Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Laura Craciun initially dismissed her 17-year-old son Nick’s behavior as a “rebellious teenager acting out.” In December 2019, the Massachusetts teen went missing for three days after an argument with his father, sleeping in a stairwell and eating a hamburger a day.
Sitting in the car together a few days after his return, what he said stunned her. “I’m not real, you’re not real, nothing is real,” he told her. He talked of suicide.
Nick’s first episode of psychosis and suicidal ideation led to a month-long hospitalization, during which he turned 18, limiting his parents’ access to his sensitive health information without his consent, even though he was still in high school.
“They didn’t involve us at all.”
The doctors didn’t give him medication nor connect him to a first-episode psychosis program that wraps support around adolescents and young adults showing early signs of psychosis — hearing or seeing things others don’t or unusual thoughts or behaviors.
Dr. Lisa Dixon, who directs OnTrackNY, an intensive, government-funded early intervention program in New York, told CrisisTalk in 2019 that early intervention improves outcomes. The longer the duration of untreated psychosis, the poorer the outcome over the short and long term.
“In 99 out of 100 people, it’s safer, more ethical and better for us to treat the person earlier,” she said.
Two and a half years after his first disappearance, Craciun’s son went missing again. He’d been staying with a friend when the friend’s father called.
“‘Nick’s in danger and I don’t think he’s well,” the father said.
Craciun reported her son missing and endangered, triggering a multistate search. They tried to find him but with no contact, his parents assumed the worst.
Nearly three months later, Nick reappeared. He was 20 pounds thinner and speaking strangely, says Craciun. He told his family he’d been living in a car with a broken window. “This is Cape Cod in the winter,” she said. “This is not the place to do that.”
At night, he slept between the seats. During the day, he climbed trees and hills naked to better hear the voices, acting on what they told him. He wore no clothing because he wanted to see what color his skin turned under the sunshine in the frigid air.
Worried, his parents rushed him to the emergency room, but the social worker said her hands were tied, telling them, “He’s not a danger to himself or others.” Craciun couldn’t understand how her son, wasting away before her, wasn’t considered a danger to himself.
In the months after his return, watching their son deteriorate and desperate to get him help, his parents dialed 988 and 911 over and over. “We called our mobile crisis teams, but they just couldn’t get him to agree to go to the hospital,” said Craciun.
The cycle continued. Sometimes, the episode passed by the time responders arrived. In other instances, Craciun says her son convinced first responders and providers that everything was alright. “When you think you’re fine, you’re very convincing.”
Nick grew increasingly delusional and began smoking marijuana heavily, “which threw gasoline on the fire.” He tried getting out of a moving car going 40 mph. He thought electronics controlled his mind, that he could see and hear aliens if he turned his head. “He got so delusional that finally, EMTs took him to the hospital four months after he returned.”
Between hospitalizations, Nick stayed at homeless shelters that set up appointments for him with a social worker. In the mornings, Craciun would pick him up, take him to breakfast and drive him to the social worker’s office. Standing outside the building, he would tell her: This is for people who really need it. I don’t need it. I want to save it for them.
On December 27, 2023, Nick’s father picked him up. He had been living at a mosque but was asked to leave when his behavior became erratic. His father took him to his house in Cambridge. “His dad knew something was wrong but didn’t want to leave him on the street homeless,” said Craciun.
By night, Nick was too afraid to be alone and asked to sleep in the same room. His father dragged a mattress to the living room so he could be nearby while Nick slept on the couch. “He laid down next to his dad, who was very uncomfortable and asked for more space,” explained Craciun. “Instead of replying, he elbowed his dad in the eye so hard he almost knocked him unconscious.”
Nick punched and bit his father, says Craciun, adding that they struggled over a shovel until his father managed to throw it over a fence.
“He thought his dad was the devil.”
Police charged Nick with kidnapping and assault with a dangerous weapon. He was initially incarcerated at Bridgewater State Hospital — as a pre-trial detainee sent for competency and criminal responsibility evaluation by the court — but was later transferred to Middlesex Jail and House of Correction.
