Sarahs standing in the hallway of the San Diego Central Courthouse, hoping to see her son Kyle as deputies lead groups of inmates, shackled together, to holding cells behind the courtrooms.
She spots Kyle and yells his name, and he gives her a quick, nervous smile. He looks younger than his 24 years and much different from the Kyle shed seen in jail last fall, before he was sent to a state hospital for treatment. Diagnosed with bipolar disorder and schizophrenia, hed refused to take his medication. Hed lost weight and let his dark hair and beard grow long. When Sarah visited him, his wrists and ankles were shackled. Despondent, is how she described him. For nearly six months, he was held in administrative segregation at San Diegos Central Jail—for his own protection, Sarah was told.
Five-and-a-half months. No medication, in his own cell in isolation, she says. All he did was sleep.
Last June, Kyle was charged with assault and resisting arrest after he verbally threatened a police officer in El Cajon. He was living in a nearby board-and-care facility and, the week prior, had walked away from a psychiatric hospital. Since he was 18, hes been in and out of psychiatric facilities and jail, his mom says.
Six months after his arrest, Kyle was declared incompetent to stand trial and ordered to Patton, Californias largest state hospital, in San Bernardino County. But hed end up spending another 70 days in custody before a bed opened up. Pattons licensed for 1,287 patients, but currently holds 1,523—the state has waived its cap through September 2020. Statewide, more than 200 inmates whove been declared incompetent to stand trial (IST) are waiting in jail—on average, 83.5 days, according to the Department of State Hospitals—for a bed to open up.
Jails are for punishment; theyre not for therapy, says Rob, whose son Mike is being held in administrative segregation at the Central Jail while he awaits transfer to Atascadero State Hospital. The backlog isnt new, Rob says. Six years ago, his son waited five months for a bed at Patton.
People are committed to state hospitals for a number of reasons—theyve been found guilty by reason of insanity or, like Mike, theyve been deemed mentally disordered offenders, meaning that although theyve served their sentence, theyre considered a threat to public safety and are kept at a state hospital until evaluators clear them for release. Folks are declared incompetent to stand trial (IST) when their mental illness has rendered them incapable of assisting in their own defense. Its this population thats putting the most strain on the state hospital system.
In 2012, the states Legislative Analysts Office (LAO) called attention to the backlog of IST inmates, warning that the state faces significant legal risks if something wasnt done to reduce wait times. The report referenced a 2010 appeals-court ruling in the case of a mentally ill man who waited in jail for 84 days before being sent to Patton. California law requires state hospitals to report on an IST patients progress within 90 days of a person being deemed incompetent, the ruling notes.
When a defendant arrives at Patton on day 84 of the 90-day period, there is no meaningful opportunity for the defendant to make progress toward recovery of mental competence, the judges wrote, let alone for the medical director of the hospital to make a written report to the court concerning such progress by the defendant.
Sometimes declaring someone IST is the only way to get that person treated. Defense attorneys are increasingly using competency proceedings to get help for clients, many of whom have cycled through the criminal-justice system without any intervention.
Over the last several years, weve been paying a lot more attention to how we help these people stay out of the system, says Deputy Public Defender Mel Epley. Its all about trying to identify why the persons in the system in the first place, treat that issue or address it so they wont have to come back.
It used to be that if a defendant knew the role of each person in a courtroom—prosecutor, defense attorney, judge—and understood his right to a jury trial, the person was considered competent, Epley says.
These are things you can question somebody about, and even if theyre mentally ill, after awhile, by the sheer repetition of talking to them, theyre going to get it right at some point.
Now the key question is whether someone can assist in his own defense and understand the consequences of his plea.
If theyre mentally ill and they have a delusion of what reality is, Epley says, then answering those other questions isnt going to get at the delusions. Its just a repetition of what the process is.
According to numbers provided by the San Diego Superior Court, between July 1, 2009, and June 30, 2010, there were 346 competency hearings. Four year later, that number had more than doubled to 745. A court spokesperson said the results of those hearings arent tracked, so its impossible to know how many of those cases resulting in an incompetency finding. Nor does the court track how many ISTs committed misdemeanors and how many committed felonies—misdemeanor ISTs are, in almost all cases, treated in the jails psychiatric security unit. But, a look the number of felony ISTs that the Sheriffs Department has transported to state hospitals shows the extent to which the populations grown. In 2010, 65 IST inmates were transferred to a state hospital. As of two weeks ago, the department had transported almost double that number—122—so far this year.
San Diegos Central Jail has only 30 psychiatric beds. Meanwhile, the county jail systems waiting list to be transferred to a state hospital has reached as high as 70. Daniel Pena, captain of the Central Jail, says theyre looking at how to better care for inmates whose transfer is delayed.
Were having to look at other options, including expanding to other housing units where were going to have to step up the level of treatment in some areas that we havent had to do before, he says. Its a growing population, and its going to be challenging for anyone whos operating jails and prisons.
Kyle did well at Patton, his mom says: He had proper care. He was given proper meds. He had group therapy daily. He was around people who had similar issues.
But his time there was bookended by jail stays. When a persons declared incompetent to stand trial, court proceedings are suspended. Sarah feared that when Kyle was released from Patton in late June and returned to jail, hed stop taking his medication and his condition would deteriorate.
There should be other options for mentally ill offenders that dont include jail, says Suzanna Gee, associate managing attorney with Disability Rights California. The law that governs competency proceedings allows for certain felony ISTs— those whove committed low-level, nonviolent offenses—to be placed in a court-approved outpatient treatment program instead of a state hospital.
Whats happening in practice is that people arent going to these community programs, Gee says. Theyre only going to the state hospital primarily.
A court spokesperson confirmed that San Diego County has no conditional-release treatment programs for felony ISTs.
