States look to involuntarily hospitalize people to confront growing mental health crisis

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• Amna Nawaz:

  Across the country, states are trying to tackle the growing mental health crisis.

  Some are enacting laws and policies that would make it easier to hospitalized or detain the severely mentally ill against their will or through voluntary court-ordered treatment. As the ranks of the homeless swell, California is taking steps toward compelling more mentally ill patients into care.

  As Stephanie Sy reports from San Diego, it is as controversial as ever.

• Stephanie Sy:

  Jennifer Parramore rescues dogs and cats and pretty much any creature in need of care and love. But her dogs Ranger and Dolly are her support. And the day we were with Jennifer, she needed them.

  You're coming off of sort of a manic state that you have been in for — for how long?

• Jennifer Parramore, Mother:

  Yes. Over a month, I think over a month now, yes. And it can last. And it can last weeks.

• Stephanie Sy:

  What does that feel like?

• Jennifer Parramore:

  Everything is elevated. Everything is heightened. Everything is hyper. You feel like you're the funniest person in the world. You feel like you're the prettiest person in the world.

• Stephanie Sy:

  Parramore has schizoaffective disorder.

• Jennifer Parramore:

  The bipolar is more prevalent than the schizophrenic part. But the violent part, the aggressive part, the really erratic part, that's the schizophrenia.

• Stephanie Sy:

  Thirty-one-year old Jillian is Jennifer's daughter, but also one of her mom's caretakers. In fact, Jillian often refers to her mom as sister.

  When Jillian was little, Jennifer was in and out of her life.

  Jillian Parramore, Daughter of Jennifer Parramore: She ended up getting three strikes for petty theft, and ended up in the prison system. And it was in the prison system that she was diagnosed. Unfortunately, she spent a lot of time in solitary confinement for behaviors.

• Stephanie Sy:

  Jillian blames the criminal justice system for robbing her of a mother.

• Jillian Parramore:

  I didn't know Jennifer was my parent until I was 12 years old. I missed out on so much of that time.

  And because her mental illness wasn't treated early on, she doesn't have very many memories of me. That's starting to fade. And so we don't get to have the relationship that we should have had.

  What if I let you have chicken nuggets?

• Jennifer Parramore:

  All right, I will go for chicken nuggets.

• Jillian Parramore:

  OK. Thank you.

• Stephanie Sy:

  Now that Jennifer is in her life, Jillian worries that a new California law raises the specter of institutionalization, which she calls another form of prison.

• Jillian Parramore:

  Right before this interview, we had a whole meltdown. That happens every day. That is also OK. We are allowed to have bad days. Everybody is allowed to have bad days.

  We don't get imprisoned for having bad days. We don't get our rights taken away for having bad days.

• Stephanie Sy:

  The new law will make it easier to court-order behavioral treatment plans for individuals with severe mental illness through so-called CARE Court.

  Here's how it works. A family member, behavioral health provider, or member of law enforcement petitions a court on behalf of someone with untreated schizophrenia or other psychotic disorder. After that, a court can order a clinical evaluation, and then a care plan that may include treatment, medication, and housing.

  If the person fails to complete treatment, they could be considered for even longer-term state oversight. The approach is part of California's effort to address homelessness. San Diego is one the pilot counties that will begin implementing the CARE Court in the fall.

  On this hot July day, police dismantled a sidewalk encampment downtown. It's a familiar scene in the Golden State, where it's estimated that nearly a quarter of the unhoused suffer from serious mental illness.

  Chronic homelessness is the result of multiple system failures, not just individual choices. The mentally ill cycle through the public health system, the housing system, and the criminal justice system. They may get some help along the way, but many of them end up back on the street.

  Anita Fisher knows this all too well.

• Anita Fisher, Mother:

  As a mother, you always think, did I miss something?

• Stephanie Sy:

  The pictures from her son Pharoh's early days as a medical specialist in the Army did not foretell what was to come.

• Anita Fisher:

  My son Pharoh is 45 years old. And for the last 22 years, he's lived with a co-occurring condition of schizophrenia and substance use disorder.

  There have been wonderful periods of recovery where he is in treatment, on his medication, and that's the person who I fight for. But it takes so long to get him back into treatment. Once he stops his medication, he starts to self-medicate with street drugs and alcohol. And that, of course, leads to trouble. And then he's arrested.

