Emergency Call

Alameda County has the highest rate of psychiatric detentions in the state, but has failed to adopt a law that could help severely mentally ill adults.

Daryl Podborny died on April 28, 2011, shot to death by a Dublin policewoman whom he allegedly punched and knocked to the ground at 1:30 a.m. near an Interstate 680 on-ramp. Podborny was 53 years old and had lived on the streets of that city for more than twenty years. He had been married once and had a daughter, had worked as a painter, and was honorably discharged from the Army in his early twenties after two years of service following high school in Dublin. His sister, Cathy Box, described him in a recent interview as outgoing, popular, hardworking, and considerate — until sometime in his late twenties, when his personality began to change.

Gradually, Podborny’s demeanor grew dark. “He said somebody pulled stuff out of his leg and he’d look at his ID card, look in the mirror, and say his identity was changing and somebody messed with his head; all kinds of things. He got to be real paranoid,” Box said. “One time, he was trying on pants and he didn’t like them so he got real mad and he was going to hit my dad. And then his mind got worse and worse.”

Over the years, Podborny was booked into Santa Rita jail in Dublin seventeen times, mostly for fighting and drunkenness. He was arrested in Los Angeles on suspicion of assaulting a law-enforcement officer and arrested in Livermore on suspicion of assaulting a first responder. According to Box, their mother tried to convince him for years to get mental treatment but he refused and she finally stopped asking to avoid upsetting him.

Box said that her mother’s death left her brother distraught and may explain why he confronted the police officer and was fatally shot. She also said her mother was told by someone who called from the jail that Podborny appeared to be mentally ill. “But they just turned him out to the streets again.”

Podborny’s torments are by no means isolated. Year after year, Alameda County confines more people for psychiatric evaluation than any other California county except Los Angeles, even though five counties besides Los Angeles have much larger populations. The five acute-care hospitals in Alameda County authorized to evaluate people suspected of being a danger to themselves or others handled nearly 16,500 such emergency psychiatric cases during the year ending July 2009, according to the most recent data available from the California Department of Mental Health. San Diego County, with the next highest number, had less than two thirds as many, but had more than twice the total population. Of all counties in the state, Alameda has by far the highest rate of such detentions per capita, and many of those patients return again and again.

There is a California law that could enable the families and partners of severely mentally ill adults to get help for them if they refuse psychiatric treatment. It’s called Laura’s Law, named after Laura Wilcox, a 19-year-old woman who was fatally shot along with two other people, and a third who was wounded, by a seriously mentally ill man whose parents failed to convince him to continue psychiatric care.

The measure, which became a state law in 2002 and is being used successfully in Nevada County, Wilcox’s home, is narrowly focused. It applies only to severely mentally ill adults who have had recent multiple arrests, had been repeatedly hospitalized for psychiatric reasons, acted violently, and refuse treatment. Under the law, those adults may be evaluated by county mental health professionals at the request of their family members or living partners, and, if necessary, ordered by a court to receive treatment as an outpatient. But the law is coercive only to the extent that it relies on the gravity of the court — the “power of the robe” — to compel seriously mentally ill individuals to accept treatment. Drugs cannot be administered involuntarily and there is no consequence if the patient refuses to comply with the court-assigned treatment program, except a judge can order him or her to be held for evaluation for 72 hours to determine whether in-patient treatment is needed.

The legislature left it up to counties to decide whether to implement Laura’s Law, but neither Alameda nor Contra Costa County has chosen to do so. The deputy director of Alameda County Behavioral Health Care Services, Barbara Majak, said that she believes the law could be viewed as forcing people into treatment against their will. “I think there are a lot of questions about the efficacy of involuntary care,” she said. Though under Laura’s Law no one can be forced to comply with a judge’s order to get treatment as an outpatient, Majak maintained that “constituents would see that court order as an involuntary treatment.”

But without Laura’s Law, acute-care hospitals in the East Bay amount to revolving doors for severely mentally ill adults. And the problem has only become worse year after year. Nearly 3,800 more people were detained and evaluated in Alameda County as suspected threats due to mental illness during the year ending July 2009 than four years earlier, even though the population of the county dropped by nearly 24,000 people during that time.

