The care network that could have been

By JACQUELYN VOGHEL
Daily Hampshire Gazette
June 26th, 2019

GRANBY — Chris Julian was someone who “would have been the golden boy” — a star athlete as a child and a successful student at the University of Massachusetts Amherst, said his friends. But early in his life, Julian endured trauma that forced him to spend much of his time managing his own pain caused by post-traumatic stress disorder, which manifested in both mental and physical symptoms throughout his life.

Julian, who lived in Granby, died by suicide, after he went missing in September, at the age of 53. His body was found in the Connecticut River in East Windsor, Connecticut in January.

On Sept. 12, the day that Julian was last seen, his friend and roommate, Ken Belliveau, first became aware that something was wrong when he received a call from Julian in the early morning hours — Julian had been stopped by police after apparently falling asleep behind the wheel at a red light in Northampton sometime before 2 a.m., Belliveau said.

Julian’s police report was not accessible to the Gazette due to medical privacy regulations, but Belliveau said that Julian had initially asked him to pick him up where he had been stopped. Before Belliveau could get there, he said, Julian called again and said he was being taken by ambulance to Cooley Dickinson Hospital.

Belliveau, who was a friend of Julian’s for about 20 years and his roommate for the past three-and-a-half years, told Julian to call him when he was ready to be picked up and told the Gazette he initially “didn’t see any red flags” in the situation: Driving was part of a routine that Julian regularly used to manage his PTSD symptoms, and he had been admitted to hospitals and recovery centers in the past under similar circumstances. But Julian never called, and Belliveau’s attempts to contact him went unanswered in the following days.

Julian was last seen in the vicinity of the hospital on North Elm Street that same day at around 7:45 a.m., according to a missing person flyer obtained by the Gazette. What happened in between the police stop and this sighting largely remains shielded by Health Insurance Portability and Accountability Act (HIPAA) laws, which establish patient confidentiality requirements.

Julian’s life was “a story of internal pain and how he brought his pain inward and never had any outlets,” said Annie Stephany, Julian’s friend of about 14 years, during an interview with the Gazette. But it didn’t need to be this way, she said.

Julian had tried a number of treatment options throughout his life, including physical and psychological therapy, recovery groups and treatment centers. Recovery groups, in particular, were a vital part of Julian’s life for almost 30 years. But Julian became frustrated with other treatment options, Stephany said. She recalled how had convinced himself that they would not work, in spite of new advancements in therapy, and instead resolved to manage much of his pain by himself.

His efforts amounted to “trying to manage something that he needed more help on,” Stephany said. But she emphasized that there is hope for healing, through systematic improvements being made in the mental health field that focus on care based on an understanding of trauma, also known as “trauma-informed care.” Facing barriers

Stephany is reluctant to give too much information about Julian’s past; she’s not even 100 percent sure of all the details. Julian was predeceased by his parents, and a brother contacted by the Gazette declined to comment for this story.

Stephany knows that Julian was born in London, England but grew up in Winchester, Massachusetts. And she knows that Julian carried the impact of childhood trauma with him for decades, even as he excelled in tennis and baseball during his youth, studied English and psychology at UMass and went on to work at an AutoZone — Julian had also been a “car buff,” Belliveau said.

Julian was “a singular individual who was extremely talented and articulate,” Belliveau recalled, echoing Stephany’s thoughts on his potential. “Smart as a whip. Extremely sensitive. Athletic early on. He was extremely empathic.”

“This was all operating with extreme PTSD underneath that,” Belliveau said.

“He was a true enigma,” Belliveau added, “because he was so articulate and approachable and could present so well, you kind of wanted to just talk him out of his pathology.”

In the Pioneer Valley, Julian found a sense of “a reprieve and a relief” even amid the difficulties that he faced, Stephany said, primarily through the friends and community that he cultivated. Some of those friends he met through recovery programs.

But when Julian went missing, Stephany said that the people in Julian’s network of support felt helpless as they sought information that they believe may have made a difference in helping him.

Aware of Julian’s history of trauma, and unable to contact him for over a week after he went missing, friends were concerned that Julian intended to take his own life, Stephany said. On Sept. 20, Belliveau reported Julian missing, and a group of other friends working with Stephany continued in their efforts to find Julian. The group sought out and reviewed security camera footage, reached out to local and state police for information and pushed for missing person flyers to be distributed until the Northwestern District Attorney’s office released a media alert for a missing person on Sept. 28.

Across Northampton, Easthampton, Holyoke and Hadley, Stephany and this group of friends visited bus stops, parks, bike paths, reservoirs, riverfront lands, hiking trails and other areas where they believed Julian may have wandered, distributing flyers and meticulously keeping track of where they had searched and who they had spoken with regarding Julian’s potential whereabouts.

But they felt as if they “were wandering aimlessly in the woods” as Stephany put it, finding that only family members seemed to have access to the information that they sought.

​​​​​​Information regarding Julian’s mental state at the time of his release from Cooley Dickinson Hospital “would have completely directed our search,” Stephany said, adding that she believes that information regarding Julian’s demeanor and whether he checked himself out of the hospital would have helped to direct search efforts by friends and police.

