When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice. “We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

“I said that when things like this happen, one of the first things you hear about is somebody being mentally ill.” She added that her son, like most people with mental illness, has never been violent.

Ms. Wolf, a neighbor who attended the same synagogue, was one of the few people Ms. Sheena talked to about her son. Ms. Wolf started her career as a hospital administrator, then after law school represented hospitals in commitment hearings. Families of mentally ill people, she said, heard about her and began to turn to her for help.

A popular, athletic child, Lance started showing signs of obsessive-compulsive disorder at age 11 and began using drugs around the same age.

“I never had trouble buying drugs because I sold drugs,” Mr. Sheena recalled. “And when I wasn’t buying drugs I got them from the doctor. Valium, Xanax, Adderall, Ritalin, Seroquel. Finished a bottle of Adderall in 12 hours once. That’s like 30 pills, 20 mg. each. I was lying under the air-conditioner listening to my heart beat. Finally I woke up, took some Xanax.”

Eight years ago, after taking “a lot of prescription drugs and Ecstasy,” he said, he landed in the psychiatric ward at North Shore Hospital in a state of drug-induced psychosis. It was the first of several such stays, some by his volition, others against his will. Three years ago, Ms. Sheena came home to find him in the woods behind the house, wearing only shorts and a T-shirt in the January cold.

“The level of life I had in me that was productive was so low,” he said. “I was almost homeless, I was a complete bum, and I decided to clean the woods. It was the only thing I could do.”

Finally, at a psychiatric hospital upstate, he received a diagnosis of schizophrenia.

“It was tearing us apart,” Ms. Sheena said. Her son’s three younger brothers were angry at him for the turbulence in their home, she said. His youngest brother, who is now in high school, had never known a normal home life. After that hospitalization three years ago Lance Sheena stopped using drugs — for his mother, he said.

Mr. Sheena returned to school and earned an associate’s degree. But his illness follows its own agenda. Last summer, he became flooded with thoughts of death and was hospitalized twice in quick succession, the second time against his will. He left his mother angry messages, which she saved.

“Nasty messages,” she said. “ ‘I hate you. Get me out of here.’ Nasty.”

“Why’d you save them?” he asked.

“I don’t know.”

“No really, why?”

During that time, Ms. Sheena began turning to Ms. Wolf for help. Ms. Wolf said she could petition to have Mr. Sheena released from the hospital and into a different kind of supervised involuntary commitment, known as assisted outpatient treatment, that would be less restrictive. But she also advised the Sheenas not to let their son move back into the family home.

“We were at a breaking point,” Ms. Sheena said. “He would come home and we’d be back in the same roles where I’m looking to see if he’s going to his meetings, if he’s taking his medicine. What is he doing? Is he sleeping? Is he bouncing off the walls all night?”

It was too much, Ms. Wolf said. “I try to get people off of that, because I have found over these 20-plus years that it works better when you put the professionals in place and the family members go back to being the loved ones,” she said.

Ms. Wolf helped Mr. Sheena move to a group home, where he has a case manager and social worker and takes the bus to court-mandated therapy appointments and group meetings. Now, when he returns home to visit, “there’s a real sense of calmness in the house,” his mother said. “It’s wonderful, it’s peaceful, it’s loving, he sleeps home often on Friday night. And he’s doing better because he’s not as stressed, because we’re not watching him like that.”

Mr. Sheena said he was unhappy about not being allowed to move back home. But his life is more stable, he said, and he has started to write about his experiences, with help from his mother.

“Now, he’s the best he’s been in the last 10 years,” she said. “He’s come to accept that he’s mentally ill, that he has an illness and that it needs to be treated. And I hope he can be better than he is now, but who knows?”

Not all of Ms. Wolf’s clients can report even that much hope.

In a Midtown financial services office, a consultant whose son suffers from bipolar schizoaffective disorder described an almost unbroken series of setbacks, with his son now living in an efficiency hotel in Georgia, refusing to take medications or acknowledge that he needs care. To avoid causing more pain to family members, the father would be identified only by his first initial, J., and his son by the initial R.

“It tears your heart out as a parent, believe me,” J. said.