On February 18, another tragedy occurred involving a seriously mentally ill adult, this time in the Berkeley hills. Daniel Jordan DeWitt, the 23-year-old grandson of the late Al DeWitt, who was an Alameda city councilman, was arrested on suspicion of fatally bludgeoning Peter Cukor, 67, in the driveway of Cukor’s home near Tilden Park.

DeWitt’s father, Al DeWitt Jr., said his son was diagnosed with paranoid schizophrenia and has been in mental health facilities at least nine times. “We wanted him to be treated and taken care of because we love him,” DeWitt Jr. said. “We advocated for that so many times with the hospital, with the doctors, with the psychiatrists. We tried to inform them how he was thinking and what was going on and they just kept letting him go, kept putting him out. They would give him a BART ticket and a voucher for a shelter and say, ‘Goodbye.’ That’s John George [Psychiatric Pavilion of Alameda County Medical Center]. It’s a shame.

“Even though we’ve lived with him — we know him — they just don’t listen to the loved ones,” DeWitt Jr. continued. “We’ve had so many people call us who we don’t know who say they are going through the same thing. It is just unbelievable how many people are out there and can’t get help.

“If we had Laura’s Law,” he added, “it definitely would have helped us.”

In Alameda and Contra Costa counties, police bear the burden of responding to emergency calls for help involving the mentally ill. At John George Psychiatric Pavilion of Alameda County Medical Center, 9,431 individuals received psychiatric services during the two years ending December 2011, and virtually all of them were originally detained by police or sheriff’s deputies under Section 5150 of the California Welfare and Institutions Code.

For many, it was not their first or even their second trip to that psychiatric emergency hospital during those two years: 1,691 entered three or more times (18 percent). According to Patty Espeseth, a hospital administrator in the county acute-care system, police are even busier responding to psychiatric emergencies than the numbers indicate: “Typically, you have to call the police at least two times, sometimes three, before you get lucky enough to have them write a 5150. They come, but end up not writing the 5150. Sometimes that’s because the family is so traumatized by how horrifying it is to watch a loved one lose their mind or become aggressive when they never have before, the family doesn’t know what to say.”

“Emergency psychiatric detentions are inherently dangerous,” retired Oakland Police Captain Anthony Hare pointed out six years ago in his Ph.D thesis in psychology, which focused on the chronically high rate of 5150 incidents in Alameda County and corrective efforts at that time. Forty percent of the emergency psychiatric detentions originate in Oakland. “I had many encounters with mentally ill persons in the course of my job in Oakland,” said Hare, a 24-year veteran of the department who later chaired the Mental Health Board, the advisory panel to Alameda County Behavioral Health Care Services, and is now the executive director of UC Berkeley’s Center for Catastrophic Risk Management. “I responded as a hostage negotiator, or the leader of the hostage negotiations team, to dangerous situations involving mentally ill persons, including suicidal subjects and people who had committed other dangerous acts. … There are areas in Oakland that house disproportionally large numbers of mentally ill persons who periodically go off their meds or whose condition deteriorates in one way or another such that they become a danger to themselves or others.”

Who are held for observation? “I would say there are three general categories of people on a 5150 who land here,” Espeseth said. “There’s the depressed and suicidal, either because of body chemistry and/or life events; then there are people who have some form of mood [disorder] combined with thought-disorder symptoms, such as bipolar disorder where they’ve gotten really grandiose or paranoid or some form of symptoms that have caused them to be unsafe out in the community; and the third is a straight thought disorder like schizophrenia who are having some sort of disabling thought-disorder symptoms — voices telling them to kill themselves or so paranoid that they are running into traffic thinking someone else is trying to kill them.”

Severe mental illness — schizophrenia and bipolar disorder — is rare, and violent behavior by people who have those diseases is uncommon. But a National Institute of Mental Health study published in 2006 of schizophrenic patients throughout the country found that 20 percent had been violent during the six months prior to being interviewed for the study. Violence among those who did not abuse drugs or alcohol was three times more prevalent than in the general population without the disease, and the incidence of violent behavior among those who did abuse those substances was ten times greater than among the general population. Living with parents and being unemployed raised the risk for violence.