• Stephanie Sy:

  Fisher believes CARE Court would offer a pathway for her son to obtain treatment he may not know that he needs.

• Anita Fisher:

  When you have especially been on a several-year journey, and you know that they're saying, no, I'm not sick, I don't need help, that's the point where there may need to be an involuntary direction.

  And I know people don't like that word. If it saves his life, if it saves him from ending up on the street, if it saves him from ending up having to be in handcuffs…

• Stephanie Sy:

  Luke Bergmann, the head of behavioral health for San Diego County, will be leading the efforts to implement the new system.

  Luke Bergmann, Director of Behavioral Health, San Diego County, California: CARE Court was meant to be an alternative that would use the specter of the court to motivate people to engage in care who wouldn't likely otherwise be motivated to engage in care.

• Stephanie Sy:

  He says the CARE Court stops short of involuntary treatment, but a new proposed law in California, currently expected to pass could radically expand who qualifies for coerced care.

  Senate Bill 43 would redefine who qualifies as gravely disabled, making it easier to detain individuals in psychological distress against their will. It would include people with severe substance use disorders, like Anita Fisher's son. She supports the bill.

• Anita Fisher:

  When I read that law, he was meeting every single word of it. No one is talking about sticking someone in an institution for years and years and years just because they have a mental health challenge. No, we're just talking about getting them treatment sooner.

• Luke Bergmann:

  There are many, many people with serious mental illness who need help with basic aspects of activities of daily living. Coercion can be an effective way to move people into care environments.

  The key is, how are we transitioning people into less restrictive settings?

• Stephanie Sy:

  But David Cohen, a UCLA professor and former social worker, says that there isn't much data on the success of forced mental health treatment.

  David Cohen, Professor of Social Welfare, UCLA: It suggests that it drives people away from the mental health care system. It retraumatizes people who have often been traumatized. It's a hit-and-run. It leaves the scene as soon as real problems appear, in fact.

• Stephanie Sy:

  The trend toward involuntary treatment worries Keris Myrick, a mental health advocate. She herself was diagnosed with schizophrenia in her 30s.

• Keris Myrick, Mental Health Advocate:

  My first involvement with the mental health system was through involuntary hospitalization, which was very traumatic. And the police came to my door. Mine is not the worst. Some people don't make it out alive.

• Stephanie Sy:

  Myrick has concerns about California's new courts for the severely mentally ill.

• Keris Myrick:

  The idea of being able to get the treatment and/or supports that you need at the time when you're most vulnerable involving a court? As an African American, I — the idea of courts, it's just not a friendly place.

• Stephanie Sy:

  UCLA researcher David Cohen says the seriously mentally ill may need a form of asylum, one that's voluntary.

• David Cohen:

  We do need a place for people who can't take care of themselves.

• Stephanie Sy:

  You're saying that there may need to be some sort of asylum for certain types of people?

• David Cohen:

  Yes, absolutely, but not with the coercion. What is asylum? It's shelter. It's space. It's books. It's drugs if they want them. Probably, 80 percent of it is just finding shelter for people.

• Stephanie Sy:

  Jennifer Parramore has a safe place, just a few blocks away from daughter Jillian. She credits getting the right dose of lithium with helping her get her symptoms under control.

  Even still, she has relapses.

• Jennifer Parramore:

  When I'm going into the hospital, I have given up. I know that I can't make decisions for myself anymore. I give up. I'm tired of running from the devil out here, exhausted.

• Stephanie Sy:

  Running from the devil?

• Jennifer Parramore:

  Yes.

• Stephanie Sy:

  What does it mean to run from the devil? What are you referring to?

• Jennifer Parramore:

  Just trying to stay one step ahead of my mental illness.

• Stephanie Sy:

  It feels like the devil…

• Jennifer Parramore:

  Oh, yes. Yes.

• Stephanie Sy:

  … haunting you, mental illness?

• Jennifer Parramore:

  All the time. It's your mind controlling you, and not you controlling your mind.

• Stephanie Sy:

  But it's her battle to fight, she says.

• Jennifer Parramore:

  It is my choice. It should always be my choice.

• Stephanie Sy:

  For the "PBS NewsHour," I'm Stephanie Sy in San Diego.