Eli Robinson’s siblings Marta and Duncan, an NBA player, and his parents, Elisabeth and Jeff, share their views on schizophrenia and mental health care following Eli’s death.
RYE — When the voices in his head warned of trouble, Eli Robinson bought a crossbow.
His mother, Elisabeth Robinson, recalled her middle child’s auditory hallucinations and spotting him in her yard with the weapon one morning. Eli clutched the crossbow, intent on defending her.
The boy who built forts and enjoyed hero narratives in movies and imaginary games as a child grew to act like a soldier intent on protecting his family.
“I woke up and he was outside without a shirt on with the crossbow, ready to protect me for the rest of the day,” Elisabeth said. She confiscated the weapon.
Calls between Eli and his younger brother Duncan, an NBA forward now playing for the Detroit Pistons, were frequent. Paranoia set in for Eli about Duncan’s NBA career after he signed a five-year, $90 million extension with his former team — the Miami Heat — in August 2021, the same year Eli was diagnosed with schizophrenia. At the time, Duncan’s new contract was the largest in NBA history for a player who came into the league undrafted out of college.
Duncan and Eli had countless conversations after his diagnosis, many of which were two-minute check-ins. If Duncan, a 3-point marksman, played poorly one game, Eli sometimes questioned their family’s safety.
“He thought people were out for me,” Duncan said.
A police officer once stopped Elisabeth at 5 a.m. when she was out walking her dog. Eli had called the department asking officers to check on her, concerned about her welfare.
“I come back and (Eli) goes, ‘Mom, you can’t leave the house anymore.’ He really believed in this,” Elisabeth said.
Schizophrenia, which can be diagnosed in anyone and presents a range of hallucinations, is a treatable mental health disorder with a range of antipsychotics available. But despite medication, Eli’s auditory hallucinations made him question reality, induced panic and eventually drove him to death, according to his family.
The voices not only flagged false danger against Eli’s family but made him anxious that he was at odds with friends.
“A lot of it was like, ‘You’re not safe. People are going to come and get you. They want you,’ that kind of thing,” Marta Day, Eli and Duncan’s older sister, said of Eli’s hallucinations. “Beyond that, he was very paranoid that people were upset with him, people in his life beyond us, friends of his. He’d do a lot of fact-checking. He’d call people and be like, ‘Are you mad at me? Did I do something? I’m having this voice that says that you’re mad at me.’”
Eight different antipsychotic prescriptions, 16 psychiatric hospitalizations and 30 rounds of electric convulsive therapy were not enough to save Eli.
In April, Eli died by suicide by jumping off the Piscataqua River Bridge, one of three bridges connecting Portsmouth, New Hampshire to Kittery, Maine. Six months earlier, he’d survived a suicide attempt from the same roughly 150-foot-tall span.
Schizophrenia patient costs can spike
Bills for schizophrenia care and consultation tend to surge past other mental and physical health conditions.
In Eli Robinson’s case, according to his family, two four-month stints at McLean Hospital in Massachusetts alone cost approximately $180,000, bills the family paid out of pocket.
“It’s an amazing place. He really got a lot of care but he just wasn’t treatable. It just wasn’t working,” Elisabeth said of McLean.
Others aren’t able to afford similar care, or even receive community mental health center guidance.
“Financial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both ‘direct’ costs of health care as well as ‘indirect’ costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care,” the National Institute of Mental Health says.
Treatment took a toll on Eli and Robinson family
The Robinson family spent several years helping Eli receive treatment at top facilities. No solutions seemed to last.
The family met with provider after provider, crisscrossing state lines to speak with experts in the field. Some medications were prescribed to counter the effects of others, all while attempting to quiet the voices Eli heard.
Breakthroughs occurred, but the family’s fight was mostly an uphill battle. They often faced difficulty in Eli’s patient records and medical history being transferred between clinics and providers.
Reminiscing on Eli’s treatment, Duncan stated: “I just couldn’t believe that there were this many inefficiencies within this space.”
“The four of us were constantly working to keep Eli afloat,” Marta said.
“He was a quagmire. He was a Rubik’s Cube of treatment, of trying to figure all that out,” Elisabeth said.
