The family of the West Burlington man who died Monday after an hours-long standoff with police hope sharing his story can help put an end to the damaging stigma surrounding mental illness and addiction.

Juli Kartel pleaded numerous times over the phone with her brother to put down his gun and surrender to the police officers surrounding his West Burlington property Monday before he set fire to his home and took his own life.

As the director of clinical services at Rosecrance mental health facility in Champaign, Illinois, Kartel has dealt with her fair share of mental health crises.

"It's harder with your own family member," she said. "He was not in his right mind."

Even as the sound of a gunshot — one of many her brother would fire throughout the course of the 14-hour standoff — rang through the receiver, her voice remained calm, telling the 62-year-old Michael Kartel his family loved him and wanted him to be safe, but her words fell on deaf ears.

"He was not going to allow himself to be placed in any facility that could keep him safe, including jail," Juli Kartel said. "He said if I couldn't get him out of the house without the police present, he was going to end his life."

The real Michael Kartel

Alaura Rappenecker knew Michael Kartel not as the man who barricaded himself inside 414 E. Pennington St. that day, but as the family man who walked her and her sister, Arrin Kartel, down the aisle at their weddings, the man who cried tears of joy when he learned he was going to be a grandfather, the man who worked hard to care for she, her sister and her brother, Jesse Kartel, who suffered long-term health issues.

"My dad was a very empathetic person — he had a big heart," Rappenecker said. "He cared about what was going on in your life. When you were with him, he wanted to make you laugh. He had the best sense of humor."

She remembers Michael Kartel as the man who threw pool league parties in the basement of their family home, worked on RC cars, brought his children with him to the Hobby Shop downtown and operated his own computer repair business. He enjoyed Sci-Fi movies and shows and music.

"We are a very close family who has been through many ups and downs," Rappenecker said. "We all are very involved in each others lives and in constant contact."

Michael Kartel had held a steady job working for the Burlington Railroad shops until it closed. Evenings, weekends, birthdays and holidays were spent with family.

"The man in my father's house that day was not the real Michael Kartel," Rappenecker said. "We lost him awhile ago."

'Trapped in a different world'

"He was really just an amazing, smart, funny, goofy guy who certainly loved his family," Juli Kartel said. "But he struggled many many years with addiction and mental health."

Juli Kartel suspects that her brother had been struggling with depression and anxiety for quite some time when, in 2012, his alcoholism became apparent. With the help of family members, he sought treatment at a rehabilitation facility — the first of three inpatient facilities he would attend over the next several years — and was seemingly doing well.

Relapse, however, is part of the cycle that is addiction, which is often made more complicated by the presence of mental illness.

"It's a chemical thing that happens in the brain," said Juli Kartel, who lost another brother, Joe Kartel, in April 2018 to liver failure. Her younger brother, Steven Kartel, died in 1984 after getting in a car with a drunk driver. "Willpower doesn't change that."

He continued to have his ups and downs since then. During the good times, Juli Kartel said, he loved life. But those good times began to grow fewer and further between as his mental health gradually declined. That decline became more drastic about six months ago, making it more and more difficult for the family members with whom he had shared such a close bond to get through to him.

"He went down hill really fast," Rappenecker said. "The best way I can explain it is that it was like he was slipping into this different reality and the door was locking behind him. This reality was full of anger, hurt, and ego. We all were banging on the door trying to get him out, but it would not open."

Juli Kartel suspects her brother began using drugs at some point in what she believes was an attempt to self medicate. She and other family members had tried to talk him into going to another treatment facility, but he refused.

"Mike had been communicating that he was not willing to go to treatment," Juli Kartel said. "Because of the drugs he was using, his behavior became very erratic and threatening to family."

His sense of humor had been replaced by anger, irrational thoughts and a belief in something that wasn't there. He began losing his ability to take into account other people's perspectives. He would ramble on and repeat things to himself.

"There was no reasoning, no advice you could give him," Rappenecker said. "He literally was trapped in this different world."

With her father unable to accept that he needed help, Rappenecker decided in June to have her father committed.

