How the pandemic’s mental health crisis tore one family apart

Now texts were telling Thomas his most challenging client was out of control. He raced back to find David Austin Rowe pacing the shelter. The 18-year-old threatened to shoot one staffer, Thomas said, and to choke another. He rambled about blowing up the Winchester Rescue Mission.

The pandemic has sparked a second epidemic of despair and the mission is on the front lines. Death and isolation associated with the coronavirus created an uptick in people needing counseling, while degrading the ability of the mental health system to provide it.

Normally, 40 percent of the mission’s residents have a diagnosed mental illness but that number shot to 90 percent at times over the last six months. Virginia’s hospitals were struggling to find beds for the mentally ill, amid a surge in patients and a staffing shortage exacerbated by the pandemic. Problems in the state mirrored those nationwide.

Rowe, who suffers such profound autism and mental illness that he had been in the care of the local county since age 11, had a history of violent outbursts. On that August day, Thomas desperately tried to get Rowe an emergency hospital commitment, but was stunned when Rowe was turned away. Then the teen tested positive for the coronavirus.

Sick and suffering a mental breakdown, Rowe could not return to the shelter so he turned to the one person he had left: Dianna Swaner — who had been one of the few constants in her grandson’s tumultuous life.

Though he had been accused of assaulting her, she took him in. On Aug. 28, Swaner stopped Rowe as he tried to take a can of beans from her home, authorities said. Rowe allegedly smashed her head through a TV, before fatally bludgeoning her with a jarred candle. He was charged with murder.

Thomas said he was deeply shaken, but not surprised. Rowe was a worst-case scenario, a collision between a new American crisis and an old one — the pandemic and a frayed mental health system — that was ripping many families apart.

“This is almost the perfect storm,” Thomas said.

The most challenging case

Thomas first met Rowe in July at a visiting room in a local jail. A guardian with the Frederick County, Va., Department of Social Services had asked the pastor if he could help her client, who was incarcerated for allegedly attacking his grandmother.

Rowe, wearing a navy colored jail jumpsuit, seemed childlike, Thomas said, and it quickly became clear he didn’t fully grasp why he was there. The young man wanted to talk about his phone and girls.

Thomas, who has tattoos running up his arms and once rode a Harley cross-country to raise money for the homeless, said the encounter nearly moved him to tears. He suspected the alleged attack was a product of unmanaged mental health issues rather than malice.

“How can jail be the answer for a young man who is mentally ill?” Thomas asked. “It’s heartbreaking.”

Thomas called a meeting of the staff at the mission and proposed Rowe come live at the shelter. Thomas told staff Rowe would present unique issues, but staff agreed they were up to it. And the courts allowed it.

Rowe was born drug exposed and his mother was in and out of jail during his early years, according to a court assessment. When his mother was around, Rowe told the evaluator she left him “in a room all day.”

Rowe struggled in school and was found to have an IQ of 75. He was placed in the care of the county at age 11 because of abuse and neglect, according to the assessment. His mother died when he was 13 and his father was either a man incarcerated for drug offenses or a sex offender.

In the years that followed, Rowe shuttled between stays at mental hospitals and group homes, punctuated by violent outbursts, fights and a suicide attempt, according to family and assessments. His list of diagnoses grew: autism, depression, bipolar disorder, post-traumatic stress disorder and more.

When Rowe turned 18 last February, Frederick County petitioned to have him remain in the care of a guardian after a psychologist found his disabilities prevented him from making “any responsible decisions” about his life.

Rowe’s issues were too severe for Swaner, 63, a retired sheet metal worker, to handle on her own, a court evaluator found. Still, Swaner told the court she wanted to be a part of her grandson’s life.

She was doing just that in April, when Rowe allegedly attacked her after family said he became upset sweet tea wasn’t available at McDonald’s during an outing. Rowe was charged in that assault and another months later that didn’t involve Swaner.

A court appointed evaluator found Rowe was not competent to stand trial in Swaner’s case. Rowe told the evaluator he talked to the Batman characters Harley Quinn, The Joker and Cat Woman.

“They’re my only friends,” the examiner reported him saying.

