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Wednesday, July 18, 2001
Mario Fiore is an example of how intensive one-on-one care of an aggressive young man with mental illness can pay off -- and how expensive it can be.
Mario has been arrested twice, once in 1996 when he broke the window on a police car, and again in 1997 after he assaulted a psychiatrist. No trial or hearing was held either time because Mario is profoundly autistic, with the social understanding of a 3-year-old.
Yet after the assault, Mario, then 18, spent one month in the Allegheny County Jail, and another 16 months in Mayview State Hospital's forensic unit, where residents must be handcuffed whenever they leave the unit. Mario's parents, James and Karen, said the county's mental health/mental retardation officials told them they had no better alternative for him.
The Fiores believed the Elizabeth Forward School District and the county simply wanted to reduce their share of the expense of schooling and caring for their son, who is now 22.
They persuaded the federal government to look into Mario's case, and in December 1997, the U.S. Dept. of Health and Human Services notified the county it would investigate the Fiores' complaint that the county was not providing their son with appropriate services.
After the Fiores also threatened a civil lawsuit, the county agreed to let Mario move to the Pressley Ridge campus on the North Side, where, at a cost of $1,000 a day, Mario has lived in a private cottage, attended by two to three staff members, since 1998. What expenses his insurance doesn't cover, the county does.
"We're very lucky that Pressley Ridge was willing to take him," said Dr. Nancy Minshew, director of the Center for Autism Research at the University of Pittsburgh. "There are folks that need structure of the type you get in an institution, with 24-hour supervision. But we've eliminated those options. There was just no place for someone like him."
The Fiores say their son was attacked while he was in the county jail and at Mayview, and they believe that experience -- along with certain medications -- inflamed his tendency to become violent whenever he felt scared or frustrated.
When Mario arrived at Pressley, he often lashed out, hitting and choking staff. But under a program run by Pressley Ridge's Luke McDonough and Lynne Boley, Mario has learned to control his anger and has even held a job, folding boxes at his cottage for a local pizza shop.
Last month, Mario participated in Pressley Ridge's graduation ceremonies, adding his own unique flair to the proceedings by stopping to salute during the processional.
At 5-feet-7-inches and 270 pounds, Mario looks like a bear of a man, but he lives in a child's fantasy world. He refers to himself as "Master Mario" and has a collection of golden-arch M's from McDonald's taped to his door. Mario will tell visitors that he is married, and he considers a small stuffed dog he keeps his real child.
"I'm not really a violent person," Mario said one afternoon. "Law and order is on my side."
He then told a story about how he once wrestled Hulk Hogan, stopping mid-sentence several times to search for a word that never came. Then he'd start again on another story. During one lengthy monologue, Mario spun a tale that included a battle involving Peter Pan, Frankenstein, the Incredible Hulk and Spiderman. "I'd like to see Garfield and the Terminator go after Raisin Bran man," he added with a smile.
At both introduction and farewell, Mario offered his left hand.
"When you shake with my right hand, that's bad luck," he explained. "It means I'll have a bad day. I may get put in restraints. I may be put in jail. So, for life and liberty, I shake hands with my left hand to bring good luck."
Perhaps the only fortunate part of Mario's story is that the severity of his autism probably saved him from prison. Anyone who spends time with Mario can see he can't be criminally responsible for anything. The Marios of the world "don't know how to lie and they don't know how to manipulate," said Minshew.
Most of the experts who have worked with Mario know that not everyone like him can be put in a cottage with two or three employees at a cost of more than $350,000 a year.
But they also know that the current system in Pennsylvania and most other places doesn't know how to handle people like Mario.
"You get people who will seriously hurt others for whatever reason, and how do you handle that? What do we do when it's part of a mental illness?" Minshew asked.
"We don't do very well with it."
Mario Fiore, now 22, will likely move into an apartment soon. (Robin Rombach, Post-Gazette)