Eli was vocal about his schizophrenia, according to his family. Introducing himself to others, Eli would let them know he was more than three-and-a-half years sober and that he experienced auditory hallucinations.
“The thing about Eli is that he very much owned his sobriety and he very much owned his schizophrenia. He was very overt about that, and would probably tell too many people, quite honestly,” Marta said. “That, and being Duncan Robinson’s big brother. He was very open about having voices. He wasn’t suicidal in the sense of, ‘I don’t want to be alive. I can’t get out of bed. This isn’t worth doing.’ He was experiencing command auditory hallucinations that were telling him to end his life. I think he got to the point where … he was just so tortured, and he didn’t see a way forward.”
Eli Robinson experienced heightened stress in his journey with the disorder.
Medications made him groggy. He became an insomniac, up at all hours of the night with potent hallucinations.
While being treated, Eli suffered cardiomyopathy after doctors upped his Clozapine, requiring hospitalization in Boston, his family remembers.
“He was very overmedicated,” Jeffrey Robinson, Eli’s father, said.
From afar, Duncan would feel his brother’s emotions ramp up in response to his progressing hallucinations. He knew his parents and sister worked tirelessly to help find Eli the best treatment possible, only for Eli’s patient history to get lost in the fray.
“We were just on this hamster wheel going over and over,” Duncan said. “He would get transferred to somewhere else and we’d have to start all over. And they said, ‘Well, what if he takes this medication?’ (We’d say,) ‘No, he can’t take this medication. We’ve already tried this here.'”
Schizophrenia is rare. Co-occurring mental, physical health struggles are not.
A National Institute of Mental Health report states schizophrenia is estimated to affect between 0.33% and 0.75% of the global non-institutionalized population.
Health challenges tend to impact schizophrenia patients, and struggles with the diagnosis lead to self-harm for some.
“Co-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia,” the NIMH report says. “Possible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them.”
Many patients already have co-occurring mental or behavioral health disorders. An estimated 4.9% of schizophrenia patients die by suicide, according to NIMH, and the estimated average potential life lost among patients in America is 28.5 years.
Male patients with schizophrenia are typically diagnosed with the thought disorder in their late teenage years or young adulthood, a younger age than most women diagnosed.
Treating schizophrenia
Mental health providers and advocates are intent on destigmatizing schizophrenia, highlighting the modernization of treatment and criticizing depictions of the disease in popular culture.
Christine Crawford, a child, adolescent and adult psychiatrist at Boston Medical Center’s Child & Adolescent Outpatient Psychiatry Clinic, serves as associate medical director for the National Alliance on Mental Illness (NAMI).
Some early onset symptoms of psychosis, including bouts of depression and a lack of motivation, tend to overlap with other mental health conditions. For a schizophrenia diagnosis, a patient must exhibit six straight months of symptoms, including auditory or visual hallucinations, delusions and paranoia, that have an impact on daily function, Crawford said.
Not everyone diagnosed experiences hallucinations calling for physical harm to themselves or others.
The portrayal of schizophrenia in mass media has come under fire, with some fictional stories showing violent or homicidal patients.
A National Library of Medicine-published study from 2012 found 41 English-language films released between 1990 and 2010 had at least one major character with schizophrenia. Violent and harmful activity among the analyzed movie characters was common, with almost one-third of them engaging in homicidal behavior and about one-fourth of them dying by suicide.
“It’s important for people to know that people living with psychotic disorders are more likely to be the victims of violence rather than the perpetrators. That’s just a fact and media doesn’t support that,” Crawford said. “They don’t want to harm other people. They don’t want to harm themselves. I have a whole bunch of patients who live with schizophrenia who are married, have children, go to work each and every day, (and) they graduated from college.”
Early intervention, medication, therapy and support from family, friends and work colleagues are crucial to helping schizophrenia patients. Crawford recommends people worried about psychosis symptoms speak to a primary care provider for immediate input if access to community mental health care is a challenge.
“These are conditions we know how to treat and people can live meaningful and full lives,” she said.
What medications are available for schizophrenia patients?
Antipsychotics are prescribed by doctors to patients with schizophrenia.
