SAN DIEGOSAN DIEGO — For Crystal, it was the voices.
Your young daughter is in danger, they warned. She’s going to be molested. You are going to be murdered. Take action. Pick up that knife.
In March 2020, Crystal did as she was told. Armed with a knife, she headed outside and encountered a neighbor in their downtown San Diego apartment building. The neighbor called police.
For Roshon, it was the paranoia.
She was sure everyone wanted to hurt her. She’d already had a childhood marked by physical and sexual abuse. Without medication to control her schizophrenia, she had no doubt: Everyone was targeting her.
In October 2020, Roshon argued with a stranger, then hurled a large rock through a car window. She got a ticket. Later that year she had another argument with another stranger and faced another response from police.
This time, a terrified Roshon tried to fight off the officers. She was off her meds. She was “gone,” she said. Out of her mind.
Both women have been diagnosed with mental illness. Both landed in jail facing felonies. But for both, that last arrest was a strangely fortunate fate.
That’s because it led them to Behavioral Health Court, a specialized program targeting criminal defendants with mental illness.
Behavioral Health Court is a small program in San Diego Superior Court, offered to a fraction of criminal defendants who suffer from serious mental illness — often schizophrenia, schizoaffective disorder or bipolar disorder.
The 13-year-old program gets participants out of jails and into group homes. There, people get access to treatment and medication, group therapy and individual counseling.
According to statistics compiled by the court, a total of 314 people have taken part in the program since it started in 2009.
In the dozen years since, 136 people have graduated — a completion rate of about 56 percent. This is a tough population.
It’s expensive — nearly $100 a day per participant, mostly out of county coffers. But it’s cheaper than jail, where San Diego County spends between $126 to $240 a day to house the average inmate.
And now, as the county looks to strengthen its response to the needs of mentally ill people, this collaborative court program is getting a closer look.
The county pays for up to 60 participants, the state pays for up to 30 more, although the county and state have different criteria for who can . In December, the county Board of Supervisors unanimously agreed to explore expanding its side of Behavioral Health Court. The feasibility findings are due back to the board later this spring.
Crystal Jenkins, 51, is in the early phases of the program and Roshon, 49, is just past the half-way mark. Both agreed to share their stories, though Roshon did not want her full name used.
‘Just waiting for someone to talk to me’
Roshon was 7 years old when she was first placed in a psychiatric ward. The next decades brought more institutions — psychiatric wards, mental hospitals, jail, prison.
She was 25 when she faced her first criminal case in San Diego County, charged with robbery and assault with a deadly weapon. Sentencing records from 1998 show a judge recommended Roshon be “evaluated by jail medical staff for appropriate medications.”
The following year she was charged with selling crack. Again, a judge wanted her evaluated.
By the time Roshon entered Behavioral Health Court last year, she had accumulated at least nine felony cases and six misdemeanor cases, and at least four domestic violence cases, according to The San Diego Union-Tribune’s review of court records.
She attacked people with whatever was at hand — a glass bottle, a can opener, even a small push cart.
Help finally came in the form of a psychiatrist brought in to evaluate her in jail after her arrest in 2020. For whatever reason, Roshon felt she could trust her.
“I guess I was just waiting for someone to come in and talk to me, someone I trust,” Roshan said. “Once I cried, I felt like a different person and it felt like another start for me.”
Roshan was among a handful of people accepted into Behavioral Health Court in 2021.
‘We can help them’
Getting accepted is not a given. The candidates have to be felony defendants, who typically must agree to plead guilty. They must be adults and they must have tried and failed at lower-intensity court-ordered programs or solutions.
And they must have a serious mental illness as defined by Title IX of the California Code of Regulations — such as schizophrenia, schizoaffective or bipolar disorder — to be eligible to participate.
Every applicant is screened by a mental health professional. A criminal and psychiatric history is drawn up. Victims are consulted.
Assault with a deadly weapon (not a firearm) is a common crime in this group. But there are restrictions. ed arsonists or sex offenders are not allowed.
Usually, potential participants are referred by defense attorneys. About 90 percent of all criminal defendants in the county are represented by the Office of the Public Defender, which has what it calls the Defense Transition Unit, a special unit focused on mental illness diagnosis and treatment for its clients.
Deputy Public Defender Neil Besse oversees that unit, which handles about 1,400 referrals a year. He also represents people in Behavioral Health Court, where the most challenging clients are placed.
“We are talking about the most scary clients, who when they are off their meds are running around with sharp things or going after vulnerable victims, and doing things that are fundamentally illogical,” he said.
“We can see clearly enough that if we can take them on, we can help them,” Besse said.
Deputy District Attorney Matthew Dix is the county prosecutor assigned to Behavioral Health Court, which he said is designed to help defendants driven to crime solely by a serious mental illness.