Cognitive impairment is the signature of schizophrenia. The disease often renders its victims incapable of recognizing their symptoms or even comprehending they are ill, which is why the parents of adult children afflicted with schizophrenia face a terrible dilemma. If they shelter their schizophrenic adult daughter or son who would otherwise be homeless and potentially violent, they may risk their own safety. But they have no legal standing, because of medical privacy protections, to get help for their child or any other adult who refuses treatment. Their only recourse in Alameda or Contra Costa County is calling the police in the event of a psychotic break.

Evelyn Forsyth was uncertain whether her son Ryan (both are pseudonyms) was merely acting out as teenagers do. But by the time he was twenty years old, she realized something was wrong when he locked himself in his room in their Fremont apartment and began talking to himself. She tried to persuade him to get therapy.

Ryan had a breakdown while she was at work, smashing his belongings and piling the debris in the living room. He was transported to a hospital, given medication, and sent home. Not long after that episode, he called 911, claiming that his neighbors had killed people. “The police came,” Evelyn said, “and he told them please look, please come with me, they’ve murdered people — look, the ceiling is leaning because that’s where the dead bodies are upstairs.”

The officers called an ambulance and again had him transported to a hospital, where he was evaluated and transferred to a facility for intensive treatment. A few weeks later, he was released with medications, which ran out after he refused to see a psychiatrist. He decided that designer labels were evil, trashed his clothes, scratched the names off sodas and food, and became obsessed with cleaning the apartment.

As Evelyn left for her job one day in May 2010, the wind in the hallway slammed the front door shut. Ryan opened the door, told her not to slam it again, and she apologized. But the wind blew the door closed when she returned that afternoon. “Didn’t I tell you not to slam that damn door? If this happens again, I am going to apply serious pressure to you,” his mother said he warned. “I looked at him and it was weird because it was as though I was looking at someone else, he didn’t look like my son. … He said, ‘I really will hurt you physically.'” She retreated to her room, locked the door, turned up the television, and called the police.

“All of sudden the door opens, [Ryan] walks up on me really fast and was very angry and asked, ‘Who are you talking to?’… I was sitting on the edge of my bed and hung the phone up. After that, I don’t know what happened. He hit me so hard that I went under right away.”

When she regained consciousness, the police had arrived, and her daughter was on a gurney in the hall, bleeding. Ryan was captured a few days later, sent to Santa Rita Jail, tried on two counts of battery, and eventually assigned to a board-and-care home, where he has finally recognized he is mentally ill, his mother said.

Had Laura’s Law been in place, Podborny’s mother, the DeWitts, and Evelyn Forsyth could have intervened on behalf of their sons before the attacks. Like the DeWitts, Forsyth is adamant it would have helped.

In September 2010, the Alameda County Mental Health Board Adult Committee decided not to recommend adoption of Laura’s Law. But Hare, the former mental health board chairman, thinks the committee should take another look. “Instead of detaining a dangerous person who has a history of dangerousness, assessing him, maybe giving him drugs for 24 hours until they can sort it out at the emergency psychiatric detention facility, and then kicking him back on the street,” he said, “they [the committee members] can determine that it would be cheaper over the long run to try and impose stability on the demonstrably dangerous person; dangerous to himself and others.

“Counties ought to consider whether [Laura’s Law] would actually be less costly in terms of revolving-door detentions and certainly less costly in terms of human misery to stranger victims or to the mentally ill subjects themselves,” Hare continued. “In light of what I saw in terms of return calls as a police officer I would be in favor of the law, especially since the counties can implement it in a way that is not oppressive. It’s benign and it gives the opportunity to reduce human misery. It’s not detention; it’s treatment.”

But Majak of Alameda County Behavioral Health Care Services said that she doubts that Laura’s Law would work — even for adults who have a history of violence and are incapable of understanding that they need help. “It is a very challenging society dilemma, no question about it,” she said. But she added that “society says people have free will to make some choices, which leads to the question of whether they are capable of making those kinds of decisions; which is why people are on conservatorships if they are not able to make those decisions.”

