed, clad in a white jumpsuit, Michael was shown being led by a police officer into the Berks County Courthouse in Reading. As he walked, his head lolled from side-to-side and his eyes were listless - as if he were in a trance. Barely looking at the camera, Michael raised his middle finger in its direction.

Michael was charged with attempted homicide, attempted first-degree murder, aggravated assault, simple assault and harassment. Two days after the attack, Nina gave a teary-eyed interview to WFMZ. Her voice contorted in anguish, Nina told the reporter: "I'm being tortured right now because I love my mom and I love my son. I have to make the hardest decision of my life and that is my son will never be able to come back to our house."

...

Michael was so psychotic when he arrived in Berks County Prison that he was held in an isolation cell for 24 hours a day in his first few weeks. Like many seriously mentally ill people who are imprisoned in the nation's jails, isolation only further aggravated his psychosis. Michael spent most of those weeks crying, often slouched on his bed, his head bobbing back and forth so frequently that he would later earn the nickname "bobblehead" from other inmates.

He was prescribed psychiatric medication but refused to take it - his right as a prisoner - because, as he told Nina on her first visit, his walnut-brown eyes staring at her through the glass screen, "the voices in my head are souls and I will not hurt them with medication."

Michael spent most of Nina's visits to the prison yelling at her through that screen, his voice muffled through the vent beneath it. He repeatedly told his mother that he shouldn't be in prison, that his incarceration was a conspiracy, and that he didn't understand why the family was afraid of him.

After multiple visits, Nina worked up the courage to ask Michael why he attacked his grandmother. But his answer made little sense to her. Michael explained that when he woke up that morning, he was overcome with sadness and decided to kill himself by getting a gun from the family's safe - despite the fact that the family, as he should have been aware, had removed guns from the house a long time ago.

Michael continued: "As I went down the hallway to the safe, I thought that I will break everyone's necks and that would be a peaceful way of dying. Don't you think so, mom?" Michael stared at Nina and she felt frightened. The use of "mom" was particularly unnerving - it was the first time that Michael had called her "mom" instead of "Nina" in a year.

Uneasily, Nina answered her son. "I guess it would be peaceful if a person is asleep," she said. "But why would you need to kill us if your intention was to kill yourself?" Michael's eyes grew wide. "I told you," he yelled. "I wanted to kill myself and die. All of you would have stopped me. I cannot go through the rest of my life like this."

Michael was found incompetent to stand trial and, after 52 days in Berks County Prison, was transferred to Torrance State Hospital near Pittsburgh for what's known, in legal parlance, as "competency restoration." Michael spent two months at Torrance State Hospital, which marked the longest hospitalization of his life and his first in a state hospital rather than a psychiatric ward. When he returned to prison, Michael was significantly more stable; for the first time in more than a year he took his medication voluntarily.

Meanwhile, outside of prison, after five days in the hospital and several months of healing, Helen Badulak had regained her strength. Berks County's District Attorney's office urged her to testify against Michael but Badulak refused.

The office was particularly interested in the possibility that Michael tried to kill his grandmother so he could inherit her property. Badulak found the claim ridiculous and insulting after everything the family had been through. "Michael didn't do this to me," she recalled telling the attorneys. "The mental illness did."

Michael's trial was held on Aug 10, 2012, in the Berks County Courthouse in Reading. Michael's public defender, Richard Joyce, argued that Michael was legally insane at the time of the incident.

Dr. Larry Rotenberg, a forensic psychiatrist who had interviewed Michael shortly after the attack, testified in support. "He may have understood the nature of the quality of what he was doing but certainly did not understand what he was doing was wrong," he told the court.

Rotenberg submitted a report that went into greater detail. After reviewing his screeds of writing that McDaniel had written in the poolroom, Rotenberg wrote, "One can see the workings of a mind that is almost totally free of any sanity."

That afternoon, Judge Stephen Lieberman acquitted Michael on all charges and he was committed to Wernersville State Hospital. In his closing comments, Lieberman called the case a "tragedy."

He criticized the closure of state hospitals in Pennsylvania and other states since the 1970s and the underinvestment in community mental health services that were supposed to replace them. "It is an idea that seems to be working out a lot like communism," he said. "Looks great on paper but in practice it's leaving families of people that suffer from mental illness, and leaves the person themselves that suffer from mental illness, with virtually no resources and no help."

Due to a lack of free beds in Wernersville State Hospital, Michael waited a month longer in Berks County Prison before he could be transferred.

On a gray September afternoon in the suburbs of Reading, Michael McDaniel opened the door to his red brick home and welcomed me inside. "I'm going to put these on if it's all right with you," Michael told me as attached a pair of clip-on sunglasses over his spectacles. "Might be able to communicate better."

Michael wore black Nike sneakers and an oversized black T-shirt. He was now 35 years old and he had gained considerable weight since he first appeared on TV, nearly four years ago, in handcuffs and a white jumpsuit.