Rowe came to live at the mission at the end of July after Thomas’s visit to the jail. It was to be a fresh start and Thomas said things went well at first.

Staff said they plugged Rowe into activities to keep him busy and he was taking his psychiatric medicine. Thomas said Rowe was fond of blasting hip-hop and walked up and down the halls of the shelter rapping in baggy basketball shorts.

Jamie Clem, a kitchen manager at the shelter, said Rowe was starved for attention. The top of Rowe’s Facebook page, where people often leave inspirational quotes or biographical tidbits, featured a banner: “I’m lonely…and depressed cuz nobody cares about my life.”

Clem said Swaner was one of the few people outside staff who spent time with him while he lived at the shelter, regularly taking him on outings.

She had taken care of Rowe when his mother was jailed as a child, and she had sent him money and bought him a web-enabled tablet when he was living in a group home as a teen, family said. Family members said Rowe was like a second son to her.

Clem recalled a day when Swaner arrived at the shelter to take an ecstatic Rowe out: “He came running to get me and said, ‘Come meet my grandmother.’ ”

Homeless shelter to mental hospital

Rowe arrived at the mission amid the largest surge in mentally ill clients Thomas had seen there. It was part of an overall 42 percent increase in people seeking beds at the shelter in 2021.

After more than a year of the pandemic, social support was collapsing for many people, said Alicia Vann, the lead case manager at the shelter. That was particularly true for the mentally ill who often had precarious living arrangements to start.

Thomas recalled the difficulty of quarantining some residents suffering paranoia after they tested positive for asymptomatic cases of the coronavirus. How to explain to them why they had no symptoms, but could still infect someone with a potentially deadly virus?

The problems were compounded by access to mental health care with psychiatrists limiting office hours and turning to Zoom appointments, which many felt were less effective. The biggest challenge came in July, when Virginia froze admissions to five of its eight state mental hospitals.

The hospitals were already stretched by a nearly a 400 percent increase in demand for beds since 2013, but the pandemic exploded an ongoing staffing shortage at the psychiatric facilities and others across the nation.

The coronavirus made a hard, low-paying job too risky for many and state officials said staff were quitting in droves. Unfilled positions at some hospitals are creating dangerous conditions for workers and residents alike.

The freeze was a major issue because the hospitals are required by state law to take the mentally ill suffering crises when beds are not available elsewhere. Thomas said the shelter saw a spike in the mentally ill after the freeze.

Thomas said he began work at the mission to be the “hands and feet of Jesus,” helping people down on their luck with drug counseling and job training. He said the crisis that was unfolding at the shelter was something else entirely.

“I went from running a homeless shelter to running a mental hospital,” Thomas said.

In late August, a coronavirus outbreak swept through the mission putting everyone on edge.

Staff had been trying to get Rowe to wear a mask on Aug. 23, but he had become increasingly upset, Thomas said. Rowe was telling staff members that no one loved him. Thomas said Rowe had been refusing to take his psychiatric medicine and his agitation had been gradually increasing for weeks. Now, Rowe couldn’t be calmed.

The threats began soon after, Thomas said. Rowe needed more help than the shelter could provide, so Thomas turned to the state.

In Virginia, a person suffering a mental health crisis can be involuntarily hospitalized for three days if they are deemed a threat to themselves or others, or if they do not have the capacity to meet their own basic needs.

But at a hospital, a screener with the Northwestern Community Services Board in Front Royal found Rowe did not meet the criteria for what’s known as a Temporary Detention Order (TDO).

Officials with the board said privacy rules precluded them from commenting on Rowe’s evaluation, but the evaluator told staff at the mission that Rowe had slept through most of it, according to contemporaneous notes taken by shelter staff and obtained by The Washington Post.

Shelter staff were surprised the evaluator never spoke with Rowe’s guardian, even though they had relayed that he did not legally or mentally have the capacity to make decisions about his care, according to the notes.

Records show Rowe was released without any psychiatric medicine and the shelter was not informed.

“He was medically cleared and could make his own decisions, so he left 10 minutes ago,” one board official is quoted as telling a shelter staffer in the notes.