Some first-generation prescriptions — including chlorpromazine, fluphenazine, haloperidol and loxapine — can cause short- and long-term movement issues and muscle stiffness in schizophrenia patients, according to the National Alliance on Mental Illness. Clozapine, which Eli Robinson took, lurasidone and risperidone are second-generation medications that are less likely to cause problems with movement or block dopamine in patients.
Susan Stearns is the executive director of NAMI New Hampshire. She said she has a 53-year-old relative who was diagnosed with schizophrenia as a young man and now receives a monthly injection to treat the disorder, rather than daily medication.
“It used to be that you’d wind up with a heavy dose of medication and antipsychotics. Now it’s a very different approach. Medication is low and slow because you’re trying to get folks to that right place,” she said.
Stearns said providers’ attitudes towards schizophrenia have changed.
“It’s really scary sometimes for the person who is experiencing it. When you hear about the hallucinations, the voices they may hear, I don’t hear stories of people whose voices are saying nice things to them,” Stearns said. “It’s a real challenge for folks when they are struggling to find the right treatment and the right care.”
Coordinated specialty care model explained
William Torrey is a professor and chair of the psychiatry department at Dartmouth College’s Geisel School of Medicine. He has practiced psychiatry in New Hampshire for 40 years and was drawn to the field with a particular interest in outpatient care.
“How do you support people to have gratifying, meaningful lives worth living who have these challenging illnesses?” he asks.
“Really good care involves coordinated, team-based care that addresses both the general medical psychiatric symptoms and the functional support of life all together as one team,” Torrey said.
Treatment teams, groups that include psychiatrists, case managers and vocational specialists, assist patients with Medicaid and their educational, housing and work status, address substance abuse, help find therapists and assist families of those experiencing psychosis. The coordinated specialty care model encourages a patient’s treatment team to help them pursue life goals.
“It’s important people don’t throw in the towel on life and give up, but to pursue their vocational and educational careers,” Torrey said.
“The research and data shows that if patients not only receive medication treatment, but the therapy, educational support (and) the vocational support, they do better,” Crawford added.
Robinsons to support Seacoast Mental Health Center
Seacoast Mental Health Center will receive over $110,000 from the Robinson family, money that’s been raised in the four months since Eli’s death. Working with center staff, the family has identified three main priorities for how to support the Portsmouth facility.
The money will be used in part to upgrade the center’s Sagamore Creek office after past attempts to find a new facility failed.
“We had been looking over the last few years at the possibility of finding a new location for our main office, as beautiful a location as this is,” Seacoast Mental Health Center president and chief executive Jay Couture said. “Real estate is expensive. There wasn’t anything out there.”
A portion of the Robinsons’ donation will also go toward suicide risk and violence assessment training for the center’s clinicians. The assessment tool was created by staff of Boston Children’s Hospital’s Trauma and Community Resilience Center. The tool was piloted by mental health experts across America, used by schools, hospital clinics, social service organizations and mobile crisis teams, and left cohort members feeling more confident in their ability to treat at risk people, according to the hospital.
Pending state approval, the donation may also be used to expand the Fairweather Lodge, Seacoast Mental Health Center’s eight-bed group home for housing insecure patients in Greenland. Couture noted the center is exploring state licensing to expand the facility, which is staffed full-time and currently houses four men and four women.
“This is very generous and certainly the level of kindness and generosity being shown just speaks to the connections of the Robinson family in the community and the goodwill people feel towards them,” Couture said.
The Robinsons said Eli felt properly cared for when in the care of the center’s clinicians.
“Seacoast Mental Health Center was a place Eli really felt seen and was where he could get effective treatment in this community,” Marta said.
But a larger task looms over the Robinsons’ mourning: Successfully getting safety barriers installed on the Piscataqua River Bridge to prevent future deaths of people suffering a mental health crisis.
Coming next: After years of crises on the Interstate 95 bridge, is change on the way?
If you need help
The National Alliance on Mental Illness – New Hampshire offers the following resources to those in distress:
- NH Rapid Response Access Point – Call/Text 1-833-710-6477 – If you or someone you care about is experiencing a mental health and/or substance use crisis, you can call and speak to trained and caring clinical staff. You’ll be served by compassionate providers from mental health centers in your community who can help you access vital resources in an emergency.
- 988 Suicide & Crisis Lifeline – Call or text 988 for 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. (Chat option is also available at 988lifeline.org.)