J. first met Ms. Wolf more than a decade ago at NewYork-Presbyterian Hospital, where he was visiting his son and she was representing the hospital in commitment hearings. By that time, R., who is now in his early 40s, had been hospitalized involuntarily several times, each time ceasing treatment after he was released. He lost apartment after apartment, sometimes for harassing the owners or other residents.

Then he took a bigger step, going to the home of a film executive and harassing the man’s wife. When he was arrested and charged, his father called Ms. Wolf.

“The D.A. wanted to put him in jail for two years,” J. said. His son’s criminal lawyer was ready to take a plea deal, which would involve prison time, the father said.

Instead, Ms. Wolf negotiated with the prosecution to allow him to be committed involuntarily to Bellevue Hospital Center. When R. petitioned to go home, saying he did not need treatment, Ms. Wolf argued that he was still a danger to himself and others.

“She went to court for us every Tuesday,” the father said, “and we were able to show cause why he should be kept there. And the doctors helped us, but only because Carolyn spoke to them and assisted us.”

After nine months in Bellevue, R. was finally discharged, against the efforts of Ms. Wolf and his father. Ms. Wolf engaged a psychiatrist, a case manager and someone to live with R. to make sure he took his medications. But soon he stopped complying again; nothing was different.

Now, J. would like to see his son in a residential psychiatric center or a hospital. But R. will not go voluntarily, and unless he commits a serious crime, the courts will not commit him long-term.

“I’ve gone through a fortune, and the system stinks,” J. said. “It can be shown by some of these recent killings in Sandy Hook and in Aurora. Or Virginia Tech. These are people who are mentally ill and they’ve proved that they’re mentally ill, who the court system fails and the mental health system fails. You can see the glary, starey eyes of this killer from Aurora in court. I’ve seen that expression from my son when he’s been locked up. And it’s because he’s totally psychotic.”

The day Melissa Klump, now 28, tried to kill herself, in April 2011, she woke with a sense of overwhelming serenity, knowing what she wanted to do. She had fought with her brother the day before, when he blamed her for destroying their parents’ marriage.

“I was calm,” she said. “I went upstairs, I showered, I did my hair, I put on a nice little cute outfit, I wrote a letter to my grandmother apologizing for what I was about to do, and I wrote that I wanted to be cremated. I lined up all my pills and took a picture and sent it to my brother and I said, Happy Easter. And I downed 20 Xanax and 10 Trazodone, and took it all with a warm Corona.

“Just then my dad started pounding on the door. I opened the door and said, ‘This is what you guys wanted, so here you go.’ I threw my bottles down the stairs.”

At a recent appointment in Manhattan, she arrived early, with polished nails and crisp eye makeup, eager to talk — about her suicide attempt, about her future, about her serial medication regimens: Lexapro, Effexor, Cymbalta, Xanax, Trazodone, Prozac, Klonopin, Lamictal, Ativan. She showed the delicate script tattoos on her wrists, reading “Carpe Diem” on one arm and “La Bella Vita” on the other, covering the places where she’d cut herself with a hot safety pin.

After she was sent home from the treatment center for slapping another resident, her mother took her to see Ms. Wolf, who asked her what her goals were.

“I didn’t think she would ask me that,” Melissa Klump said. “It seemed nice that she was interested in me as a person. She said she had someone who could help. She also said I was one of her few clients who have goals and plans.”

Ms. Wolf arranged for a care manager and a life coach to see Ms. Klump several times a week at her grandmother’s house.

Christopher Mooney, the care manager, said he was working with her to meet her goals: to pay down her five-figure credit card debt — the result of a few manic sprees — to set a budget, to make a financial plan; then they will start to look for apartments. “She’s got the capability, but she needs someone there to help her make it happen,” he said.

Mr. Mooney bills $150 an hour for his time. The life coach, who meets with Ms. Klump more regularly, charges $50 an hour. Ms. Wolf would not discuss her fees.

It adds up, Elisa Klump said, especially on top of all the other expenses. “We’re coming to the point where there’s going to be no more money left,” she said. And still she knows that her daughter could slide back, as could any of the others. Their lives remain subject to powerful forces, both internal and external, for which a lawyer can do only so much.

“We’re in baby steps,” Elisa Klump said. “She’s lost many years of her life. Carolyn put her down the right road. We’ll see where she goes.”

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