One mom fights the system to help mentally ill son

• Doctors noticed Max had problems during his 9-month checkup
• By age 2, he smashed his infant brother's head with a can of baby formula, drawing blood
• At age 6, he clawed a child inside a McDonald's playground until the boy's face turned bloody

CINCINNATI — Mom Melissa Brown was driving her 10-year-old son, Max, to get chili when he told her, "You know, Mom, I'm going to kill you someday."

Brown knew Max was mentally ill, that something had been wrong since she was pregnant, but a chill ran through her.

She looked in the rearview mirror. He was looking back at her.

He was calm, and Brown wasn't afraid at that moment. But she knew he meant what he said.

When Max was 2, he attacked his infant brother. When he was 5, he was kicked out of kindergarten because he attacked another child on the school bus. When he was 6, he clawed a child inside a McDonald's playground until the boy's face turned bloody.

Brown knew her son needed help. So for his whole life, she fought to get Max the kind of treatment that is expensive and increasingly hard to find after years of government cuts to mental-health programs.

It's a challenge that thousands of parents with troubled kids face, and one that is suddenly drawing national attention in wake of the killing spree Dec. 14 at a Newtown, Conn., elementary school.

When Brown heard about the shooter, Adam Lanza, she had only one thought.

"That could be my son."

"One of the saddest parts of the story is that nobody talks about (Lanza) as a victim," she said. "We keep using the number 26. But his mom was a victim. He was a victim.

She worries the same could happen to more and more people as money for mental-health services continues to dwindle and help becomes even harder to find.

Ohio has cut spending for the Ohio Department of Mental Health by $86 million since 2008, a 14.8% cut, according to state figures, though Gov. John Kasich's administration has been adding money in recent years.

"We absolutely know we don't have the safety net at the local level," Kasich said Wednesday. "We are going to do the best we can to provide the resources."

Brown has cried countless tears, been isolated from friends and family, and had to practically stop working so her family would qualify for Medicaid during her struggle to get the help her son needs.

Doctors noticed signs of trouble almost immediately. At Max's 9-month-old checkup, the doctor noted he was constantly moving and suggested he might have attention deficit disorder. She was shocked but shrugged it off.

At age 2, his parents divorced, and brother Owen was born.

Max didn't respond well to the new arrival. Max smashed his infant brother in the head with a can of baby formula so hard he drew blood, Brown said.

"Owen is going to climb up a ladder and fall down and go to the hospital and never come home," Max told his mother.

She assured Max that wasn't true.

A year later, when Max was 3, he refused to play instruments in kinder music class. He wanted to hit other kids with them, Brown said.

Packing up one day, Brown told the teacher she'd see her next week.

The teacher told her, "I don't think so."

"I thought, 'Oh my gosh, did we just get kicked out of kinder music?' " Brown said.

A family member who is a physician told her: "You need to do something now. Max is the type of kid who would push another kid off the balcony."

An attack at a McDonald's

For kindergarten, Brown camped out all night to get Max into a Montessori kindergarten. Max was disruptive, aggressive and scared the other kids. School officials asked him to leave after one month, she said.

Max was 6 when Brown took him to Mental Health Access Point, an agency that serves as the entry point in Hamilton County to get taxpayer-financed mental-health counseling.

Max started screaming, and he wouldn't stop. He knocked down everything in the office, swept the desk clean of its contents.

Brown knelt down, eye to eye with her son, pleading with him to calm down.

"You need to reschedule," the assessor told her.

Brown drove off, Max still in distress.

An assessment that added Asperger's syndrome to Max's diagnoses allowed Brown to seek county Department of Developmental Disabilities help.

Mental Health services couldn't help them because Brown made too much money as a sales and marketing representative. But Developmental Disabilities Services connected them to programs that private insurance would cover and others that they could afford out of pocket, Brown said.

Max's current diagnoses are Asperger's syndrome, attention deficit hyperactivity disorder and bipolar disorder. He's being assessed for early-onset schizophrenia.

But Max still wasn't getting the intensive treatment he needed. He was getting worse, attacking a boy and drawing blood at a McDonald's playground.

