A new way of thinking 

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He wore an oversized purple dress shirt and jeans, but no coat, walking stiffly on a pair of crutches the morning of Jan. 11. Eyes wild, hair disheveled, face red from the freezing air, he approached and asked to bum a smoke. I was sitting on a low brick wall trying to stay warm in a spot of sun, killing time with a cigarette and a Bob Cuddy article on county supervisor Adam Hill—snubbed again for a committee chairmanship—because I’d stupidly hopped the early bus to San Luis Obispo without bringing my New Times office key.

So I obliged the desperate-looking man, and within 30 seconds of perfunctory chat, he revealed that he’d tried to kill himself several times in the last few weeks. Clearly, it was a cry for help, but I had no idea what to do. He was having trouble staying upright, so I helped him to my little wall in the sun where he could rest and warm himself.

He was in obvious pain and said he’d slept outside the previous night with no blanket or coat. He also swore that his uncle had recently mailed him a bunch of money, which would let him get a motel room once the post office opened. I asked if there was anybody he could call in case the money wasn’t there and offered to let him use my cell. That’s when things got really weird.

He called his mom and told her that he was in trouble, that the police were conspiring against him, and that he’d tried to kill himself. He yelled that she’d abandoned him then abruptly changed his tone, told her repeatedly that he loved her, and hung up.

We talked a little longer, and from what I could gather, he believed that methamphetamine gave him the ability to build and destroy entire cities with his mind. He said God was mad at him for abusing the power, so he’d commanded the local police and judges to frame the poor man as a child molester and send him to prison for a lifetime of beatings at the hands of his cellmate. He knew this, he said, because he’d recently seen a Manchester United shirt in a store window while on the way to a court hearing for vandalism charges. The Manchester shirt was a sure sign that they’d charge him as a “Chester molester” instead, he said.

Soon the post office opened, and one of my coworkers arrived with a key to New Times. I reluctantly left the man, hoping that money was in fact waiting for him in the mail. I went inside, fired up the Internet, and searched for the best person or agency to call. The police would probably respond the quickest, but the man hadn’t done anything wrong as far as I knew. I chose the mental health mobile crisis line, and the lady who answered said she’d send someone to check on him. I redialed his mom, too, and left a message explaining her son’s condition and encouraging her to organize some help for him. And that was that. I spent the rest of the week wondering if I’d done right by the guy, if anyone would find him before he hurt himself again.

Lost in the shuffle

I eventually reached the man’s mom and learned how he ended up cold, crazy, and alone in San Luis Obispo. Her name is Anita Keefe (a last name that differs from her son, who won’t be named for privacy reasons). She said she was living across the country, in Massachusetts, and was devastated to know her son was struggling so much so far away.

She said her son, now 39, grew up like any other Southern California boy—friendly, intelligent, and active outdoors. He didn’t show any mental health problems until adolescence, when he became extremely anxious and was plagued with intrusive thoughts that he couldn’t get out of his head. He was diagnosed with obsessive compulsive disorder and mild schizophrenia. Combined, they make his life hell. Delusions result from the schizophrenia, and the OCD forces him to latch onto the odd thoughts and follow them to their extremely illogical ends.

“Everything he thinks is negative,” Keefe said. “That’s his reality.”

Medication stabilized him, Keefe said, but he didn’t like the side effects and struggled to stay on his prescriptions. He started smoking marijuana and taking other drugs instead, and his mental health deteriorated, Keefe said.

Keefe admitted that she had her own alcohol problems, which estranged her from the family. She explained that her son filed for emancipation and attempted a few years of college, but uncontrollable panic attacks caused him to drop out. He became homeless and started travelling alone across the state.

Family members successfully signed him up for Supplemental Security Income, but he opted out of the program when his dad died and left a trust in the son’s name under the control of other family members.

“He didn’t understand that he didn’t just get all the money,” Keefe said.

