Cathy Costello lost her husband, Mark Costello the Oklahoma Labor Commissioner in a stabbing incident, in NW Oklahoma City a few months ago. It has been said, their 26 year old son, inflicted 17 strikes with a knife, which killed the father. The son, indicated to have advanced issues with mental health and addictions was reportedly paranoid and unmedicated or under medicated. The son, Christian Costello was apprehended at the scene and has remained jailed since that late August day.
Following this incident and death, Mrs. Costello has made at least 4 attempts to obtain a Verbal Protective Order, a VPO for herself and her 16 year old son, regarding identified risk from Christian’s life partner and others. The VPO has been refused because there has been insufficient information provided to the Oklahoma County Court Judge. The original VPO request was regarding 3 adult children, the minor 16 and Mrs. Costello, immediately following the incident. Subsequent requests have been regarding only Mrs. Costello and the 16 year old son. There has not been any posting this situation has been resolved by granting Mrs. Costello the VPO’s requested, now four months later.
Currently, Mrs. Costello is calling for broader options for detention of persons with mental health issues like Christian. No diagnosis has been posted publicly for Christian, though dual issues of mental health and substance abuse are noted.What Mrs. Costello’s wish is regarding care, is not clear. Her intention was to ask for incarceration in a jail or prison? Or some other better method to recognize the pre-emergents in Christian’s presentation, which could have circumvented the incident and required that he be held in an inpatient setting? Did Mrs. Costello hope Christian could be in a 3-6 month relapse prevention program? It makes for a very interesting question, one which many families often answer repeatedly no to, or are told “no” by Oklahoma systems, and insurance rather public or private.
Christian was 26 years old. His mother, and perhaps his father knew he needed higher levels of care and containment. Were there funds for Christian to go into a residential relapse prevention or longer term inpatient program? Is there such a program, with active bedspace which is effective for people in Oklahoma who have complex mental health diagnoses or struggles with medications, struggles with relapse and sober living? Or was Christian simply in an acute state of psychiatric, addictive or medical need and he simply needed to be hospitalized under some plan which would indicate a broader stability than he had been able to achieve otherwise?
Honestly, even the most educated and caring parents sometimes do know the answers to their adult child’s diagnosis and sometimes not. Many programs in Oklahoma over subscribe to the concept that mental health and addictions services function under a version confidentiality which excludes education, diagnostic and ongoing care information or a referral to NAMI and prevents loved ones or appointed caregivers from comprehending the problem in a medical/diagnostic sense and also then understand the “care and feeding” of a wellness based self in the identified patient and family given that.
An example of a like, extreme local issue is the ongoing release of information on the female who drove 50 mph into the parade at the Oklahoma State University Homecoming Parade in Stillwater, Oklahoma who appears to have some complex psychiatric problems under diagnosed, under treated and possibly un-medicated or mis-medicated. Her family noted she had been to the psychiatric hospital a couple of times, but noone knew she had a full mental health diagnosis. By law one cannot be admitted inpatient without some psychiatric or addictions diagnostic question to rule in or rule out.
Was Christian covered by his father’s Oklahoma employee health insurance? Does the Oklahoma employee health insurance offer flexible plans for dependents, or others to join the care plan or is it only for employees or immediate household residents? If the plan was covering him, did it cover this advanced and complex care need? Is there an Oklahoma program which can be paid for by the Oklahoma employee’s insurance? Could the family have paid out of pocket for a higher grade or level of care? Would Catholic Social Services have offered to pay for this care, to scholarship Christian or to pay a percentage of this need?
Was Christian covered by Oklahoma’s SoonerCare Medicaid? Did the family pay out of pocket for him to be eligible for care? Did he have a diagnosed disability at 26, and was he on Medicare and SSI?
Oklahoma struggles to fund programs for addictions and mental health services, though Oklahoma has some of the highest rates of diagnoses of things like prescription pill addictions and complex mental health issues like Bipolar and Schizoaffective Disorder?
At a recent meeting of the Oklahoma City County Health Department, a leader brought up the question of whether he could have some letter registering him with the City, County and State as having a diagnosis which requires medications in certain doses and has a high rate of mental health relapse. Noone at the meeting knew of such a form or registry in Oklahoma but everyone there understood the man was trying to relay his understanding of his own health limitation to others, particularly to the police to indicate what care is proper given the physicians diagnosis.
One person pointed out that it might be prudent to have a mental health or addictions option like the Med-Alert bracelets which connects unconscious diabetic sufferers to systemic information about that exact individual’s diagnosis and proper care. This to focus care on mental health or addictions services continuum, and not to light on criminal incarceration.
What role does reporting play in Mrs. Costello’s request that others not suffer as her family has, technically losing two family members in one day. Had the Kay Floyd generated law enforcement Lethality Scale have been applied in documentation of the case, though Mr. Costello was dead by the time OKCPD arrived, if that scale was applied to case note writing by the police, or another like documentation from a person on call as a CIT officer, or ODMHSAS licensed professional, would that have improved Mrs. Costello getting future services as a victim or person at risk?
Had Mr and Mrs. Costello had prior access to superior evaluative processes and reporting writing professionals for incidents with Christian, would her reports have focused on pre-emergents in Christian’s presentation, ensuring he could be sent to higher levels of service, beyond simple crisis review or initial stabilization? Much of Oklahoma review of crises in mental health or addictions bypasses lesser everyday realities which indicate a ramping up to disasters like Mr. Costello’s death. Sometimes, noone can predict. Often, there are relevant details to a trained observer.
Both addictions and mental health diagnoses have features which wear out and wear down family members or loved one. Having access in various situations, especially after hours, on the weekend and on holidays to specialized services to assess situations and need is not clear and sometimes not available to family members. Persons who have had multiple bouts of extremes from their family member who is the identified patient, often risk situations where they really need an interventionist, and there isn’t one, isn’t money for one or they don’t know how to ask for this help.
The sheer number of people news reports and obituary statements indicate these parents spoke to about this adult child’s issues and struggles is significant. That Mr. Costello was a core administrative employee under the Governor, did not improve his chances of being heard, considered nor change applied by the Governor Mary Fallin, using his lead and questions as a pivot.
Perhaps Mrs. Costello will be more successful in Mr. Costello’s honor.