“I feel like those people are actually innocent victims of their own mental illness,” Dix said. “They didn’t ask for this mental illness, they didn’t do anything to deserve it, they were just given it. And it’s that illness that pulled them into incarceration.
“With this population, you can’t really protect the community by just locking them away,” Dix said.
Even if a person is deemed eligible, they sometimes decline the offer. Many find the program too long and too intense.
Of the 154 applicants screened in the two years ending Dec. 31, 2021, about 47 percent were accepted and ed.
‘I shouldn’t have gone to jail’
That number includes Crystal, who said she has been diagnosed with schizophrenia. She had spent roughly seven years homeless before she obtained ive housing in April 2019. But soon the voices started.
The voices were real to her, real as any lucid conversation she’d ever had. For eight months, the voices tormented her with constant, ominous warnings that her elementary-school-age daughter was in danger.
“I had been hearing that my daughter was going to be molested. I was going to be murdered. Horrible things. Scary things. It was the scariest time of my life, worst time of my life.”
They had her convinced. She often called police for help.
In early March 2020, she took action. Knife in hand, she went to the hallway outside her apartment.
“Not intending to hurt anyone,” she said, “intending to protect myself and my daughter.”
Crystal said she and a neighbor “had words,” but she doesn’t much more. The neighbor called police.
Crystal said police took her to the nearby Jane Westin Center, which provides mental health services.
“They knew something was wrong,” Crystal said. “The cop had been to my house before, so he knew something was wrong.”
But, she said, as she stood at an intake window talking to a staffer, the police officer came back and arrested her.
“In the middle of my assessment — she was asking me what are you hearing, are you taking your meds — and he just said, ‘Ma’am, put your hands behind your back,'” Crystal said.
“I shouldn’t have gone to jail,” she said. “I should have gone to the hospital.”
By the time Crystal was released from jail a month later, she said she had been evicted from her apartment and was once again homeless. The following year, she was in jail again. Her public defense attorney told her about Behavioral Health Court.
‘Their alternative is custody’
Behavioral Health Court is what is known as a collaborative court, a specialized court that partners various entities and is geared toward offenders with a specific need. There are other collaborative approaches, such as Drug Court, Homeless Court or Veterans Treatment Court.
In San Diego, Behavioral Health Court teams a Superior Court judge — who leads the group — with a deputy district attorney, a city attorney, a public defender, probation officers, and representatives from the county Department of Behavioral Health Services and from the private, contracted service provider Telecare Corp.
They sit down every week and discuss cases in detail. They decide who gets in to the program, who is on target with their goals, who needs extra help, and who needs to go.
“I really view this as saving lives, changing lives,” said Judge Cindy Davis, who runs the program out of her 12th floor courtroom at San Diego Central Courthouse.
“They get to a point in their life where they’ve been in and out of hospitals or in and out of jail enough times that they want to make a change,” she said. “Their alternative is custody. There’s motivation there.”
“You have to be at that place and be receptive to this kind of intense treatment,” she said.
Of all the people who participated in Behavioral Health Court since its inception, 28 percent had schizoaffective disorder, 24 percent had schizophrenia and 21 percent had bipolar disorder, according to data produced by the court. A variety of diagnoses make up the rest.
Participants move through the four-phase program at their own pace, but it lasts a minimum of 18 months. Everyone lives in group housing, typically 10 or so people to a home. Everyone gets a mental and physical health assessment and receives a treatment plan specific to their needs.
They all must take their prescribed medication, and they all must remain sober, obey curfews and not commit new crimes. Some must complete a residential substance abuse program before they can move into a group home.
Telecare provides wraparound services for the clients, starting with a ride from jail (or residential treatment) to their offices. There, on day one, they get a clinical assessment, medicine and food and clothes. Before the day is done, they have settled the new client into a group home.
The clients all return to these offices several times a week for group sessions and skills-building classes. They meet with case managers who help them secure Medi-Cal coverage, Social Security benefits and job training, even get a state identification card. They meet with nurses who ensure they are taking their medication.
“Studies show that this works, and our experience shows that this works,” said Mary Wood, a regional director of operations for Telecare.
“The people that we serve shouldn’t be in jail,” she said. “Treatment is the appropriate way to go, and people do get better. We have seen it.”
The county Probation Department also plays a role, acting as guide and guardrail. The probation officers assigned to this special program help clients find help like job services and also ensure their compliance with following the rules.
Failure means getting kicked out of Behavioral Health Court and going back to jail. Court-provided numbers show 44 percent don’t make it through.
But for those who graduate, sustained success — staying out of criminal trouble — is likely, with 21 percent later facing a new felony charge in San Diego County.
Compare that to a snapshot of jails and prisons statewide. According to a 2019 report by the nonprofit Public Policy Institute of California, of prisoners released in October 2015, more than half were arrested on suspicion of a new felony crime within two years.
