Not long ago, in late autumn, a man in rural Maine spiraled down into the depths of mental illness, the symptoms of which included paranoid delusions and frightening behaviors. His concerned family alerted authorities over and over again, but no help came. No resources were available; any treatment or hospitalization was brief. Then one day, after escalating violent behavior, he killed.

I’m not talking about Robert Card. I’m talking about Justin Butterfield.

After several years of progressively worsening schizophrenia, Justin Butterfield, 34 at the time, killed his brother Gabriel Damour on Nov. 24, 2022. Thanksgiving morning. This past February, he was found not guilty by reason of insanity. After the Lewiston shootings, as the facts of Robert Card’s struggles and his family’s attempt to get him help, all I could think of was Justin’s case.

The first thing you should know is that “mental illness” is a catchall phrase that encompasses a whole host of conditions and is more common than you might think. According to the National Alliance on Mental Illness, 1 in 5 American adults experience a mental illness every year (including me!). And for most people with mental illness, a combination of outpatient therapy and medication management, along with possibly a brief inpatient admission for stabilization, is usually enough to manage. And the vast majority of people struggling with mental illness are not a danger to anyone around them. But there is a small percentage of people who develop severe and persistent mental illness that can, if untreated, lead to violence.

The keywords there are “if untreated.” By all accounts, Justin Butterfield was a good partner, brother and father when he was on his medication. So was Robert Card. They were victims of their mental illness too. They weren’t monsters or movie villains, they were people. Human beings. Mr. Card is dead. Mr. Butterfield is in a psychiatric institution and will likely be there for a long, long time, and even if he were to be released he has to live with the knowledge that he killed someone he loved.

This sort of behavior is not inevitable. We do not need to lock up people suffering from severe mental illness. There were multiple paths that could have led to different, safer outcomes for these men – including a functional “red flag” law, instead of the “yellow flag,” which is confusing, overly bureaucratic and difficult to implement in an emergency. Card and Butterfield could have refused treatment all they wanted – if the weapons in their homes had been removed, they couldn’t have hurt people.

If you or a loved one is so unlucky as to find yourself dealing with chronic mental health issues, you will find that there is no real “system,” just a scattered handful of resources, most of which are underfunded and not in communication with each other. The cops usually get called first, because police are our first responders to pretty much everything, especially if someone is acting threateningly or perhaps just strangely.

Then the cops transport the person to an emergency room. The emergency room either stabilizes them or places them in a psychiatric facility for treatment. These stays aren’t usually long. They aren’t supposed to be. And then when pronounced sufficiently stabilized, the patient is released. Sometimes there are community follow-up supports available, but a lot of the time what they get is waitlists and loved ones who do the best they can to keep them stable. Can they afford their medication? Who knows. Can they get to a pharmacy to refill it? That’s the patient’s problem! The lucky ones make it through and recover. For the unlucky ones, their condition begins to deteriorate until someone calls the police, and the cycle begins again.

The truth is there is no safety net in Maine for people suffering from severe, persistent mental illness. You either have the means to pay for private treatment, end up on a month- or years-long waitlist, or you go without. Psychiatric treatment is expensive and labor-intensive as well as highly individualized toward the patient. A method that works for one person may not work for another, which makes it hard to mass-produce resources and services.

Additionally, the most severe cases of mental illness often involve anosognosia or lack of awareness that a person has a mental illness. Someone who does not have the capacity to understand they are sick is not going to seek treatment. Otherwise, they’ll end up in the cycle of cops – emergency room – home. Or cops – emergency room – streets.

As a state, and as a society, we have decided we would rather not fund services. A violent death every so often is just the price we pay for low taxes. It is more pleasant for the average citizen to turn their head and never have to deal with the mess of pain and poverty and insanity. It is uncomfortable to deal with mental illness. Trust me, I feel you on that one; I’ll never forget that first shift at the walk-in clinic where a patient entered and told me they were having thoughts of suicide. I’ve witnessed police be called for erratic behavior. No matter how often those incidents happen, I never felt confident; I never felt like I knew what I was doing; and I never felt the solutions we were offering were good ones.

What happened to Butterfield and Card will happen again if nothing changes and we continue to go about our business with our heads in the sand. Once is an aberration. Twice? In two consecutive years? That’s a pattern. And it won’t be a surprise. In the aftermath of whatever horrific event makes the news, reporters will find out that the perpetrator had a million and one red flags and had a history of being reported to the authorities as a potential danger to themselves or others.

There will be documentation that the family reached out for help, only to find nothing. Pundits like myself will say, how could they have been allowed access to weapons? Politicians will shake their heads and say how tragic it is that mental health care is so underfunded and disrespected in this country, and then come budget time won’t increase it meaningfully.

Average citizens will shrug and say that some people are just crazy because it’s easier to dehumanize a struggling person than to have empathy. And mental health workers like my fiancée will continue to get up every morning, overworked and underpaid, to advocate for their clients.