Steve Wilson called the Rock County Crisis Line because his stepson was cussing, screaming and throwing furniture.
Wilson feared his stepson, Cole Fuller, would hurt someone.
The crisis worker advised Wilson to hang up and call law enforcement to restrain Cole.
But before Wilson could make another call, Cole was dead.
Cole died from suicide April 4 at the rural Milton home of his mother, Robyn Hansen, and stepfather.
He was 17.
Cole's father, Jeff Fuller, and Wilson believe lack of care from the Rock County Human Service Department contributed to Cole's suicide.
Cole had suffered from mental illness for years. At the time of his death, Cole was on a Chapter 51 mental commitment that mandated Cole receive treatment for impulsive behavior, according to records provided to The Gazette by the family.
A Walworth County Court had ordered the commitment, but a short time before his death Cole moved from his father's home in Darien to his mother's home near Milton. His care was transferred to the Rock County Human Services Department.
"Honestly that (the transfer to Rock County) was when there was a total failure," Jeff said. "To say he fell through the cracks, I don’t think is fair because there was no support there at all."
Rock County Crisis Intervention Supervisor Bette Trimble said she could not talk about Cole's case because of patient privacy regulations.
The county has a crisis intervention department and a case management department to help people experiencing mental health crises. Those services are offered to all of the 160,000 people who live in Rock County, Trimble said.
If someone dies by suicide, the county offers support to family and friends, Trimble said.
People experiencing mental health crises get referred to the county by schools, law enforcement agencies, family members or elect to get help themselves, Trimble said.
The county sees people who are being placed on or considered for Chapter 51 commitments nearly every day, Trimble said.
On the day of his death, Cole was distraught because he had learned his commitment was going to be extended, Wilson said.
"He said, 'I want out of it, I am tired of being referred to as a mental defect,'" Wilson said.
'Passionate about everything'
Cole had a "magnetic personality." From the time he was 2 years old, everyone wanted to talk to him, Jeff said.
But Cole always "had an edge." He was argumentative and highly intelligent. He rarely turned down a debate or conversation about sports, Jeff said.
The 5-foot 10-inch teenager was a stellar athlete, Jeff said. If not for his mental illness, Cole likely would have played college football. He was fast—he ran the 40-meter dash in 4.6 seconds even though he was out of shape. He played as a running back and safety.
"He played with an intensity that few people do, but everyone should have, as far as the passion he played with," Jeff said. "That was kind of the way he lived life. He was passionate about everything."
Cole played football for Elkhorn before transferring to Milton his junior year. He hoped to play football, basketball and track for Milton after he was in better shape.
But that never happened. Cole's struggles stood in his way, Jeff said.
"Throughout all of this, it is easy to point fingers, but at the same time Cole never accepted help," Jeff said.
Cole's family took him to a counselor for the first time about three years ago. It was challenging to find someone who would meet with Cole at least twice a week, Jeff said.
In February 2018, Cole was placed on a 72-hour hold at Winnebago Mental Health Institute in Oshkosh, where he stayed for two weeks, Jeff said.
Cole was diagnosed with cyclothymia, a rare mood disorder; bipolar disorder; and depression, according to his county records.
Cole was given treatment with Walworth County Human Services under his Chapter 51 commitment. The county gave him a full psychological exam, prescribed medication and provided counseling services, Wilson said.
Over the following months, Cole was committed to Willow Creek Behavioral Health Clinic in Green Bay twice. Cole's family then sent him to a residential program at the Eau Claire Academy, which seemed to help, but his family could afford it for only a few months, Wilson said.
Cole's case was transferred to Rock County's Human Services Department after he moved in with his mom.
"I wish that we would have never gotten out of Walworth County's level of care," Wilson said. "I wish I would have fought harder for that or convinced Jeff to have residency in Walworth County. We thought it would be a simple transfer of care. I wish I had a do-over."
Details of Cole's time with Rock County Human Services were corroborated by Rock County Human Services records provided by the family and interviews with his family members.
On March 7, Cole and Wilson met with workers from Rock and Walworth counties to discuss Cole's transfer. A worker from Rock County told Cole a doctor would have to evaluate him to see if he could be taken off his Chapter 51 commitment, which was due to expire in May.
Cole said he didn't think he should be judged on the past and that he did not think individual counseling would benefit him, but he was open to family therapy.
Cole had been seeing a psychiatrist in Walworth County. A worker from Rock County said Rock County would work with the family to match them with an outside treatment facility that would accept their insurance.
Walworth County offers in-house mental health services, but Rock County in many cases works with individuals and families to find private-sector treatment. The crisis team tries to link people with service providers and offers some in-house services for people without insurance or are under-insured, Trimble said.
On March 22, a doctor in Rock County evaluated Cole and determined he would recommend Cole's commitment be extended. Meanwhile, Rock County was working on matching Cole with a private-sector therapist and connecting him with a county crisis worker.
Crisis worker Steven Miller was chosen March 18 to work with Cole. After rescheduling with the family twice, Miller met with Cole the afternoon of his death.
Cole was incredibly upset to learn his commitment would be extended.
Hours later, Cole was dead.
In the month Cole was in Rock County's care, he was never connected with a counselor or therapist, his dad and stepdad said.
On the day Cole died, Wilson sent two text messages to Miller asking Miller to call him. Wilson sent another message the following day. Miller replied the next day with two messages saying:
"I'm actually off on Fridays."
"I was informed by the Crisis Unit."
Miller reached out to the family eight days later asking if they needed any help. Wilson told him they were seeking grief counseling from their church.
Suicide and youth
Wisconsin like the rest of the nation has a shortage of mental health providers and psychologists, said Brad Munger, who works with the state's Bureau of Prevention Treatment and Recovery.
Getting immediate help can save someone's life but is not always available.
"I will never feel like I did everything I could do," Jeff said.
Awareness campaigns and people sharing their stories has resulted in more people going to Rock County Human Services for help than in years past, Trimble said.
Universal screening, trauma informed care, peer support and talking to people with experiences are some of the best practices crisis workers are implementing now across the state, Munger said.
Rock County is working on implementing the Columbia Suicide-Severity Rating Scale at all local organizations that come in contact with people experiencing mental health crises, Trimble said.
"Now, having had a child that struggled and going through that, it is like, ‘My gosh, there are so few opportunities to get help,'" Jeff said.