Now, she explained, he has to get in touch with faraway relatives and beg for his own money every time he runs out, a mean feat for someone with no home, no phone, and a limited grasp on reality. According to Keefe, her son did get a check the morning we met, but he made a scene trying to cash it at Wells Fargo. The police came, and finding he had outstanding warrants for failing to appear in court, they hauled him off to jail.

“They keep throwing him in jail, and all the while he really just needs some counseling and care,” Keefe said. “He doesn’t do well in jail.”

According to court records, he’s faced criminal charges for 31 separate incidents in SLO County since 2010, most of them misdemeanors: trespassing, possession of a controlled substance, drunk in public. He was simply fined and turned away for the minor offences, but he served 120 days behind bars in 2010 and was sentenced to a subsequent drug treatment program. In 2011, he did a year in prison for petty theft with a prior, and when he came out, he was worse than ever, racking up 25 charges in 2012 alone. His sanity was questioned multiple times over the last few years, but he wasn’t deemed incompetent to stand trial until after his arrest the day we met. He stands accused of committing felony vandalism on Oct. 29.

He’s currently in Atascadero State Hospital, where doctors are working to restore his competency and can force him to take medication.

“It’s heartbreaking,” Keefe said. “He’s really been lost in the system.”

 Although the mentally ill often commit crimes, suffering from brain or personality disorders isn’t illegal in and of itself, so the local agencies tasked with enforcing laws and maintaining public health have traditionally addressed the matter of mental illness from separate vantage points. The cops give tickets or lock folks up when they trespass, drink in public, harass passersby, or commit assaults, and the San Luis Obispo County Department of Mental Health and partner nonprofits attempt to treat the disorders through various inpatient and outpatient programs.

While the two sides inevitably intersect in certain situations—when people present imminent threats to themselves or others, or when a suspect is too far gone to stand trial—serious efforts at collaboration are relatively new in SLO County and were temporarily interrupted when the recession ripped through public budgets.

In 2005, the Board of Supervisors commissioned a Mental Health Criminal Justice Task Force with stakeholders representing the offices of the Court, District Attorney, Public Defender, Mental Health, Office of Administration, Sheriff, National Alliance for the Mentally Ill, Economic Opportunity Commission, Public Guardian, Probation, and the Health Commission. The group met monthly and developed several new programs using a cash injection from the Mental Health Services Act (MHSA), which stemmed from the passage of 2004’s Proposition 63, a one percent tax on individuals earning more than $100,000 per year that was dedicated to transforming mental health.

Notable results from the task force include the implementation of Crisis Intervention Training (CIT) opportunities to teach police better methods for interacting with the mentally ill and the creation of a Forensic Collaboration Team. Featuring many of the same stakeholders as the task force, the team would meet regularly under a memorandum of understanding that allowed them to share confidential information for focused discussions on problem individuals whose frequent bumps with the law might better be addressed through service referrals and targeted probation requirements in lieu of incarceration.

The programs didn’t really get going until 2007, and the economy started to slow shortly afterward. Though the county continued to collect dedicated MHSA funding, the general fund shrunk, and when key leaders of the effort retired, they couldn’t be immediately replaced.

The programs ground to a halt, but they’re beginning to see new light, thanks in large part to the efforts of Cathy Bianchi, a part-time reserve sheriff’s deputy, and Denise Braun, a certified therapist and forensic specialist with the mental health department. Their unique partnership, a year in the making, is beginning to bridge what they described as a dialogue gap between treatment providers and cops.

“Communications between law enforcement and mental health are kind of convoluted,” Bianchi said. “We speak different languages: I’m legal, and she’s clinical.”

Plus, they have to dance around pesky confidentiality laws. Bianchi can tell Braun all about a frequent offender’s behavior problems and the person’s history of contacts with the cops, but Braun can’t divulge any information about the suspect’s treatment history, medications, or delusions, or else she runs the risk of violating California’s Confidentiality of Medical Information Act, which prevents her from sharing anything that isn’t relevant to an immediate and direct threat to public safety.