Such programs are less expensive than putting someone in a state hospital and would, ideally, get a person into treatment faster.
The statute on placement isnt being really applied fully, Gee says. Youre harming the client, youre costing the state and youre getting, really, an inefficient system.
The LAO report highlighted a program in San Bernardino County, where felony ISTs are treated in jail, as one way to alleviate hospital wait times and prevent malingering—when patients fake symptoms to avoid being sent back to jail.
Ralph Montaño, spokesperson for the Department of State Hospitals, says theres a similar program—with 20 beds, like San Bernardinos program—in Riverside County, and there are plans to start programs in other counties to help reduce wait times.
But Gee doesnt think this is the way to go.
If they want to pilot another program, not in the jail. If they can pilot something in the community and see how that goes, I think its a start.
Unfortunately, its not something anyones really advocating for, Gee says: I think its unfounded fear about violence, and stigma.
The LAO report estimates that California would need to spend $200 million annually to clear the state-hospital backlog. But, thats money wasted if there arent the right resources to keep a person stable once he gets out of jail. There are community programs for mentally ill offenders, says Connie Magana, supervisor of the Public Defenders Mental Health Unit, but they sometimes exclude the people who most need help.
Sometimes the court orders them to try to seek case management, but some individuals have told me that theyve gone to try to get case management and theyve been denied; theyve been told, You dont meet our criteria, so we cant help you, she says.
CityBeat talked to several parents of mentally ill adult children who described how easy it is for someone to fall deeper and deeper into a system thats ill-equipped to handle them.
Like Kyle, Robs son Mike also did well at Patton. He was prescribed Zyprexa, a medication used to treat schizophrenia.
It was a night-and-day change, Rob says.
After two months at Patton, Mike was sent back to jail, where he was denied Zyprexa and put on a different drug, Seroquel. Shortly after he was released from jail, he was re-arrested for assault.
Nobody was hurt, Rob says. Hes not making excuses for his son, he adds, but in this case, he doesnt think the punishment fit the crime. He was on the wrong medication. He was in crisis, Rob says. He was in really bad shape.
Rob says he was led to believe that if Mike pleaded guilty, hed be sent back to Patton. Instead, he was sent to prison. There, he was put on a high dose of Seroquel, so they could make him compliant, so theres no problems, Rob says.
Because his crimes were tied to mental illness, before Mike was released from prison, he was evaluated by state psychiatrists and deemed a mentally disordered offender. Instead of being released, he was transferred to Atascadero, where hes been since 2010. Once a year, hes allowed to challenge his commitment, but to do so, hes transported to San Diego for a hearing, meaning he loses his bed at Atascadero. For an early August hearing—where he was ordered to remain in Atascadero for another year—he was brought back in June.
He is still in the San Diego County jail, in a cell 23 hours a day by himself—no therapy, no groups, waiting for a ride and a bed back at Atascadero, Rob says.
Anita Fishers son, who suffers from schizophrenia, self-medicated with crack cocaine and ended up with a mandatory prison sentence. That started a cycle: Hed be released to parole, violate his parole and end up back in prison.
Fisher is the education director for the local branch of the National Alliance on Mental Illness (NAMI) and leads a monthly Criminal Justice Family Support Group. She says shes an advocate for Lauras Law—she emphasized that she wasnt speaking on behalf of NAMI in saying this. Lauras Law says that a mentally ill person who refuses treatment, is a threat to himself or others and has a history of hospitalization and/ or incarceration can be court-ordered into treatment. Involuntary treatment is controversial, and only four California counties have implemented the law.
Had I been able to get my son into something involuntarily, he wouldnt have had all those trips to jail and prison and been on the streets, homeless, Fisher says.
In May, she went to pick up her son from jail.
Sometimes youve got to sit there for hours, she says. You dont know when theyre coming out. As she watched inmates being released, she started keeping count of those who were clearly mentally ill.
Now, this person needs help, shed tell herself. Hell be back here probably in 24 hours.
Kyle was in court this week to find out if hed be accepted into a program, Exodus, as part of his probation. Sarah had been told by Kyles public defender that to be accepted, hed need to show some level of awareness of his illness and that he wanted to get better.
He has to be cognizant that theres a correlation between taking medication: My life is smoother and its better; things are more positive, she says. I dont take my meds and things are bad, I get arrested, Im found naked under a bush. He has to draw the distinction on some level.
Sarah stood outside the courtroom with Bob, Kyles father. To them, this seems like Kyles last chance. His parents have struggled to help him, but having Kyle live with either of them isnt an option; hes disruptive in a way that only a parent of a seriously mentally ill child could understand.
Bob worries that if Kyles not accepted into Exodus, hell end up back on the street, then back in jail, where he doesnt always get along with other inmates.
If you dont have someone making him take the medication—. Bob trails off. Right now, I dont think theres an answer in the system.
The hearing was supposed to start at 9:30 a.m., but a bailiff comes out to explain its been delayed while attorneys discuss a case. Sarah wonders if its Kyle theyre talking about. Shed been in contact with Magana, the Mental Health Unit supervisor, and even sent a letter to Public Defender Henry Coker, pleading for help finding a program for Kyle.
At a little after 10 a.m., a deputy public defender calls Sarahs name and pulls her aside. Kyles been denied a slot at Exodus, she explains, but theyve found him another program, one that will provide the kind of intensive care he needs. The next morning, a representative from the program will pick Kyle up from jail. As part of his probation, hell have to stay in the program for a full year and come back to court each month to update a judge on his progress.
If my son would just come home, Sarah says. I dont think there would be anything better in life.
Some of the people interviewed for this story asked that last names, or entire names, not be used, for privacy reasons.