San Francisco Chronicle - (Sunday)
My homeless sister is mentally ill. I can’t help her
There is a debate among policymakers and mental health advocates as to whether treatment should be mandated for those with severe mental illness. It is a debate well worth having — and a question I’ve struggled with for years.
Before my sister Kori became ill, she was a normal, healthy young woman with a bright future. She was smart, beautiful, strong, independent. She wasn’t perfect. She had dark periods. But
she would always pick herself up and move forward. She was a fighter.
Fifteen years ago, however, Kori started to change dramatically. She began talking in strange accents, became prone to fits of paranoia and rage, and she started drinking heavily. We thought alcohol was the problem, so we staged an intervention. Kori never came.
She disappeared for six weeks only to end up in a psychiatric hospital in Vancouver, British Columbia. She refused any medical treatment but was stable. The doctor’s diagnosis was “psychotic break, not otherwise specified.” She repeatedly refused treatment. Over the next six years, she not only lost her sanity, she lost her husband, home, savings, friends and future.
Because she was an adult, we were powerless to help her. We had to watch her destroy her life from the sidelines.
It wasn’t until Kori threatened my father that we were finally able to get her treatment and a more specific diagnosis — Bipolar I with psychotic features. It sounded bad, but on medication, mandated by our home state of Arizona, she was herself again. She started taking classes at the community college and talking about her future. Things were changing for the better. At 40, she still had a chance to reclaim her life. Her recovery was short-lived. Arizona mandated her treatment for one year and as soon as that year was over, Kori stopped taking her medication. Her mental descent was quick. She would go on to spend the next decade living life mostly on the street — spending summers in Seattle, winters in Phoenix and visiting me in California for short stints in between. She traveled by bus or hitchhiking, living off the modest amount of money my parents provided her.
Kori’s behavior remains erratic to this day. She fights with invisible enemies and flees from nonexistent threats only to leave herself vulnerable to real ones — isolation, hunger, robbery, assault, the elements. She often goes on homophobic, racist, and antisemitic rants that belie her true nature.
Life on the street hasn’t been easy or kind. It has taken a toll on her physically. She’s aged exponentially.
My parents have tried many times to take Kori in. Without medication, this is difficult, if not impossible. In addition to severe behavioral issues, she self-medicates with cigarettes, alcohol and likely drugs. She can be destructive.
For the past six months, Kori has been in Menlo Park, close to me. She typically spends her days taking the train up and down the peninsula, visiting places familiar to her from happier times. She frequents our local coffee shop where they know her by name. She won’t tell me where she sleeps. Sometimes she bids me goodnight with a simple “night, dork.” Other times she accuses me of a crime and tells me I’ve earned the death penalty. Both make me equally sad. My family and I have tried to find out if she was eligible for disability or temporary housing, but we’ve made no real headway. She won’t work with mental health professionals or outreach programs. She runs at their mere mention.
A few weeks ago, when I was searching for her after an uncharacteristically quiet period, I found out she had been arrested and taken to jail. There was a hearing that afternoon, so I went to court to be with her. The charges against her were serious. As she waved to me enthusiastically from behind the glass partition, in her orange prison suit and handcuffs, she seemed oblivious to the trouble she was in or the harm that she had caused.
She was charged with violating someone’s civil rights, threatening them outside of their home on multiple occasions. I felt sadness and shame, but not disbelief. Her bail was set at $25,000 — an insurmountable sum for someone in her circumstances.
Although Kori belongs in a hospital, not jail, perhaps this is the best we can do for now.
In California, the recent passage of the Care Act tries to address many of the mental health shortcomings and loopholes that have existed for decades. It’s in its infancy and much remains to be seen, but it attempts to take a long-term, holistic approach to treatment that incorporates housing, substance abuse and other social services alongside clinical care. People like my sister are given legal counsel. There are regular checkpoints with an end goal. An imminent threat doesn’t have to be present for care to be mandated. The mandate can be renewed.
What strikes me the most about the law is the tone of the language used — compassion.
The Care Act is only for those with severe psychotic disorders like my sister. It may not be fully functional in my county for another two years.
We will wait. It’s our best hope for Kori.