In situations where she knows a patient with a violent history is off medication and expressing rising levels of anger and frustration, Braun can’t legally warn officers to be on the lookout. Nor can she say whether or not a missing person is safe and sound at the county’s Psychiatric Health Facility, and the police may have to waste manpower and resources searching for someone who isn’t lost.

“If we can change the way we can communicate, all in the interest of getting people into treatment and making the community safer, that’s the goal,” Braun said.

To that end, Bianchi’s boss, Sheriff Ian Parkinson, initiated a campaign for legislation that would clear away some of those communication hurdles. In the wake of recent massacres across the country, Parkinson has been vocal about the need for improved mental health services as opposed to gun control. He brought stakeholders representing law enforcement, the court system, therapists, and patients’ rights advocates together on April 30 to share ideas and air any concerns about his goal.

“It was good in the sense that we had the right people there, and the right conversations taking place,” Parkinson said. “This is something we could do to get real results with no added expense.”

The process is still in its early stages, with no language written into an actual bill and no legislators officially on board to introduce the law in Sacramento. So far, the plan is to define partnerships like Bianchi and Braun as a special relationship with the ability to share information more freely. Only officers with specific mental health training and working ties to therapists would be allowed to know a suspect’s diagnosis and mental health history.

“Everyone always thinks of law enforcement as jack-booted thugs, but we’re not,” Bianchi said. “The info I’m interested in really goes no further than getting these people out of the criminal justice system.”

Parkinson said that everyone supported the general idea of allowing sensible exceptions to confidentiality restrictions, but some urged caution.

Roger Gambs, a local activist with the National Association for the Mentally Ill, noted that patients are extremely sensitive about their rights, often rising to the level of paranoia. If they learn their therapists talked to the cops, he said, that discovery could enrage them.

“There could be some blowback for the one who does the divulging,” Gambs said.

He would prefer to see legislators throw their support behind Senate Bill 585, which is already in the mill and would give counties a more straightforward path toward using MHSA funding to institute intense outpatient treatment and case management for mentally ill people before they run afoul of the law, instead of after.

“I understand there’s little else they can do other than going to the step of breaking confidentiality to get these people some sort of help,” Gambs said. “But the help they’re going to get with this kind of thing is probably being able to live behind bars.”

Jill Bolster-White, director of the nonprofit Transitions - Mental Health Association, spends much of her time battling the stigma that surrounds mental illness and prevents a lot of people from seeking or accepting treatment. She said there’s a risk that allowing police to access more information could scare people away from the help they need, but it would also improve safety for the patients and the public. As long as the information is shared responsibly, she supports freeing it up.

“It’s an issue with a lot of ethical ramifications, and we have to proceed with caution,” Bolster-White said.

By May 14, Parkinson said the potential bill was taking a more definitive shape, but it likely wouldn’t reach the floor of California’s Legislature until 2014. Preliminary talks with local representatives Assemblyman Katcho Achadjian and Senator Bill Monning seemed promising, Parkinson said, but when New Times reached out to the legislators, both said they were unfamiliar with the effort.

In the meantime, Bianchi and Braun continue to work together. They’ve reinstituted the Forensic Collaboration Team in recent months and cited several success stories, including a woman San Luis Obispo motorists used to see regularly darting into traffic without warning. Again, confidentiality prevented Braun from dishing details, but she said law enforcement couldn’t do anything since the woman seldom broke serious laws or presented a direct, imminent danger. Ultimately, the collaborative group focused its efforts on the woman and was able to get her the help she needed.

“From what I hear, she’s doing amazingly well,” Braun said.

In the last week of April, Bianchi and Braun used MHSA money to offer the first Crisis Intervention Training seminar that’s been available in the county for two years. The 36-hour class was available free of charge for any law enforcement department in SLO County. Twenty-two officers from the city of San Luis Obispo, Grover Beach, Cal Poly, California Highway Patrol, Probation, and the Sheriff’s Department (both patrol and correctional officers) participated.

In the training academy, cadets spend only four hours learning how to deal with the mentally ill, and unlike driving maneuvers or shooting practice, no continuing education is ever required on the subject.

