By Jason Laughlin
Nick Craciun believes he talked to aliens and saw the devil himself. Yet despite criminal charges, homelessness, and inpatient psychiatric care for treatment of bipolar disorder, the 22-year-old denies having mental illness and refuses medication, his parents say.
He’s now in a jail cell in Billerica, charged with assaulting his father. Craciun’s parents, Laurentiu Craciun and Laura Balboni Craciun, believe their son would benefit from medication and are supporting legislation under consideration on Beacon Hill that could give psychiatrists more leeway to involuntarily medicate patients.
“I think he wouldn’t be where he is right now if we had that choice,” said Laurentiu Craciun.
Each year, 2,000 Massachusetts residents experience the onset of a psychotic disorder. Some become lost to private realities that lead to homelessness or imprisonment. Available to them are antipsychotics more precise and more varied than when such drugs were first introduced 70 years ago. Failing to treat when a delusional patient says no is indefensible, many psychiatrists say. Yet treatments are imperfect, and expanding psychiatrists’ power invites abuse, critics fear. They cite a shameful era of shock therapy and lobotomies that placed patients at the mercy of their doctors.
Now, the process of involuntarily medicating a patient in Massachusetts routinely takes more than a month, and with a few exceptions requires a finding of legal incompetence and then a judge’s order.
The proposed legislation lays out specific circumstances in which psychiatrists can medicate a patient without a court order
or a finding of incompetence, including when there are signs of significantly impaired function, risk of harm to self or others, and an expectation the person’s condition will not improve or will worsen over the next three days. Supporters say the bill simply clarifies existing law, giving providers clearer instructions on how to treat patients who cannot recognize their own need for medication.
“I find myself in these instances erring on the side of wanting to get that person the treatment as soon as we can,” said state Senator John Velis, chair of the Joint Committee on Mental Health, Substance Use and Recovery. “The longer it takes to treat them, in many instances the worse off the outcomes.”
Advocates for people with disabilities and some defense lawyers argue the legislation does much more than affirming the status quo. It greatly expands what current law allows, they said, increasing the likelihood that providers will violate patients’ constitutional rights.
“If it becomes law, it will allow our clients to be forcefully medicated without judicial oversight or legal representation,” said Robert McGovern, spokesperson for the Committee for Public Council Services.
Moreover, forced medication is counterproductive, even for those with delusions, said Daniel Fisher, vice president of the National Coalition of Mental Health Recovery. It destroys trust, creates trauma, and worsens chances of recovery.
“Recovery requires people’s engagement in their own life conditions,” Fisher, who is also a psychiatrist, said.
The legislation, now with the Senate Ways and Means Committee, is one of several bills under consideration to address a mental health crisis in Massachusetts.
Separate bills seek to to establish court supervision for seriously, persistently ill people receiving outpatient psychiatric care, to ensure they continue treatment. Balboni Craciun, Nick Craciun’s mother, sees that as another important tool for families powerless to help a relative unable to recognize their own illness.
Nick Craciun began showing signs of serious mental illness in 2013 when he was around 11 years old, his mother said. Over time, his behavior grew more erratic, his delusions increasingly bizarre, his parents said. He was diagnosed with bipolar disorder with psychotic features and was committed to inpatient care twice, in 2022 and 2023.
Both stays were brief, and he always refused medication. Late in 2023, Nick began a spiritual journey that led him to a Boston mosque. He seemed better, his father said, and showed flashes of his old humor, warmth, and kindness. But Nick’s delusions returned, and he was asked to leave.
On Dec. 27, 2023, Laurentiu Craciun brought Nick to his Cambridge home. Nick didn’t want to sleep alone, so his father brought his mattress into the living room to be nearby. Then Nick hit his father without provocation, Laurentiu said.
The assault continued outside, where Laurentiu took blows to his head and bites to his back as he tried to restrain his son. Police charged Nick Craciun with kidnapping and assault with a dangerous weapon, according to court records.
He went to Bridgewater State Hospital, the Department of Correction’s mental health facility, for evaluation. His parents hoped he might receive antipsychotic medication there, but a judge in March determined Nick Craciun was competent to stand trial. He was transferred to the Middlesex House of Correction, where he remains.
“Inside me, I’m devastated,” Laurentiu Craciun said. “Even now, he thinks he’s OK.”
Nick Craciun and his lawyers did not respond to requests for interviews. At a recent competency hearing, Nick Craciun stated, “I believe I don’t have mental illness.”
He also faces breaking and entering and larceny charges in Barnstable Superior Court and Lawrence District Court.
If a legally incompetent patient refuses medication, a judge can be petitioned to determine what treatment patients would want if their judgment were unimpaired. The judge consider factors including the diagnosis, the patient’s desires, prognosis, family needs, and possible side effects, and can then decide to permit involuntary medication through what’s called a Rogers Order.
State law allows a patient to be medicated without consent or a judge’s order if there is an urgent risk of violence or self harm, or a psychiatrist determines the patient could suffer “immediate, substantial, and irreversible deterioration.”
The bill’s supporters say vagueness in existing laws discourages practitioners from even trying. They also argue obtaining a Rogers Order takes too long. One study at Bridgewater found an average of 41 days passed from petition to medication, though judges approved about 82 percent of requests. The study also found patients’ rates of self harm and violent incidents declined after being medicated under a Rogers Order.
The study’s author, Dr. Jhilam Biswas, president-elect of the Massachusetts Psychiatric Society, described patients at Bridgewater who refuse medication put in restraints and forcibly drugged. It’s inhumane, she said, to leave patients oblivious to their own illness untreated. Studies suggest that both bipolar disorder and schizophrenia can be degenerative, another reason to begin treatment quickly.
“It’s medical illness and we’re allowing it to fester,” she said.
“It’s causing our patients to ... live in this constant revolving door of homelessness and incarceration and long-term institutionalized care.”
Opponents worry the legislation would expose a wider swath of mental health care patients to involuntary medication without a judge’s input by expanding the definition of “immediate, substantial, and irreversible deterioration.”
“Any bill that would erode people’s rights this much has to be of serious concern,” said Tatum Pritchard, the director of litigation for the Disability Law Center, a Boston-based legal advocacy organization. “This is not a tool that we would expect would be used sparingly, with so little guardrails up.”
Amid complicated questions surrounding treatment of mental illness, families such as Nick Craciun’s just want a route back to health for their loved ones.
The father and son shared a love of the Boston Celtics even through the younger man’s struggles. As the Celts charged toward another championship, Laurentiu Craciun had to tell his son, who spends most of his time in a solitary cell, the results of games. The jail’s curfew, he explained, didn’t allow him to see the final minutes.
“These are the hardest years of my life,” the father said. “To be mentally sick and to be in a cell, that’s very hard.”
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