"There was no remorse," Brown said.

Shortly after that, Max started talking about voices in his head.

"Max once described them as bullying him," Brown said. "It was easier for Max if he just did the things they told him to do or said the things they told him to say."

The week after he threatened to kill his mother in the car, Max threatened to kill the other kids in his therapy class. His babysitter, a woman trained to deal with children suffering from mental illness, took him home and she sent him to his room to calm down.

Max smashed the window, wielded a shard of glass and told the sitter he was going to kill her, Brown said.

When Max sleeps, 'he's innocent'

Brown loves to watch Max sleep. He might wake up kicking and screaming, but when he's sleeping he's peaceful.

"He's innocent," Brown said. "He's not in pain and he's not causing anybody else pain."

By June 2011 it was clear to his family and to his doctors: Max needed residential treatment.

Brown's insurance paid for a stay at Cincinnati Children's Hospital Medical Center. Even that was a challenge. Every three to seven days the insurance company forced a "utilization review," putting Max's hospital stay at risk.

That meant it really wasn't the long-term treatment it was meant to be.

He had some good days. And that was all her insurance company needed to say that Max didn't need that level of care.

After 58 days, Max was sent home Aug. 12, 2011. He was taking six medications.

"He reportedly made little to no progress during his stay and had a decline in mental health symptoms and reports of active hallucinations," according to an April doctors' assessment.

Max was sent home and back to the fourth grade at a Cincinnati public school.

"It was clear this kind of merry-go-round care would not provide any sort of success," Brown said. Every assessment said he qualified for residential care, yet no county program existed to provide it. Max was put on a waiting list.

A residential stay would cost Brown about $160,000 a year. She was working, but she didn't have that kind of cash. Brown could have relinquished custody to the state. But that would mean she would have no say in where Max went, no say in what medication Max would take.

Instead, she intentionally cut back her work hours so she made so little money that she qualified for Medicaid, which would give Max a chance at residential care.

That made money so tight she almost lost her house.

It took six months, but in June Max was accepted at a southeastern Ohio treatment facility about three hours away.

But that didn't work out either. Max was asked to leave, not because of his behavior, but because of Brown's complaints about her son's care.

Legal Aid Society of Greater Cincinnati lawyers helped Brown get Max into Buckeye Ranch, a residential treatment campus-like facility in Columbus, Ohio.

Brown is no longer on Medicaid or government assistance. Because Max has been in residential care for more than 30 days and continues to need out-of-home placement, federal money pays for Max's treatment.

Typically, about 85 kids ages 10 to 18 live at the ranch. They have diagnoses severe enough that they need to be in a treatment center so they don't hurt themselves or anyone else.

Brown and Owen visited Max last week with a Cincinnati Enquirer reporter and photojournalist.

The violent little boy described in hundreds of pages of doctor's reports shown to The Enquirer or in stories his mother shared was not in evidence.

"A bad day is when I cuss and yell and flick my lights," Max said. "Sometimes I get mad at my mom because she's yelling at me. A good day is when I get to go on an outing. I don't cuss, yell or flick off the lights."

"I feel comfortable here," he said.

Max, who wears braces and carefully styles his hair, is smaller than his younger brother.

He and Owen went to work on a Star Wars puzzle.

Max talked about school and activities and reading a "chapter book," the kind of things most kids tell their mothers at the end of the day.

Earlier this year Max had regressed so much he didn't know the days of the week or the months of the year.

Brown smiled at Max's stories. She held back tears. Tears of happiness, not frustration, fear or sadness.

Brown attributes Max's progress to finally finding the right therapeutic environment.

"Max is doing better now than I have seen him in his whole life," Brown said. "He is enjoying learning, he has friends. … It fits his needs."

When it was time to say goodbye, Brown went to high-five Max. He ignored her outstretched palm and went in for a hug.

She hugged him back. Owen piled on.

Then a stocky man, dressed in a white T-Shirt and dark sweatpants, came to walk Max back to his room.

Although she was sending her son away with a stranger, Brown didn't cry.

"I know he's in the right place," she said. "We have hope he'll come home to our family and lead a happy, normal, life."