Senior Officer Kelly Cook of the Grover Beach Police Department said he deals with the mentally ill several times a week, if not daily, and was happy to take the class, which included role-playing exercises; PowerPoint presentations; and lectures from professional therapists, a person whose mentally ill son killed himself, and a stabilized schizophrenic who had once fired a gun at police officers.

“He was talking about trying to kill a cop to a room full of cops,” Cook said. “That was the oddest experience. And now, he’s volunteering to help enlighten the very same people.”

Cook said the experience was eye-opening. Cops often suffer from emotional fatigue, he said; after trying to help stubborn people for a long period, police tend to grow calloused and insensitive, which is understandable but far from helpful. These kinds of training exercises reintroduce officers to the humanity behind the mentally ill, he said.

At the same time, Cook said the training gave him tools and techniques to probe deeper into a disturbance and identify situations where the suspect’s delusions are getting out of control and posing serious threats to the general public.

Braun and Bianchi provided a field reference book with localized contacts for services and tips for communicating with the mentally ill in a manner that won’t escalate the situation and render violence or incarceration inevitable, and the role-playing allowed him to see what an interaction with police feels like from the perspective of someone struggling with a disorder.

“You want to be calm, patient, and deliberate with these people,” Cook said. “You don’t want to shout orders and demands. That’s confrontational, and will probably escalate the situation.”

Approaching a suspect with the wrong attitude can transform a quiet talk to a full-blown fight. For instance, on the morning of May 10, a man named Mike Campos was waiting for an appointment with a tiny puppy in the lobby of Stenner Creek Animal Hospital in San Luis Obispo when the police walked in and demanded that he talk to them outside. Campos has long struggled with mental illness, and as he left for the veterinary clinic, he’d gotten into an argument with his dad, he said.

The police told Campos that his dad had called them afterward, worried that his son would try to kill himself. According to Campos, he told the officers he was fine and tried to go back inside the lobby, but they began yelling at him and grabbing him, which made him extremely agitated. He screamed and fought back, but the officers subdued him and took him to the county’s Psychiatric Health Facility (PHF) for a 72-hour involuntary hold, under Welfare Code 5150 and the assumption that Campos was an imminent threat to himself or others.

Campos was taken in on a Friday, and there were no patient’s rights advocates available over the weekend, he said, so he had to stay at PHF despite being in a sound state of mind.

“A person that’s going to kill himself doesn’t take his seven-week-old puppy to the vet’s office,” Campos said. “I feel like my rights have been violated.”

A receptionist at Stenner Creek Animal Clinic said that Campos was behaving normally until the police arrived and hauled him away.

“We’re taking care of the puppy in the meantime,” she said. “He’s a cutie.”

A day in the life

Though Bianchi is technically a sheriff’s reserve deputy, her direct partnership with mental health benefits all local law enforcement departments. She’s really a communications hub. Before this gig, she worked 12 years for SLOPD, where her experience with the bomb squad put her in touch with officers across the county.

“She knows everybody,” Braun said.

When officers have repeated problems with a mentally ill suspect, they call Bianchi, who works with Braun in the hopes that they’ll be able to find services for the suspect that will help him or her more than another jail sentence would.

New Times tagged along with the duo on April 24 to see what exactly they do.

Bianchi and Braun begin most of their days at the San Luis Obispo Superior Court, where Braun has a downstairs office as a forensic therapist.

First Braun printed out a list of all the people from jail with known mental illnesses who would be in court that day. There are five to 10 on average, she said, and Bianchi and Braun focus their efforts on cases that have garnered particular interest from law enforcement, hopping back and forth between courtrooms hoping to be present when a high-interest case is heard.

“If an officer takes the time to track me down and call me, they’re really concerned,” Bianchi said.

On April 24, the duo was particularly interested in cases involving an arson suspect from Atascadero and a frequent trespasser in Cayucos. Nothing happened with the alleged arsonist, but Braun was able to inform the Cayucos suspect’s public defender about the man’s repeated problems and recommend that he push the judge for a psychiatric evaluation or potential sentencing through Behavioral Treatment Court instead of fines or jail time.