Julian “found his home here,” Stephany said of the Valley. “He found his home in his friends. And yet, as friends, our hands were tied behind our backs.”

As they tried to get information from the hospital regarding Julian’s mental state at the time that he was released, Stephany said that Julian’s friends came away without answers, with the hospital citing HIPAA laws. Belliveau ran into similar barriers, although he believes that he would have been the most effective contact for Julian at the time.

“People felt like we could work around the system, but we couldn’t,” Stephany said. “The system has these crazy barriers.” Health care professionals respond

In a statement sent to the Gazette, Cooley Dickinson Health Care spokeswoman Christina Trinchero said that the hospital does not comment on individual patients “for privacy and regulatory reasons.”

“In general under the law, any patient who is alert and oriented has a right to privacy and confidentiality,” Trinchero wrote. “They will make their own decisions about involving their next of kin in their health care decisions. If a patient does not request that we contact their next of kin, we will not.”

Karen Franklin, vice president of outpatient services at the mental health and human services organization ServiceNet, said that a person who has experienced trauma or other mental health conditions can sign release forms to allow professionals to share details with others involved in their lives, although it “has to be someone who agrees and wants to do that.”

“There’s a fine line between privacy and also someone’s safety,” Franklin said. “So we try to do everything we can for patient care and for caring about people’s safety, and at times we have to make judgment calls about what we can or can’t do in terms of helping to ensure that someone is safe.”

Exceptions exist in cases where providers believe that a patient is a danger to themselves or others, Franklin said.

“We don’t need a release, for example, to call somebody who might be connected to the person at risk if we believe there is an imminent risk,” she said, adding that these situations often come down to a “clinical judgment call.”

“You have to assume when people are in the hospital that they don’t get discharged if it’s assumed that they’re still at risk,” Franklin added.

But when Stephany looks back on Julian’s admittance to Cooley Dickinson in the early morning of Sept. 12, she sees a scenario where Julian was clearly in need of help and didn’t get the resources that he needed before he was discharged.

“Where was their trauma-informed care?” she asked of the hospital. “Where was their psychiatrist to talk to him deeply? To make sure he had a care plan?”

Although sharing information can be complicated by privacy laws, providers can work with patients to establish a crisis team, or a network made of friends, family and other supportive individuals, Franklin said, for the patient to reach out to if they feel that they are in danger. Hope for healing

Those suffering from post-traumatic stress not only remember but reexperience past traumatic events in response to triggers, said Ian Barron, a UMass professor and director of the school’s Center for International Education, whose research specializes in children and adults who have experienced trauma. And traumatic memory is “crystal clear,” he added.

“The present no longer becomes safe even when this happened in the past,” Barron said, “because the past can come into the present at any time.”

Barron recounted this information to around 80 teachers in training at UMass — most of whom will go on to teach at Massachusetts public schools — at a workshop centered on trauma-informed care in education. Stephany, a field experience specialist for the College of Education, is part of the group that put the workshop together.

As is the case with many children who experience trauma, Julian’s reported childhood trauma went unanswered for years, Stephany said.

It’s possible that Julian died on the same day he went missing, she added. Multiple calls to the East Windsor Police Department went unreturned earlier in the year when the Gazette attempted to gain further information on the date of Julian’s death. But Stephany holds that the real window of time for helping Julian was in the years before he died.

Through the workshop, which was held for the first time on May 2, Stephany and Barron hope to provide future educators with the resources that they need to recognize symptoms of trauma in students and how to act when they believe that a student might need help. Eventually, Stephany hopes to have all future teachers at UMass complete the workshop.

Karen Franklin of ServiceNet said that the mental health field has also made advances as providers incorporate a trauma-informed care approach to treatment and use evidence-based practices that incorporate specific lessons, skills and knowledge to help people gain a better understanding of how to manage trauma.

“I think it has to be an overall practice in the organization to really understand how trauma impacts people’s lives,” she said, “and how to help people in an environment where we recognize that.”

“People can recover, people can be hopeful,” Franklin added. “You can learn and use skills that can help you get to those goals to recover.”

Beyond the trauma that Julian struggled with for decades, Stephany remembered him as someone possessing a striking “depth of thinking and depth of love.”

KC Scott, a Greenfield-based artist and Julian’s friend of nearly 25 years, recalled Julian as someone who “always spoke with truth and wisdom.”

“Sometimes the wisdom was in the humor, but it was always there,” he added.

Belliveau also recalled this side of Julian. “He was funny as all hell,” he said. “He was witty, and his wit was a little sardonic, but he was a fun-loving guy. He would pull you out of yourself, sort of disarm you and get you comfortable so you could have fun.”

In Julian’s memory, Stephany and other friends have set up a Trauma-Informed Care in Education fund through UMass, which may launch as early as July. Until then, donations made to the UMass College of Education Priorities Fund marked “in memory of Chris Julian” will be set aside for the fund.

“I think he would want to share his story,” Stephany said, “and if he felt like his story could help people, then there’s a really good purpose in that.” Jacquelyn Voghel can be reached at jvoghel@gazettenet.com.

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