Data from a September 2021 report by the California Department of Corrections and Rehabilitation showed that inmates whose prison records included a mental health designation had a far higher rate of re-conviction within three years of release than prisoners who did not have that designation in their record.
An alternative court
Every Tuesday in San Diego Central Courthouse, a dozen or so defendants who struggle with mental illness gather outside Davis’ 12th floor courtroom. They shuffle inside and prepare to speak directly with her.
A handful of participants enter the courtroom not from the front, but escorted through the side door, in jail scrubs and handcuffs. These are new participants and this is often their first time in this court. They have agreed to the tough of this special court.
There are two tracks to Behavioral Health Court: BHC Probation and BHC Diversion.
There are about 60 slots for people who committed a crime and agreed to plead guilty. This is the BHC Probation side of Behavioral Health Court, and it is funded by San Diego County, which puts in an annual budget of $1,876,000.
The second track, BHC Diversion, was created in 2020. It covers up to 30 more participants, each of whom is charged with a crime but not yet convicted because their competency has come into question. In order to keep them out of a state mental hospital, the California Department of State Hospitals provides San Diego County roughly $1 million a year to put them in Behavioral Health Court. Those state-funded 30 spots are nowhere near full.
But the county-funded side with 60 beds is often full — and it could grow. The county Board of Supervisors recently voted unanimously to look into expanding it. The findings are due soon.
The county has funded growth before. The program started in 2009 with 30 participants. In 2016, it doubled.
Ideally, the county would get help to people before they reached a mental health crisis that resulted in with law enforcement, Board of Supervisors Chair Nathan Fletcher said. But for those whose illness led to crime, he said, Behavioral Health Court seems like an effective way to help them recover while also keeping the community safe.
“We know people are not going to get good mental health care in jails,” Fletcher said. “It could be far better if we could get people into treatment programs and get their lives back on track.
‘Promise’
At her Behavioral Health Court hearing in December, Roshon appeared before Davis to discuss her progress. The other program participants appearing that day watched while they waited their turn to talk to the judge.
“I’m doing OK,” Roshon said. “I’m going to my groups, my appointments, keeping my sanity.”
“I understand you’re known as a leader at (Roshon’s group home),” Davis said, smiling.
Roshon said her anxiety had been worse recently because of changes in the house, but she was going to group therapy to manage her stress “and learn to deal with it without blowing up and getting depressed.”
For example, she said, her adult son had recently had a crisis and she used one of her “tools,” a group therapy session, to keep her son’s crisis from triggering one of her own.
“I got a ride to a meeting and went there to take care of myself before I tried to take care of my son,” she said.
Everyone in the courtroom applauded her healthy choice. Then, like all participants who follow rules all month, Roshon was entered into a drawing for a $20 gift card to Walmart at the end of the hearing.
For participants who were found to have violated rules since their last hearing, there is rarely applause. Sometimes they leave in handcuffs.
A man who appeared for a hearing in February had been discovered taking all of his medication for the week in a couple of days, and it appeared he had also taken medication prescribed to another patient, too.
“I’m doing the best I can, but I’m not mentally stable enough,” the man told Davis.
Davis said she understood and agreed he needed a higher level of care — perhaps a board-and-care home or maybe even a conservatorship.
Until then, the judge said, she wanted to keep him and the community safe, so she was returning him to jail until they could find the right out-of-custody care for him.
He balked.
“In custody, I really don’t feel well,” the man told Davis.
“I get in fights and I get beat up by people because I really can’t take care of myself.”
Davis said the court team would work with jail psychiatrists to his treatment in custody, then work on getting him into a board-and-care home or a conservatorship.
“We’re going to work hard,” Dix, the prosecutor, told the man as he was being handcuffed.
“Promise?” the man asked.
“Promise,” the prosecutor said.
‘I chose a different way’
For Crystal, Behavioral Health Court is a pathway to normalcy. She wants to reunite with her young daughter. By the end of January, she was making good on her goal to move quickly through the program and had already moved to the second phase. Crystal shared with the judge her good news: She had completed a two-week peer program, and was now armed with the certification to help others.
“It was awesome,” she told the judge, explaining how the program had taught her “a different language, a language, a different way to say things.”
It meshes with her past as a home health care provider. She wants to help.
By March, she was nearing promotion to the third phase.
For Roshon, Behavioral Health Court did what decades in psychiatric hospitals, jails and prison did not: It got her on medication that controls her symptoms without intolerable side effects and provided the wrap-around she needs to recover.
“Through the program I learned that there’s people who do care,” Roshon said. “Maybe it took me longer to find it, you know, because I’ve been in and out of institutions forever, not just prison but jails, mental wards …
“I’ve prostituted, I’ve sold drugs, I’ve robbed, I stole, I fought, I did it all and all I got was my freedoms taken away.
“Today I choose not to have that,” she said. “Today I choose to go a different way and use my resources.”