“A forensic evaluator determined him incompetent to stand trial but the judge decided against the hospital,” said Craciun. “The judge actually said, ‘Though he is delusional, he is competent.’”
Today, Nick is out on conditional release. He must comply with the mental health treatment plan, which includes therapy and prescribed medication for 18 months or he’ll be charged with the attack on his father. He’s also awaiting trial for offenses related to when he went missing in 2022, including breaking and entering and larceny. Together, he faces up to 28 years in prison.
Craciun says her son shouldn’t be stuck in the criminal legal system but fell through the cracks of the mental health system because there isn’t a policy safety net for young people like him who don’t have insight into their mental health condition. “He has anosognosia, he is unaware of his illness, so when his lawyer asked him if he had a history of mental health issues or had ever been hospitalized, he said no.”
Nick hasn’t participated in a first-episode psychosis program or assertive community treatment, a type of intensive, multidisciplinary, community-based mental health care where a team meets the person where they are, including unsheltered spaces and temporary housing. These teams are designed to help the person with medication management and monitoring, skill building, employment and housing support, 24/7 crisis intervention and, if needed, substance use treatment, and family education and support. Assertive community treatment is voluntary, so teams first focus on the person’s basic needs, building trust and being consistent but not intrusive.
To Craciun’s knowledge, providers haven’t attempted to connect her son to either. “Even if they had, he would never agree to services because he believes he’s not unwell.”
She believes assisted outpatient treatment, court-ordered involuntary outpatient treatment under civil court commitment, could have altered her son’s trajectory. “That would’ve been a huge tool hospitals could have used.” She says the approach also improves coordination between the judicial and mental health systems, reducing rates of incarceration, homelessness, hospitalization and interactions with police.
Management teams are intended to be multidisciplinary and include civil court staff and different levels of mental health care providers so that there’s coordination between the person’s care manager, crisis services, community support and residential placement.
In some communities, people under court-mandated treatment received assertive community treatment as a part of their treatment plan. New York City’s assisted outpatient treatment plans include a care coordination provider or assertive community treatment team. The city has a single access point for assisted outpatient and assertive community treatment referrals, allowing for improved coordination.
The Protecting Access to Medicare Act of 2014 defines assisted outpatient treatment as “medically prescribed mental health treatment that a patient receives while living in a community under the terms of a law authorizing a state or local court to order such treatment.” Depending on the state, people who don’t comply may be involuntarily hospitalized for 72 hours.
Assisted outpatient treatment exists, in some form, in all states but Connecticut and Massachusetts. Last year, Maryland passed legislation authorizing each county to establish an assisted outpatient program by July 1, 2026.
The court-ordered treatment is also known by other names, such as Kendra’s Law in New York and Laura’s Law in California or simply involuntary outpatient commitment.
In Massachusetts, bills were introduced in the 2023-2024 House and Senate to establish a process for assisted outpatient treatment, called critical community health service treatment plans. The bills have been refiled and are on the 2025-2026 Senate and House dockets.
The current law allows people to be involuntarily hospitalized for 72 hours if not hospitalizing them would otherwise “create a likelihood of serious harm by reason of mental illness.” Craciun says a person’s lack of insight, impairing their judgment and understanding of the need for treatment, and deterioration should be part of the calculus. “If you have a threat of psychiatric deterioration, that’s like being gravely disabled — you can’t do anything for yourself.”
Throughout her son’s experience, first responders, providers and judges have inconsistently interpreted his risk. “I didn’t want to go public, but I’m so disappointed by all the professionals, medical and legal,” she said. “That his lawyers would want him to stay away from treatment and judges who don’t know enough about psychosis to understand people can look and sound OK when they’re delusional.”
Aside from the 72-hour hold, Craciun says there’s nominal support for people like her son who experience psychosis and are unaware they’re unwell.
“We need to do better for people with psychosis and support them in the community. Putting them in jail is not the solution.”