The weight gain was a side effect of Michael's antipsychotic medication, which boosted his hunger. As of September, he had been taking the medication for the longest continuous period in his life: beginning in prison, over the two years he spent in Wernersville State Hospital, and since his discharge in April back into the community.

The extra weight frustrated Michael - he was walking two miles a day to try and fight it off - but he had no intention of stopping his medication. He remains deeply remorseful about the attack on his grandmother and he still struggles to understand why he did what he did. His memories of that morning are blurry.

Michael now lives in a house with two other people with mental health issues - the same kind of housing that Michael's parents desperately wanted for their son in 2008. He's stabler and happier he has been in eight years. He proudly shows me his white-walled bedroom, immaculately clean, and a composition book full of his religious writings - a slightly more coherent continuation of his former poolroom ruminations on God, the soul, space, and Satan.

He talks to his mother over the phone each evening and visits his family every weekend in their new home in downtown Oley, an historic brick building that Alan and Nina are restoring and plan to open as a bed and breakfast.

The Sunday before Michael and I met, Michael gathered there in his grandmother's bedroom with Nina, Alan, Krissy and Billy to wish her a happy birthday.

But while the McDaniel family is proud of the progress that Michael has made they still struggle to understand why it took a tragedy to get the help he needed. "Why do those with a brain disorder have to commit a crime in order to get help and treatment?" Nina asked me.

Nina and Alan also believe that it's miraculous the incident wasn't worse than it already was. On that January morning, as Michael searched for a weapon in the garage, it's unclear to them how he didn't find one: a sledgehammer lay in plain sight on the back of the family's John Deere Gator - beside a hatchet for chopping firewood.

And, while Michael is doing better than he has in years, the costs of those years still linger for he and the McDaniel family.

Due to his increasing absences at work to take care of Michael, and the onset of Parkinson's disease, Alan, the family's sole breadwinner, was laid off in 2008. The family has struggled financially ever since. Meanwhile, while Badulak does not fear her grandson, she still wakes in terror on some evenings reliving the memory of that morning.

And Michael, although he was found not guilty by reason of insanity, it has still left him with a criminal record that haunts him. It was because of his attack on Badulak that the McDaniel family struggled to find a housing program that would take him from Wernersville State Hospital.

Because of their experiences, Nina and Alan have since dedicated their lives to advocating for improvements to the mental health care system. They now teach classes through the National Alliance on Mental Illness to help families navigate the system.

They have also become vocal supporters of legislative change: They would like more funding for community mental health services, like mental health housing, and they support changing Pennsylvania's involuntary commitment threshold to something broader than "dangerousness." They don't have an exact standard in mind but are open to those used in states like Wisconsin, which has one of the most flexible criteria in the nation. In Wisconsin, a mentally ill person can be committed if there appears to be a substantial probability that the person "needs care and treatment to prevent further disability or deterioration."

For that reason, Nina and Alan are staunch supporters of a bill introduced by U.S. Rep. Tim Murphy, R-Pittsburgh, Congress's only licensed psychologist. While Murphy's bill doesn't change the nation's involuntary inpatient commitment criteria, it encourages states to broaden their criteria beyond "dangerousness" in exchange for grant money.

Murphy's bill, which has 138 co-sponsors, also encourages states to adopt or expand "Assisted Outpatient Treatment," or "AOT," a program that legally mandates certain seriously mentally ill people - those who have a history of arrest or hospitalization for instance - to take medication or attend therapy.

Much like broadening the standard for involuntary inpatient commitment, AOT is controversial among some mental health advocates who consider it an attack on civil liberties. But Nina believes that had Michael been subject to AOT, it might have dramatically altered the course of his life and the fate of his grandmother. "We don't want other families going through what we're going through," Nina said.

The McDaniel family is cognizant, however, that criteria changes are only one element of an effective commitment system.

Even when Michael's parents thought that their son met Pennsylvania's commitment criteria, crisis intervention workers appeared to apply an overly strict interpretation of the law. Stories abound of similarly strict interpretations of commitment laws even in states with broader criteria, underscoring the importance of good training for mental health workers in all states.

Similarly, another element that can erode the effect of broader commitment laws are shortages in state hospital beds. Pennsylvania currently has 12 state hospital beds per 100,000 people - about a quarter of the minimum rate recommended by the Treatment Advocacy Center, a national mental health advocacy group.

For his part, Michael, sitting on a deck chair in the patio of his new home, a cigarette between his fingers, told me that he hopes he won't need to be hospitalized ever again. With his medication, and the skills he learnt in Wernersville State Hospital, he believes he's on the right track.

That said, Michael added, he now understands that the insidious thing about his condition is that it's unlikely he'll know he's psychotic when he's psychotic. "Everyday I could relapse," Michael told me. "For all I know, right now, I'm in the midst of relapse - having a psychotic episode could be a year in the making."

And what should happen if he relapses? "I want treatment," Michael said. "Absolutely."