JOIN THE CONVERSATION: How should law enforcement agencies, the courts and mental health facilities coordinate efforts better in treating the seriously mentally ill? To write a letter, go to sacbee.com/sendletter. Or comment on our Facebook page at facebook.com/sacramentobee.
Matthew Herrera showed me his fingernails. Nice manicure. He jutted his cleanly shaven chin. Smooth.
He handed his mother a sweet Christmas card he made in a crafts class and ate the brownies she brought for him. He smiled, made a few jokes and was feeling much better than when I saw him the last time.
In October, a day and a half after being released from Sacramento County jail, he lay on a gurney at the UC Davis Medical Center, mumbling and asking what the nurses were saying behind his back.
Never miss a local story.
Now, he’s back at Sacramento County Mental Health Treatment Center, taking anti-psychotic medication and attending regular therapy to manage his illness and drug and alcohol issues. He makes eye contact. He talks in complete sentences.
“I get stronger and stronger each week,” he told me by phone the other day from the locked psychiatric facility where he has been living since mid-October.
Herrera wants the basics: a place to live, a few bucks, a girlfriend, a car. Whether he attains any of it, or falls through the gaps again, is a question mark.
Herrera first was treated for mental illness when he was 6. Since age 15, he has been in and out of psych wards, jails, two state prisons and two state hospitals. He didn’t complete high school and has no job skills. He turned 28 this year in jail.
On the news side, Cynthia Hubert and Phillip Reese have written extensively about Nevada’s practice of busing mentally ill patients to all corners of the nation. We on the editorial page have chimed in by denouncing that reckless practice.
California dumps patients, too, in different ways.
Herrera started the year in Sacramento County jail. He was a TSEP, which in jailers’ parlance stands for total separation, isolated on a psych unit. I became acquainted with him when his mother, Karen Herrera, called The Bee at wits’ end. He was going to be released at the start of the Presidents Day weekend.
He had no clothes, so jailers gave him a paper jumpsuit and flip-flops, and he was dumped with no plan for his care. His hair was wild and his beard was scraggly. He acknowledged my presence that Saturday morning with a grunt. Karen took him into her small Elk Grove home. He got worse through the weekend, sped off in her car and totaled it.
“That was pretty dramatic,” Matthew said, aware now of how bizarre he had been when he stole his mom’s car.
He was back in jail by the end of that three-day weekend. Released in May, he made it two weeks before he was back at the mental health treatment center. There, he took a swing at emergency medical technicians. That landed him back in jail, until he was dumped again, this time on Oct. 9, at 1 a.m. in downtown Sacramento.
Within two days, he had smoked a joint, got paranoid and ended up at the UC Davis Medical Center emergency room.
Senate President Pro Tem Darrell Steinberg had learned of the Herrera family’s struggles from me back in February and made it known that he wants Matthew helped. If attention from the leader of the California Senate and a columnist for the hometown paper motivates the county to try a little harder, great. His mom, a state worker, has struggled for years to get him help. She could use a break, as could he.
Care isn’t cheap. The cost of a day at the Sacramento County Mental Health Treatment Center runs $1,200. That’s $36,500 per month, or $438,000 for a year, though patients don’t stay that long.
California earmarks upward of $1 billion a year from a special income tax on high earners for mental health care, thanks to the voter-approved Proposition 63 Mental Health Services Act.
Steinberg, the main proponent of that 2004 initiative, pushes for more mental health care spending when he can. He recently announced plans to seek $50 million in next year’s budget to improve care for mentally ill jail inmates, on top of $260 million he helped secure in this year’s budget.
Money is not the issue. The law is. It ensures the civil rights of severely mentally ill people, no matter how ill they are. Except in the most extreme cases, no one can force them to get treatment. For many, like Matthew, they deteriorate until they break a law and end up in jail or prison. There are better ways.
California has had a statute since 2002 authorizing courts to oversee the care of severely mentally ill people, allowing them to remain in their homes so long as they undergo therapy and take their medication.
It was named for Laura Wilcox, a Haverford College sophomore who was killed by a mentally ill man while she worked at the Nevada County mental health department as a fill-in receptionist during winter break 13 years ago.
Nevada County responded by fully embracing Laura’s Law and has improved its care of severely mentally ill people. A few counties have followed or are contemplating doing so.
Sacramento is not among them. Instead, Sacramento County is starting a different program in 2014 in which 20 hard cases would receive intensive care while living in their homes.
Dorian Kittrell, head of Sacramento County’s behavioral health department, said the overall cost of caring for the 20 or so residents who might fall into that category will be about $400,000 a year, roughly what it’d cost to house one person for a year at the county psych hospital.
The rub is that to get into the program, Matthew and people like him must be overseen by court-appointed conservators. For now, the Sacramento County public guardian’s office is Herrera’s conservator. He intends to challenge the conservatorship in February.
“I don’t want anyone over my life, my house, my money,” he told me.
Matthew has that right. Steve Lewis, Sacramento County’s chief assistant public defender, said his office has an obligation to represent him. Lewis also said deputies have discretion. Perhaps the lawyer will conclude that it’d be in his client’s interest to remain under the guardian’s eye.
That decision hasn’t been made. It won’t be easy.
On Christmas, Karen Herrera visited Matthew and gave him a wallet, gloves, shoes and a beanie. He was feeling good, not hearing voices. The disheveled guy I saw in February and in October has little resemblance to the well-groomed and lucid guy I talk to now. It remains to be determined whether his recovery will continue in the new year, or the door revolve will once more.