After Connor MacCalister allegedly slit the throat of an unsuspecting grandmother in a Saco supermarket this month, one of the first things he said, according to police, was, “I’m off my meds.”

Family members have since confirmed that MacCalister, who was born female but identifies as male, struggled for years with mental illness, although they haven’t elaborated on the details.

Horrific crimes like this, committed by individuals with profound mental illness, are rare in Maine, yet each time they occur, the same question arises: How could someone like that be out on the street, in a position to commit such a brutal crime?

The answer is simple. The threshold for committing an adult against his will is whether he poses an imminent danger to himself or others – a tough standard. With no evidence that MacCalister had harmed himself or someone else before the Aug. 19 killing, it was all but impossible to confine him to a psychiatric hospital.

This intersection of mental illness and violence has played out in communities across the country, sometimes on a much larger scale.

Adam Lanza, who carried out a mass shooting at an elementary school in Connecticut in 2012 and then killed himself, suffered from mental illness. So did James Holmes, who killed 12 people inside a Colorado movie theater, also in 2012, and was sentenced last week to multiple life terms in prison. On Wednesday, a disgruntled and mentally disturbed former journalist shot and killed two former colleagues in Virginia on live television, then took his own life a short time later.

The country’s gradual shift away from institutionalizing the mentally ill, which coincided with the advent of anti-psychotic medication, has allowed more people with severe mental illness to live within the community.

But when patients stop taking their medication, as MacCalister says he did, their behavior may become unpredictable or violent.

Another option, short of committing someone against his will, is assisted outpatient treatment, or forced medication. In those cases, legal guardians, health care practitioners and law enforcement personnel can petition for that.

The threshold for forced medication is lower than the bar required to commit someone to a psychiatric facility involuntarily.

But the option is rarely used in Maine.

Dr. Michelle Gardner, clinical director of Dorothea Dix Psychiatric Center in Bangor, said in the last five years, 128 people statewide have enrolled in assisted outpatient treatment, including 31 active cases. She said the option is not widely known and is cumbersome. Some mental health advocates also worry that forced medication is an infringement on individual rights.

It’s not clear if anyone ever sought such a court order to force Connor MacCalister to take medication for mental illness.

John Nutting, a former state senator who in 2010 sponsored the legislation to create assisted outpatient treatment in Maine, said he wonders whether that option might have saved the life of Wendy Boudreau, the Saco grandmother.

“Every time I see a case like this, I can’t help but think we failed,” he said.

MENTAL ILLNESS, BUT FEW DETAILS

Connor MacCalister’s struggle with mental illness remains a mystery to those outside his family.

His family members, including his brother Jeremey Hopkins of Biddeford and cousin Wallace Clark, have confirmed that MacCalister was mentally ill but have not elaborated on the nature of his illness, and have not returned phone calls or emails to discuss it further.

MacCalister was born Tanisha Hopkins in Newburyport, Massachusetts, but lived most of his life in the Biddeford-Saco area. His mother, Patricia Rae Hopkins, taught and ran an in-home day care and later became a foster parent and full-time volunteer in the community. She died last year from breast cancer at 68.

Little is known about MacCalister’s father. He is not listed in any court documents, not even on Tanisha Hopkins’ birth certificate.

In his teenage years, MacCalister wrestled with his gender identity and eventually decided to live as a male. He officially changed his name in early 2005 with the support of his family, but Clark said MacCalister’s gender identity crisis coincided with increasingly strange behavior. Clark would not elaborate on what the behavior was.

Clark said MacCalister saw several doctors but none seemed to agree on a diagnosis. It’s not clear whether MacCalister was ever hospitalized for his mental illness.

His mother served as his primary caretaker, even into adulthood. When she died, that responsibility fell to Jeremey Hopkins.

If MacCalister’s mental illness manifested itself in violent behavior, it never rose to the level of criminal conduct. His only documented brush with the law was a charge of criminal mischief in 2012 for allegedly damaging a police cruiser in Biddeford. That charge was dropped.

STANDING OUT, KEEPING TO HIMSELF

At the time of his arrest this month on a charge of murder in the slaying of 59-year-old Wendy Boudreau, MacCalister was living at Kallock Terrace, a subsidized housing complex in Saco that serves adults with mental disabilities. Most of the tenants are seniors.

Court documents indicate that MacCalister also lived at a group home in Biddeford, but one of the case managers there, Ruth Burke, said she did not remember MacCalister.

