They are among mental health providers' biggest challenges. They are mentally ill people who have had multiple stays in psychiatric hospitals, county jails and emergency rooms.
They struggle with homelessness or refuse mental health medication and treatment.
A Yolo County mental health pilot program approved by county supervisors last week attempts to tackle the problem. The program of intensive, court-ordered outpatient treatment is designed to head off hospitalization, jail or worse for those with serious mental illness, but who do not meet emergency or conservatorship criteria.
The program adds about $65,000 to mental health providers Turning Point Community Programs for outpatient treatment, enough to treat as many as four clients, said Yolo mental health officials.
Turning Point serves as many as 50 people in similar treatment programs.
Yolo County mental health professionals modeled the program, with its mix of mental health counseling, case management and psychiatric care, after one in Nevada County and say it is essential for those who need care but are too ill to recognize it.
"There are times when folks do not understand their own illness and their own needs and do not see how that illness is impacting their behavior and stability," Kim Suderman, Yolo County director of alcohol, drug and mental halth, told the Yolo County Board of Supervisors at its June 25 meeting.
"When someone is encouraged by (judges) to participate, that's often enough incentive," she said.
The Nevada County program and the law that paved the way for the Yolo pilot stem from tragedy.
And it has also courted controversy.
Laura's Law, penned by then-Assemblywoman Helen Thomson, D-Davis, went into effect in 2003, enabling county courts to mandate outpatient treatment for those who refuse it and are considered dangerous.
Laura's Law is named for Laura Wilcox, who was 19 when she was killed in 2001 while working in a Nevada County mental health facility.
Scott Harlan Thorpe, accused in Wilcox's killing and the deaths of two others, was found not guilty by reason of insanity and was committed to Napa State Hospital.
But controversy over forcing mentally ill people into treatment has since stopped many California counties from implementing Laura's Law.
Nevada County, which did in 2008, is only one of a few California counties Los Angeles, Orange and San Diego among them to have implemented Laura's Law or alternative measures.
But after deadly mass shootings in Arizona, Colorado, Wisconsin and, last December, in Newtown, Conn., more attention is being paid to how mentally ill people are treated.
Michael Haggerty, Nevada County's director of behavioral health, said he was concerned that without Laura's Law in place, a crime had to be committed to compel potentially dangerously mentally ill people to get treatment.
"You can't engage these folks until something bad happens," he said. "For us, Laura's Law fills that gap. It's a huge concern for their loved ones and family members. They're desperate to get help."
But patient rights advocates and lawmakers have long rallied against the legislation as a violation of patients' civil rights.
And some county supervisors also harbored concerns, but ultimately supported the program.
Supervisor Jim Provenza, once a patient advocate at Camarillo State Hospital, recalled the "bad old days" of patients being "overmedicated as a means of control. It shows us the risk of going too far too fast," he said Friday.
"The fact that this is a pilot project addresses some of my concerns," Provenza said. "There are people who are severely mentally ill who might not realize it but can benefit."
"More and more, there's a core issue of mental health. It's kind of everywhere and we don't have the tools to deal with it," said county Supervisor Matt Rexroad. "Is this perfect? No. But does it serve the greater good of Yolo County? I believe it does."
Call The Bee's Darrell Smith, (916) 321-1040.
Editor's note: This story was changed July 8 to correct that Scott Harlan Thorpe was found not guilty by reason of insanity.