“[The public defender] thought there was just the one case,” Braun said. “But he’s got five arrests. The lawyers don’t have all the information, not because they’re unqualified or lazy, they’re just slammed.”

According to Chief Deputy District Attorney Jarret Gran, the Behavioral Treatment Court (BTC) handles qualified defendants who have entered guilty pleas to minor crimes with a stipulation from the judge saying a mental illness was the driving force behind the offence. Under BTC, judges can sentence the individual to a tailored probation stint with mandated treatment programs and orders to stay on medication. As long as the person complies, he or she won’t see the inside of a cell.

After court, Bianchi drove to Atascadero while Braun sat in the passenger seat making phone calls to the jail and PHF to check on the status of a suspect who’d been deemed incompetent for trial two weeks prior. The judge had hoped the suspect would be restored by April 25, but on April 24, the person had just been admitted to PHF, an inpatient facility with just 16 beds to serve all of SLO County’s mentally ill. Three beds must be held on reserve for emergencies, and when the rest of the beds are full, incompetent misdemeanor offenders linger in jail without being charged of a crime. Accused felons go to Atascadero State Hospital for restoration and usually don’t have to wait for beds to open up.

According to Undersheriff Tim Olivas, the jail had only one inmate awaiting restoration on May 1, but he’d been waiting four weeks. At one point in the last three months, there were nine waiting, Olivas said. The staff doesn’t keep detailed records on what type of inmates are in custody, so past information couldn’t be reviewed.

“We call over every day to find out if beds are available,” Olivas said.

At the Atascadero Police Department, Bianchi and Braun met with Detective Rochelle Hanson to see if any progress had been made with a particularly troublesome character. Since 2010, her department had contacted the individual a documented 34 times, not including officer-initiated talks.

“It’s taxing on an agency,” Hanson said. “It’s a drain of resources.”

Departments don’t document whether or not mental health played a role in their calls, so there’s no real way to measure how many police resources are devoted to dealing with the problem. The only “crimes” tagged and logged with an obvious mental health component are suspected violations of Welfare Code 5150, the provision that allows police to place people who pose an immediate, direct threat under arrest.

According to records from the various law enforcement departments countywide, officers responded to 1,588 calls for Welfare Code 5150 over the last five years.

“People say no one’s watching these people, but we’re doing the best we can,” Braun said. “It’s more than a full-time job.”

Since bringing the problem person to Bianchi and Braun’s attention, Hanson said the man is doing much better. The last time she talked to him, he was still on the streets, but he was coherent and had received help settling his open warrants and applying for Supplemental Security Income. The police department hadn’t heard from him in two to three weeks—a good sign.

“I’ve been dealing with this guy for my entire career with APD,” Hanson said.

From Atascadero, Bianchi and Braun drove to SLO County Jail to check in with Lt. Kelly Kenitz and discuss implementation of an incentive program that would encourage mentally ill inmates to take their medications by rewarding them with simple privileges. Braun brought the idea back to SLO after attending a state conference in March and learning how well it worked in San Bernardino.

Unlike PHF or ASH, the jail can’t force medicate, because there’s no doctor on staff 24 hours a day, Kenitz explained. Of the jail’s average daily population of 700 inmates, 20 to 25 percent use services from the psychiatric ward. About half of those people suffer from situational depression brought on by life in the jail, but the rest are seriously ill, Kenitz said.

“The jail’s not a detox facility, and it’s not a mental health facility,” Braun said.

The jail employs four full-time mental health therapists who process 40 requests for treatment or medication every day in addition to preparing psychological evaluation packets for the court and performing safety checks for detoxing inmates.

“They’re going all day long,” Kenitz said. “And they do an amazing job considering the circumstances.”

