OCEANSIDE — Deborah said she’ll never forget how she used to drive by an intersection at Vista and Jefferson in Oceanside and see the same young man standing at the corner, dirty and disheveled, holding a cardboard sign at the stoplight.
“This was long before the homeless explosion, so it wasn’t as common a sight,” said Deborah, who requested not to use her last name citing privacy concerns.
One time, she made eye contact with the man.
“As we drove away, I said to my husband ‘How can that happen? Where’s his family?’”
‘Who are you?’
Deborah’s oldest son Jake grew up “in paradise” along the sunny beaches of Oceanside. As a boy, he fell in love with science and excelled in his classes at Lincoln Middle School. At Oceanside High, Jake was an honors student and president of the school’s environmental club. Upon graduation, Jake went to Humboldt State, where he majored in environmental resource engineering.
Jake was just one semester away from graduating college with honors when his illness started to take hold. At that point, Jake was an idealistic, smart, funny and successful 23-year-old, passionate about the environment, starting the first animal rights club on his campus and helping organize food giveaway events for charity.
Two years later, Jake was on the streets of San Diego — homeless, hungry, cold and tormented by psychotic delusions. Jake’s drug addiction got him kicked out of his parents’ house, suspended from college and bouncing between homeless shelters, drug rehabilitation centers and psychiatric hospitals. Jake was obsessed with religious ideations, sometimes believing that friends or family members were actually spiritual figures reincarnated.
What happened? Deborah thinks Jake’s marijuana use in college may have triggered psychosis that progressed into mental illness. Whatever it was, Deborah said that Jake’s condition worsened to the point where she couldn’t recognize her own son.
“He was really, really angry and dark…we barely could recognize him…I remember asking him one day, ‘Who are you?’”
Jakes’ case is far from unique. According to Dr. Susan Partovi, who works with the homeless on Los Angeles’s Skid Row, hard drugs, such as heroin, methamphetamine and LSD, frequently trigger psychosis in adults, oftentimes resulting in permanent brain damage and mental illness.
At least half of the homeless population on California’s streets suffer from either drug addiction, mental illness, or a combination of the two, Partovis said.
“When you walk through a homeless encampment, the amount of people who are acting psychotically is astounding, it’s just unreal,” Partovi said. “What’s happening is that meth is causing schizophrenia in these people…we’re now seeing these illnesses, like bipolar, schizoaffective disorder, or schizophrenia in 30 or 40-year olds who were never psychotic before…it’s a whole new ballgame.”
And once someone ends up on the streets, Partovi said that it’s highly likely that this individual will try more drugs, furthering whatever mental illness they had and making it less likely that such a person will seek help.
“Over the past eight years, it went from people on the streets only using heroin to now everyone is doing heroin or meth, or meth with fentanyl…these users are the people that don’t trust you, that are too paranoid to accept resources, these are the people that are dying and getting incarcerated and going in and out and in and out of jail,” Partovi said.
In Jake’s case, there were multiple attempts at treatment, both voluntary and court-ordered. Most were outpatient, one was residential, and none were intensive or long enough to really make a difference. Jake’s co-occurring illnesses required a much higher level of care than what his family could find in San Diego County.
The underlying issue, Deborah said, is that Jake suffers from anosognosia — a symptom common to the mentally ill that makes the individual incapable of realizing that they’re sick. This lack of awareness is a neurological condition also exhibited by those who have suffered a stroke, those with dementia, major depressive disorder.
“With anosognosia, someone can be bleeding and say ‘Oh, I’m fine, nothing’s wrong,’ they just can’t appreciate what’s wrong, they’re missing the chemicals in your body that tell you something’s wrong and you need help,” Partovi said. “You think everything’s fine or you have delusions around it that explain your problems…your capacity for reasoning is either diminished or not there at all.”
In California, no matter how severe someone’s condition, virtually every patient at a psychiatric hospital must consent to treatment. But because of Jake’s anosognosia, this meant it was impossible to get him any real help at all, Deborah said.
“The thing is that you don’t know you’re sick if you’re paranoid or if the drugs give you false perceptions, you’re not even rational enough to know that you need help…my son doesn’t think that he’s seriously mentally ill,” Deborah said.
And so Jake has ended up back on the streets again and again.
Sometimes, Jake lived in his van, at other times he would spend weeks on end in dangerous encampments all over San Diego with the other homeless individuals. In the encampments, Jake tried even more drugs, including methamphetamine, heroin and PCP.
After one particularly bad experience with heroin, Jake sobered up for a time and consented to undergo psychiatric treatment at the Aurora Behavioral Health Care Center in Rancho Bernardo.
As the family feared, doctors at Aurora confirmed that Jake’s drug use had progressed his preexisting mood disorder to schizophrenia. Jake’s doctor at Aurora broke the bad news to the family, saying something that Deborah will never forget.
“I’m very sorry for your loss,” the doctor reportedly told Deborah.
Jake left Aurora two days later, with no medication and no long-term treatment plan. The hospital told Deborah that they simply couldn’t hold him against his will.
Inevitably, his drug use began to lead to arrests. He was sentenced to four months in jail after breaking a glass door at a local recreation center to get to the water fountain inside, while under the influence of PCP. After his release, Deborah recalled that it seemed for a short time like they had gotten “our old Jake back”—he was lucid, with the psychosis dramatically diminished, and he was even able to get a job with DoorDash.