MacCalister was a visible presence around Saco, particularly in the downtown area, which is in walking distance of Kallock Terrace. Shop owners and others in Saco said MacCalister’s appearance – shaved head and camouflage clothing – made him stand out, but he kept to himself.

There are several services for adults with mental illness or disability in the Biddeford-Saco area, but it’s not clear whether MacCalister used any of them, and patient privacy laws prohibit agencies from discussing individual clients.

According to an affidavit filed one day after MacCalister was arrested in connection with Boudreau’s slaying, he told police he had been planning an attack for weeks.

He said he was angry with life and wanted to get back at someone. He planned to go to Shaw’s supermarket in Saco – a place he frequented – and kill several people. He said he wanted to target an elderly woman who couldn’t resist, and Boudreau fit that description.

Witnesses who responded to the grisly scene of Boudreau slumped in the frozen food aisle asked MacCalister, “Why did you do this?”

MacCalister replied that he was “off my meds” and that Boudreau “looked at me wrong,” according to court documents.

Brad Paul, police chief in Saco, said he couldn’t discuss MacCalister’s case because of the ongoing murder investigation. But he said mental illness intersects with public safety more often. He added that most people with mental illness are never violent, and predicting who may become violent is not easy.

More details about Connor MacCalister’s life – and his mental illness – could emerge at his murder trial.

A judge has ordered a mental health evaluation, but most of the details will likely be made public only if MacCalister’s attorney, Robert LeBrasseur, opts to use an insanity defense.

MacCalister is being held without bail at the York County Jail, and LeBrasseur has declined to comment on his client’s mental health history.

CIVIL RIGHTS VERSUS PUBLIC SAFETY

Joe Bruce said he’s followed the case so far and can’t help but draw similarities from his own experience.

In 2006, Bruce’s son, Will Bruce, attacked his mother with a hatchet, believing that she was an al-Qaida agent, and left her body in the bathtub.

Bruce, who suffered from paranoid schizophrenia, was found incompetent to stand trial and later deemed not criminally responsible by reason of insanity. He currently lives at Riverview Psychiatric Center in Augusta, Maine’s primary psychiatric hospital.

Since his wife’s death nine years ago, Joe Bruce has become a passionate advocate for reforming the mental health system, but said he’s seen few changes in Maine.

Only two months before Will Bruce killed his mother, he had been committed to Riverview. When he refused medication, Riverview released him. Assisted outpatient treatment was not allowed under Maine law then.

Joe Bruce, who lives in Caratunk, a small town in central Somerset County, said he wished his son had been forced to stick to his medication. His wife might still be alive.

Bruce said he understands that individuals have civil rights, and thinks the government did the right thing decades ago by closing mental institutions, but he believes it may have gone too far in preserving rights at the expense of safety.

“It’s a matter of balance,” he said. “How do you get effective treatment and at the same time protect their rights? I think it has gone so far in the other direction, away from institutionalization, that people slip through the cracks.”

MEDICATION, COMMUNITY SUPPORT

Jenna Mehnert, executive director of the Maine chapter of the National Alliance on Mental Illness, said she doesn’t think forced treatment is the way to go.

“What we really need to do better is getting people to understand their own illness,” she said. “It’s when they don’t understand, or don’t accept that they are ill that they go off their medications.”

Mehnert said anti-psychotic medication works but only when backed up by a network of community support, including counseling and safe housing options.

Gardner, the clinical director of the Bangor psychiatric hospital, agreed that forcing someone to take medication needs to be supported with other options, but she has found it to be successful.

“We’ve seen people who were in and out of the hospital for years because of non-compliance with their medication,” she said. “Now, we haven’t seen them back at the hospital.”

High-profile cases of violence involving people with severe mental illness have slowly shifted the national discussion toward reforming the system.

There are competing U.S. House and Senate bills introduced this month that are already described by some as the most comprehensive mental health reform bills in the last 50 years. Both would use Medicaid funds to create more inpatient beds, assist families in breaking through barriers created by the Health Insurance Portability and Accountability Act and expand capacity for assisted outpatient treatment.

Bruce said he’s hopeful.

“I still get calls from people, from all over,” he said. “They have a loved one who is struggling and they say, ‘Can you help?’

“Unfortunately, I often tell them, ‘I don’t have a lot of good news for you, but we’re working on it.’ ”

Staff Writer Eric Russell can be contacted at 791-6344 or:

[email protected]

Twitter: @PPHEricRussell

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