The evening of April 6, 2017, I let my dog outside with no idea that just across the street, my longtime neighbors, the Nicholson family — a husband, wife, and 24-year-old daughter — had just been shot to death in their home by their 20-year-old son/brother, a young man with undiagnosed schizophrenia in the midst of a severe psychotic episode.

Around midnight, two Polk County Sheriff’s deputies rang our doorbell and questioned my husband and I about the family. After they left, we didn’t sleep much for the rest of the night, in shock over the incomprehensible deaths of Mark, Charla, and Tawni, and that Chase was now missing with a warrant out for his arrest.

Later that day, Chase turned himself in to the authorities in southern Missouri, was extradited back to Iowa, and confessed to the murders.

I followed the news reports closely, the interviews with extended family members of the Nicholsons, and their stories of how Chase had struggled with mental illness for most of his life, and how hard his family, particularly his mother, had tried to get him adequate help. Just days before the murders, Chase had a serious suicide attempt and was taken to the ER where he told doctors he was sick and needed hospitalized.

But in 2017, after then-Gov. Terry Branstad closed two of the four state mental health hospitals, Iowa ranked last in the nation for psychiatric beds, with only two beds per 100,000 residents. The night of Chase’s suicide attempt when he begged for help, there were no beds available in the entire state, so he was sent back home with his parents. Days later, in the grips of undiagnosed and untreated paranoid psychosis, he killed his family.

The accounts of the Nicholson’s private, painful struggles struck a deep nerve with me, and I felt compelled to do something. So I did what I know how to do best: I wrote about it. I started with a guest contributor column for The Des Moines Register titled “When Iowa’s Mental Health Crisis Lands Next Door” and chronicled the details of the case.

In the conclusion I wrote, “A June 11, 2016, Des Moines Register editorial . . . said, ‘To secure help in a state psychiatric facility here, apparently you need to break the law.’ And that’s precisely what Chase Nicholson did. He will now be treated for his mental illness in the Iowa penal system, not the Iowa mental health system. Therein lies the tragic irony of it all: Chase is finally getting the help his family fought so hard for and, ultimately, died for.”

Six years later, that last line haunts me. Because now I know Chase very well, and know just how true that statement was and still is.

In the spring of 2018, after Chase pleaded guilty and started serving three consecutive life sentences in the mental health prison at the Iowa Medical Classification Center in Coralville, I wrote my first letter to him. I couldn’t stop thinking about his mother, how much she clearly loved him, and my belief that she would want someone in the world to still care about him. He remembered me, remembered playing with my kids at my house when he was a child, and was grateful to have a pen pal. We’ve been communicating ever since.

As I’ve gotten to know Chase over the years through letters, emails, phone calls, and eventually visits, we’ve built a genuine friendship. Today, he’s accurately diagnosed and medicated by a prison psychiatrist, is stable for the most part. He’s incredibly bright and artistic, but also haunted and tortured by what he did during his psychotic episode. Whenever he’s experiencing an acute, serious mental health episode and needs a few words of support, he sends me an email with the subject line “988”— the national Suicide and Crisis Lifeline number.

And as I learned more about the complexities of his serious illness, I eventually came to a stark realization:

Back in 2017, without long-term in-patient treatment, Chase and his family never had a chance. They were undoubtedly overwhelmed, frustrated, and in over their heads with a son who was far more ill than they realized, or could help on their own. They were just getting by, doing the best they could to manage their situation. As I’d predicted in my first article, Chase finally secured the necessary long-term, in-patient help he needed in a state psychiatric facility by breaking the law. But four lives had to be sacrificed in order to get it.

Sadly, my opinions of Iowa’s mental health care system have not changed much in six years. Progress has been slow and miniscule, and our state still seems to accept that it’s easier to deal with mental illness in the penal system rather than the medical system. The stories of other families struggling to help loved ones continue to strike a deep, emotional nerve with me.

So much work remains, and I’m still doing what I know how to do best: writing about it.