Rappenecker hoped the committal would result in him being admitted to a dual-diagnosis facility — one that treats for co-occuring mental illness and addiction — but such facilities are in short supply when financial resources are limited.

"We couldn't make him go on our own," she said.

Instead, he was put in out-patient care for about three months. While the program wasn't what Rappenecker and her family had hoped for, the check-ins seemed to help keep him stable. But then they stopped.

Need for reform

Des Moines County Sheriff Mike Johnstone was among the many local law enforcement officers outside Michael Kartel's home that day.

Negotiations were going nowhere, he said, and officers tried more than once to back away in an attempt to de-escalate the situation, at which times Michael Kartel shot at them and began setting and extinguishing fires inside his home in what Johnstone said seemed like an attempt to draw them in for a confrontation.

While the day's events were alarming to many in the community, Johnstone wasn't surprised.

"In law enforcement, we deal with these situations every day," Johnstone said.

The Des Moines County Sheriff's office is responsible to picking up individuals on mental health committals and transporting them to Great River Medical Center, which has eight beds for inpatient mental health services, for an evaluation.

If the individual is determined to need inpatient care and no beds are available, they must wait at the hospital until one opens up, either at GRMC or at a facility in another part of the state.

"There is a lack of beds and a lack of long-term beds," Johnstone said. "You have to have long-term care for these folks and we just don't have it."

That wasn't always the case.

The 78-bed Mount Pleasant Mental Health Institute was one of Iowa's four state-run mental health facilities.

But the much needed, dual-diagnosis MHI was shuttered in June 2015 after former Gov. Terry Branstad signed legislation to stop funding it and the mental health institute in Clarinda. While the Clarinda facility was privatized, MHI's services were transferred to the 75-bed mental health institute in Independence. With 36 beds, Cherokee Mental Health Institute is the only other state-run facility in Iowa.

Mount Pleasant MHI's patients were transitioned to community-based care.

Too often, Johnstone said, those with mental illness now are sent home within two to three days, putting the burden of medication management and mental health monitoring on family members. The burden is made more arduous when addiction is present, as those with substance abuse issues sometimes mix alcohol or narcotics with their medication. It is made further difficult by the fact that those who have been involuntarily committed often return home angry.

"It puts so much strain on families," Johnstone said, remarking some family members need to seek mental health treatment themselves to cope with the stress of caring for a loved one with mental illness. "It's a revolving door."

Without sufficient mental health care, many who need it wind up behind bars.

"Unfortunately, a lot of these mentally ill people end up in our jail," Johnstone said. "And that's another tragedy in itself because they shouldn't be there."

Doug Ervine, administrator of the Des Moines County jail, said about 30 percent of inmates at the Des Moines County jail are there for mental health and/or substance abuse issues.

Inmates are screened upon arriving at the jail. Those identified as needing addiction and mental health services are seen within a week by the jail's mental health specialist. Those needing more intensive treatment are kept there until a bed opens up.

Ervine said he has noticed a drastic uptick in the number of inmates with mental health issues since MHI closed. They also stay there longer.

"They stay there longer just because there's no treatment options for them," Ervine said. "There's just nothing available."

The uptick in such inmates, as well as the extended stays, have resulted in the county having to pay to house inmates in other county jails.

Johnstone is hopeful that legislators will put at least some of the state's $289 million surplus toward mental health reform, for children as well as for adults.

"I know that people are watching and I know people are expecting something to be done," Johnstone said.

Time to end the stigma

For Johnstone and others familiar with mental illness and substance abuse, reform is long overdue.

Juli Kartel believes the reasoning behind the lack of adequate treatment availability is two-fold. First of all, the brain is a complicated organ.

"The science behind addiction and mental illness has lagged," Juli Kartel said, though she noted progress is being made.

The other reason, she said, is because of the negative stigma toward mental illness and addiction, making those who struggle with them ashamed to seek the treatment they need.

"There can't be any shame," said Juli Kartel, who herself struggled with depression until she sought treatment. "Denial and shame impact people's ability to get what they want and need."