A report about Laura’s Law prepared prior to the county Adult Committee hearing at the request of the director of Alameda County Behavioral Health Care Services recommended against its implementation, in favor of conservatorships, according to the author, Francesca Tenenbaum, who is the director of Patients’ Rights Advocates of the Mental Health Association of Alameda County, a nonprofit organization under contract to the county. Tenenbaum is a committee member and attended the hearing.

“I’m not going to say it [making better use of conservatorships] would help everyone whom they say would be helped by Laura’s Law, but they would be helped by improving the system we already have,” she explained. “A conservatorship is stronger than an outpatient commitment; a conservatorship is so much stronger because a conservator can decide where somebody lives, what their treatment is going to be.

“The conservator signs for their medication,” she continued, “decides what medication will be taken in conjunction with treatment, makes sure they get routine medical treatment. … The law says that the purpose of conservatorship is to make sure a person gets the treatment necessary to make them not gravely disabled.”

Tenenbaum believes the county would need to set up a new court to hear cases under Laura’s Law and that the county would have to demonstrate to the state that the mental health services it offers would meet the high standards called for by the law. To be subject to court-ordered outpatient treatment under the law, someone must have refused services and the criteria for such services under Laura’s Law are extensive.

But Randall Hagar, the government affairs director for the California Psychiatric Association, which represents 3,300 psychiatrists statewide, disagrees with Tenenbaum’s conclusions. “We see Laura’s Law as an early intervention, not a panacea, to enable treatment for people who do not realize they are sick. … We not only support the law, I helped draft the bill. It is counterintuitive and defies common-sense why people would oppose this opportunity for treatment.”

According to Hagar, conservatorships are not the answer. “Conservatorships do not apply to people who are dangerous. They are only for people who are gravely disabled, not people who have intent to harm themselves or other people or could. Typically in a county, you’re seeing people who are suicidal on a very regular basis. You also see people who have a history of lashing out; the danger of violence is focused outward: They get into altercations, domestic violence, assaults, and threats. That group who is not gravely disabled, who do all those other things, is excluded from the authority of the conservatorship. It is forbidden by law that conservatorship be used for the purposes of giving structure and treatment for those people.”

Compared to Laura’s Law, which places no burden on people other than to voluntarily comply with a judge’s order to receive assistance as an outpatient, Hagar said that a “conservatorship can potentially be an absolute control over a person’s life in every detail: finances, their health, medications, where they live. The conservator becomes the substitute decision-maker and those powers can be very, very broad.”

Hagar believes that the real reason that counties have not adopted Laura’s Law is a fear of accountability. “When the judge issues an order in the Laura’s Law proceeding, the order is binding not only on the patient to adhere to a treatment plan, but also on the county to provide the services in the law and in the treatment plan for that particular person. In that respect, the mental health system is accountable to a judge, to a superior court judge, and I think that scares bureaucrats and the mental health departments.”

Gloria Hill, a former adult family coordinator for the Mental Health Division of Contra Costa Health Services, sides with Hagar. Hill worked for ten years through 2010 with the families of adults who received psychiatric care. “Laura’s Law has never been seriously considered in Contra Costa County,” she said. “The problem as a result is we have the same people cycling in and out of the system all the time and people don’t get the help they need. You basically have something like one hundred people cycling through jail and the psych emergency and being hospitalized, and bad things happen. People step in front of trains, kill themselves, get into psychotic states and kill family members and victims in the public.

“When your brain isn’t working correctly, you don’t know that; you can’t possibly know your brain is not working correctly — just like someone with Alzheimer’s,” Hill continued. “They don’t realize what’s going on, they are not able to think, their cognition is gone: That is what happens to people who are severely mentally ill. Yet we let them make decisions, which are harmful, very harmful. We need to be thinking about how we can help people to stay in treatment and stay out of jail and stay out of the hospital and have some success in the community. That is what Laura’s Law could do.” 

Correction: The original version of this story erroneously stated that police and sheriff’s deputies transported nearly all of the 5150 patients to John George Psychiatric Pavilion of Alameda County Medical Center. They were transported by ambulance.


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