The jail is the only facility in the county qualified to take incarcerated suspects to and from the courthouse, so suspects who spend time in ASH or PHF working to have their sanity restored for trial have to return to the jail, sometimes waiting another week to have their day in court. Often by then, Parkinson said, their medication wears off and can’t be forced, so they face the judge just as delirious as the last time.

A psychiatrist at ASH, Dr. David Fennel, said that one percent of the population suffers from schizophrenia, but the cause is unknown. The disorder responds well to medication, and improvements to drugs are making side effects less intense, he said.

The hospital has a maximum limit of three years to restore a patient’s sanity, but that process can usually be done in six months. In cases of extreme insanity complicated by Alzheimer’s disease, competency can’t be restored, but counties often direct ASH to keep trying for the full three years, Fennel said.

“They know they can put off the reckoning,” Fennel said.

 Competency restoration consists of medication regimens, therapy aimed at dealing with triggers, general court education, and a mock trial.

“By the time they go back to court, they’re psychotic again,” Fennel said. “It’s not infrequent.”

According to Ralph Montaño, a spokesperson for the California Department of State Hospitals, five percent of patients are returned to the hospitals statewide after restoration.

After lunch, Bianchi and Braun had an afternoon schedule stuffed with staff meetings the press couldn’t attend, so we parted ways. Bianchi noted that their work is mostly behind the scenes and hardly exciting, kind of like pushing a boulder uphill, but their communication efforts can make a big difference.

“I don’t want to make it sound like we’re the saviors of the day,” Bianchi said. “We’re not. We’re just trying to keep people from falling through the cracks.”

Theirs isn’t the only such effort.

The San Luis Obispo Police Department developed a Community Action Team last year to respond to public concerns about aggressive panhandling and harassment happening downtown at the hands of mentally ill homeless people and transients. According to Lt. Jeff Smith, CAT’s been staffed on an overtime basis by whichever officers want to sign up for five-hour shifts dealing exclusively with the mentally ill’s “nuisance” crimes and illegal creekside campsites.

The department has recently selected two officers to staff the team full time, creating a point of constant contact with a particularly troublesome population.

On May 22, Officer Kevin Waddell took a CAT shift and let New Times follow him around. Right away, he was called to talk to a man who’d been yelling at himself in the street. By the time Waddell arrived, the man had calmed down. Waddell recognized him, talked to him briefly, and ran him for warrants, finding nothing.

“They’re not always up on all their stuff,” Waddell said. “They just don’t care, don’t go to court, ignore tickets. … The biggest asset for us is finding something criminal going on.”

Waddell said he hasn’t been through the Crisis Intervention Training, but would be interested. He prefers targeted police work to general patrol.

Throughout the afternoon, he responded to more disturbances, talked to a guy who’s been barred from several service programs for violent outbursts, and cited a pair of women for illegal camping, but he didn’t make any arrests. Nor did he direct anyone to any specific services.

“A patrol officer has to stay in this cocoon of a car all day, but getting out and making these contacts and interactions is going to benefit all of us in the end,” Waddell said. “The stuff that becomes important is the small victories.”

From the service side, four representatives from Transitions - Mental Health Association, two from the Department of Mental Health, and one from the Department of Public Health formed the Homeless Outreach Team (HOT) in October 2012. According to team leader Joe Madsen, HOT attempts to replicate the efforts of the Homeless Outreach Program, which started in 2000 but was killed by former governor Arnold Schwarzenegger in 2007. That program had more money, resources, and workers, but the goal is the same: to connect with homeless people on the streets and direct them to services.

Madsen said the team has already exceeded its contractual duty with SLO County for the year and has contacted more than 200 homeless people, getting 140 to cooperate and seek services. Of those, 37 have undergone full mental health assessments, a process that opens case files and allows individuals to apply for such benefits as subsidized housing. Of those, 14 have created Full Service Partnerships and go to regular therapy sessions to address the root causes behind behavior problems.

“I have a funny feeling we’ll be asked to do more with the same, and I’m prepared to meet that challenge,” Madsen said.

Former staff writer Nick Powell can be reached via Managing Editor Ashley Schwellenbach at [email protected].