Dan Morain

Dan Morain: Finally, aid for severely mentally ill?

Dan Morain
Dan Morain

In the language of Sacramento County jailers, Matthew Herrera is TSEP, short for total separation, a designation given to inmates who are kept isolated for the safety of themselves and others.

He must wear a "blue suit," signifying he is severely mentally ill. The garment, which happens to be green, is made of such tough fabric that it cannot be shredded and used for hanging or choking.

Karen Herrera last saw her 27-year-old son two weeks ago in the eighth-floor visiting room at the downtown jail. She sat on a metal stool and watched aghast as he paced behind unbreakable glass, his blue suit "open to the front."

"He tried to access the phone and was having difficulty and became frustrated," she wrote in her diary, which she let me read. "He got up and began to talk nonsense and in rhymes about me, and he was flaunting himself and exposing himself."

Herrera is a single mother who has worked 29 years for the state, currently as a management services technician for the Department of Corrections and Rehabilitation and previously for the Youth Authority, where she came into contact with troubled kids, some of them like Matthew.

Her daughter, Melissa, works as a waitress and plans to enter a University of California campus in the fall, hoping ultimately to study psychology so she can help people like her brother. Compassionate though she is, she doesn't want Matthew to know where she lives.

At a coffee shop the other day, they tried counting the number of times Matthew had been 5150'ed, a reference to the Welfare and Institutions Code by which authorities detain severely mentally ill people for 72 hours. Ten, maybe 20 times.

He has been in the Sacramento County Mental Health Treatment Center, halfway houses and two state prisons. He spent 2008 at Napa State Hospital, after a court found he was incompetent to stand trial on a burglary charge. He got out of Atascadero State Hospital last May.

Unless something unexpected happens, Matthew will take off his blue suit and get into street clothes on Saturday, and walk through the revolving door once more, no longer a TSEP. Having served the maximum time for his latest transgression, a parole violation, he will be a captive to nothing other than the demons who control his mind.

"They're going to release him to the street," Herrera said, exhausted. "Mental illness is an illness. It needs to be dealt with. The laws need to be changed."

California has laws regarding severely mental ill people. But as Herrera and moms like her know, the laws are a maze, and too little money goes where it's needed most, although that could change, finally.

Senate Democrats including Lou Correa of Santa Ana, Leland Yee of San Francisco and President Pro Tem Darrell Steinberg of Sacramento are turning their focus to mental illness, specifically how to expand Laura's Law.

Named for Laura Wilcox, a college sophomore who was shot to death by a severely mentally ill man in 2001, the little-used 2002 law authorizes judges to direct that certain extremely ill people receive intensive care in what's called assisted-outpatient treatment.

Matthew would be a candidate, if such a program existed in Sacramento. Nevada County, where Laura Wilcox lived and died, is the only county that has embraced the law. Officials in other counties say they don't adopt it because they can't afford to and fear being sued by disability rights advocates.

In 2004, California voters approved Proposition 63, which was supposed to fix the mental health care system by raising income taxes on people earning $1 million or more. It generates $1 billion a year for all manner of programs, except ones for the sickest of the sick, like Matthew.

In a convoluted interpretation, state mental health care authorities concluded that Proposition 63 money could not be used for involuntary treatment. The state deemed assisted-outpatient treatment was involuntary, even though people in such programs could remain in their homes, free to come and go, so long as they followed therapists' rules.

The state had sided with vocal advocates and legal aid attorneys who say no one should be forced into treatment, unless they've broken a law, and with some therapists who believe people won't seek care if they might be forced to take anti-psychotic medication.

In the past, Steinberg, Proposition 63's main promoter, had sought to avoid offending people who oppose any treatment that smacks of involuntary care. But advocates of more aggressive care gain clout each time an untreated mentally ill person commits a terrible act. Last week, Steinberg told me he has changed his stand and will push a bill stating that counties can use Proposition 63 money for Laura's Law programs.

"It is time to put this behind us and send a clear message to the counties that they have the freedom to use Proposition 63 funds in whatever way they think is appropriate," Steinberg said.

Skeptics say assisted-outpatient treatment won't solve the insanity that led to the massacres at Sandy Hook Elementary School, the Colorado movie theater or any of the other horrors carried out by deranged men with guns.

True, no law can stop all bad things from happening. But in Nevada County and in New York, where assisted-outpatient treatment is used, there is ample evidence that sick people get help. Permitting someone who is a TSEP one day to walk free the next protects the rights of no one, as Karen Herrera knows.

She has lived with the reality of a son who at age 6 wrapped a cord around his baby sister's throat and told a therapist that "the voices" had told him to do it.

In later years, he accused his mother of implanting a probe in his head so people would know what he is thinking, and asking his sister whether she could see the eyeballs that were on his arms and staring back at him.

Herrera, 55, keeps copious notes, and meticulously documented the days following Matthew's release from Atascadero State Hospital last May 29. He was stable and she took him in, hopeful once again.

On June 1, he cleaned his room and did his laundry. Over the next 10 days, he helped with vacuuming and dishes, saw a movie, went to McDonald's, visited the library twice, went out to dinner, attended a chili cook-off in Elk Grove, trimmed the backyard cherry tree, and attended an Alcoholics Anonymous meeting.

On June 22, while Herrera was at the wedding of a friend, Matthew got drunk, a parole violation, and his parole officer took him back to jail. His mother made sure jailers knew about his meds. On June 26, she placed a follow-up call, "and of course they didn't follow up with meds."

By July 8, he was back on the streets and called her for help. He spent a night at the UC Davis Medical Center's emergency room, was discharged and showed up at the home of a friend.

"Dehydrated, confused, suicidal and distraught," she wrote on July 9. He was in and out of jail, a halfway house, and hospitals, and back on the streets until November, when he ingested so many aspirin that he nearly died. He was returned to the Sacramento County Mental Health Treatment Center, where he assaulted a staff member, and landed in jail.

That jail term is supposed to end Saturday. Sheriff's spokesman Jason Ramos said he will be free to leave. Legislators, meanwhile, will fashion bills. Sometime next year, there might be a way to compel lost souls like Matthew to receive treatment before they commit a crime. Or maybe it will be too late, and something bad will happen, again.