Some state mental hospitals had a few spots open that day but overall the system was over capacity, so it’s unclear if a bed would have even been available if Rowe qualified for a TDO, according to state records. There is no indication in the shelter’s notes the hospital freeze played a role in the screener’s decision to turn Rowe away from mental health care.

Thomas said he was stunned Rowe was not hospitalized and so were some other mental health experts. Anna Mendez, executive director for Partner for Mental Health a nonprofit that focuses on mental health issues, said Rowe seemed a prime candidate for a TDO given his extensive history of mental illness and violence.

“It’s hard to wrap around your brain around how a TDO was not issued,” Mendez said. “Generally, in our community experience, I don’t think we’ve ever experienced a time when a person made threats against themselves or others when they were not TDO’d.”

A relative picked Rowe up from the hospital and drove him miles down rutted dirt roads to Dianna Swaner’s home in the woods outside Winchester.

The county had mapped every move for Rowe since he was 11, but now he was suddenly adrift. Over the next several days, Rowe alternately crashed in a worn green trailer behind Swaner’s home and in a tent his cousin had pitched in his yard.

Michael Swaner said his mother had looked out for Rowe all his life and she was doing the same again, despite the risks. Matthew Swaner, Rowe’s cousin, said Rowe’s stepfather had told him Rowe threatened to kill him and Swaner before he arrived at Dianna’s home.

“She was closer to him than to me, her own son,” Michael Swaner said. “She would do anything for that boy.”

Meanwhile, Thomas said he was racing to try to find an another living arrangement for Rowe, but it was nearly impossible given he had tested positive for the coronavirus. Thomas said he planned for Rowe to return to shelter once he was free of the virus.

By Aug. 27, Rowe’s coronavirus symptoms were worsening, so he went to the hospital, according to records. The next morning he was released and family drove him back to Swaner’s trailer. Less than an hour later, Rowe called 911 to report his grandmother was dead.

Matthew Swaner said the first indication something had gone wrong came when he saw police cars speeding up a dirt road toward Dianna Swaner’s home. He called her phone and Rowe picked up.

“He said you need to come, somebody got in here and beat her up,” Matthew Swaner recalled Rowe telling him. “I said, ‘What do you mean? He said, “ ’I think she’s dead.’ ”

Michael and Matthew Swaner rushed to Dianna’s home, where they found sheriff’s deputies poring over the house and Rowe standing in the rain. The trio stood in the front yard for eight hours as the investigation continued.

Rowe denied he killed Swaner, but kept telling his relatives he had caused “so much sorrow since I got home.”

“I have to grow up now,” Matthew Swaner recalled Rowe telling them at one point. “My grandma ain’t here to take care of me anymore.”

The Frederick County Sheriff’s Office said Rowe eventually admitted killing his grandmother, according to charging documents. He remains jailed pending trial and a judge had ordered he undergo a psychiatric evaluation. Rowe’s attorney did not respond to multiple requests for comment.

State Sen. R. Creigh Deeds (D-Bath), whose son stabbed him and then later took his own life in the midst of a mental health crisis in 2013, said Rowe’s case disturbed him greatly and had echoes of his son’s. A judge had ordered Gus Deeds to be involuntarily committed before the stabbing but a bed could not be found at a mental hospital so he was released.

Deeds said he is going to investigate the killing and said it raised questions about how the state’s mental health system handles those with autism and the training of evaluators who examine people for TDOs.

Over the summer, state officials allocated $485 million for mental health care in the state to address the staffing shortages at state mental hospitals and other problems, but the omicron surge added a fresh dimension to the crisis.

With omicron cases easing, admittances to all state hospitals have been reopened but delays in admissions remain, according to state officials. The staffing shortage has remained an intractable problem.

Deeds said the $485 million lawmakers approved is a historic investment, but is still a one-time fix. He said state legislators need to find more permanent funding sources for the state mental health and several have proposed bills that would help improve the system during the current legislative session.

Without more help, Thomas said he fears other incidents like Rowe’s.

“We have invested record amounts of new money in mental health care over the last three years, but covid made every problem we have worse,” Deeds said. “Some problems that already existed went from near crisis, to crisis, to house-on-fire crisis.”

Story editing by Maria Glod, photo editing by Mark Miller, design by Twila Waddy

By Percy