“He was doing ok…and then he wasn’t,” Deborah said.
Just a few months later, Jake got into a fight with another homeless man at a local park and was charged with making criminal threats and brandishing a deadly weapon. Jake’s attorney was able to get a plea deal avoiding jail time under the condition that Jake had to go to rehab.
He walked out after two days.
Jake’s family meanwhile, looked into getting him conserved under state law. Under the Lanterman-Petris-Short Act, or LPS, individuals requiring extensive mental health care can be placed under a conservatorship through an adult guardian, meaning that they can receive involuntary treatment. But Deborah said the family’s investigations into conservatorships ultimately proved fruitless.
“It’s virtually impossible to meet the threshold for grave disability,” Deborah said. “I’ve had authority with the county tell me that in order to meet the grave disability requirement they can’t feed or clothe themselves…I asked him, ‘Do you mean to tell me that if my loved one is eating out of garbage cans and living in cardboard boxes he will not meet the requirements for a conservatorship?’ And he said, ‘You are correct.’”
According to Partovi, it’s usually impossible for even the most determined family to get a conservatorship for their loved one, as California courts require an extremely high burden of proof to demonstrate that an individual is “gravely disabled” as required under the LPS law. The results have been catastrophic for families like Deborah’s trying to keep their loved ones off the streets, she said.
“Under the laws of California, if you have a loved one with schizophrenia, for instance, he basically can’t get help until you can definitively prove that he’s a danger to himself or others, or until he won’t take food or exposes himself or something like that…you’re out of luck, your loved one will end up homeless and in and out of jail, and that cycle might continue for 20 years,” Partovi said.
Even in cases of extreme mental illness, Partovi said that a conservatorship judge will generally err on the side of declining a case if the individual does not consent to be treated.
“In the medical world, if I have to hospitalize my mother or father who has dementia, no one will listen to them and say, ‘Well we don’t have your consent so we’ll let you go wander the streets,’ it’s just common sense…but then when someone is suffering from a mental illness like schizophrenia, for some reason it’s different, we let them make decisions for themselves.”
For those eligible under the state’s strict criteria for conservatorships, LPS cases are still often denied simply because there are no residential care centers with beds available to take a new patient, which stems from an underlying lack of state and federal funding for such facilities, Partovi said.
“At the end of the day, LPS laws are not being followed in California because there is simply nowhere to put people…like if we had a funding stream for places where people could stay while they’re getting stabilized, trust me, people would be using LPS to the nth degree, but as it is, LPS is just not being used,” Partovi said.
‘Failed him repeatedly’
After five years of fruitlessly seeking long-term care for Jake, the family’s luck seemed to change when Jake was ordered into substance use disorder treatment after spending three months in jail for another felony vandalism charge. Here, Jake was going to finally be given access to a stable team made up of therapists, psychiatrists, and caseworkers, as part of the county’s volunteer psychiatric program known as Assertive Community Treatment.
But after several months of being on the waitlist for the program, Jake relapsed, started using again and went back to the streets. Deborah now visits his camp now and again with care packages.
“We’ll still celebrate birthdays and holidays with him if he chooses to join us. His illness is difficult, but he’s still family and we love him,” Deborah said.
Despite his painful journey, Deborah said she still considers Jake as one of the lucky ones. She often thinks of families in similar situations that lack the resources, knowledge or just sheer determination necessary to fight against a system that works against the mentally ill.
“What about a majority of people who don’t have my resources or know they exist, or maybe they don’t even speak the language? The barriers are insurmountable, they really are. The only reason my son got any [help] at all is that he’s been in jail so many times, but why did it have to come to that?”
Partovi said that the underlying culprits for cases like Jake’s are laws at the federal, state, and county levels that undermine families of the homeless by prioritizing personal liberty at the expense of human life.
“Is it really the ‘free will’ of these people to live on the streets, eat from garbage cans, to not take care of health issues like diabetes, hyperextension, and heart failure? People like me say it’s not their free will that’s at stake here — they literally lack the capacity to make these decisions…It all comes down to our laws, federal, state and local all intersecting together and worsening the problem.”
“Voluntary treatment has failed Jake repeatedly,” Deborah said. “[The problem] is laws that give the person with delusions, with hallucinations, with a severe brain impairment — the decision-making power over whether or not to get help…How does our society, our leaders, stand by and let the notion of personal rights to remain sick supersede the right to care? Or society’s right to be safe?”
“It will take a courageous act of Congress and substantial government funding in order for our society to come into alignment with a truly ethical, evidence-based mental health system for those with serious mental illness. We simply don’t have legislative leaders courageous enough to reinstate involuntary treatment, where voluntary treatment has failed repeatedly.”
Deborah said she often thinks back to the young man at the corner of Jefferson and Vista whom she used to see holding up his cardboard sign. She didn’t understand then how that could happen to someone.
“Now I think back to that young man panhandling, and I know exactly how he could end up there, and how his family probably tried to help. And I understand their heartbreak,” Deborah said.
EDITOR’S NOTE: This article is the first in a three-part series profiling homeless individuals and their families in North County.