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Steve Winters' single room in the Tenderloin's Ambassador Hotel is a dismal scene. The bare mattress shoved against the wall is a dirty gray, a heap of clothes inhabits one corner, and the bathroom is a little too gross to describe. But Winters brags about his room. "It's got a refrigerator," he says proudly. "I feel like Jeffrey Dahmer with that refrigerator."
Winters suffers from paranoid schizophrenia. Although he's now on medication, he still has the delusions and obsessions that have been his companions since he was an adolescent. Conversations start normally, but veer abruptly off course suddenly he's reviewing the Zodiac Killer's string of grisly murders, or he's ranting about a racist Georgia politician who was arrested for several church bombings. His illness and its lack of treatment has defined his life for most of his 53 years.
For about 20 of those years, Winters lived homeless in San Francisco, a shambling, unmedicated wreck who cycled through the city jail for a succession of petty crimes. The courts had placed on him what is known as a "stay away" order from a street corner in the Inner Sunset where he routinely harassed shopkeepers and their customers.
In one year, he was evaluated by jail psychiatric workers 18 times, and each time he was released back out onto the street instead of being sent to a treatment program. He didn't slip through the cracks he didn't want to get better, and no one could force him to.
Winters was living a life punctuated by incarceration. He says he has been confined to mental hospitals in North Carolina, Georgia, and Louisiana and they weren't so bad, he says; they were better than jail. He's known penitentiaries in North Carolina and Georgia, and has become very familiar with the San Francisco jail since he started visiting it in the late 1980s. Toward the end of his drifter days, the locked doors stopped bothering him. "When you're young, jail seems worse than it does when you get older," he says, rocking back and forth.
For those 20 years on the city's streets, Winters was the type of hard-core homeless guy who gave San Francisco politicians heartburn, and made tax-paying citizens feel simultaneously guilty and resentful. He was part of a troubling problem that everyone wishes would go away.
Now, although he still looks like a street-dweller with his long, greasy gray hair and grungy sweatshirts, he's a success story. He gets his shot of medication every two weeks, and lives a stable life under the roof of the Ambassador Hotel. An examination of his case shows exactly what it takes to get one troubled homeless person off the street. It shows that there are solutions to San Francisco's homeless problem but they're expensive and time-consuming, and it's an open question as to whether citizens are willing to pay the bill.
Winters went through the Behavioral Health Court, a program that takes mentally ill defendants off the path to prison, and hooks them up with mental health care. In the unusual courtroom, the defendants come to court every few weeks to report on their progress, and a judge tries to keep them on the high road through a combination of praise, counseling, and stern warnings. It worked for Winters. Since he "graduated" from the program three years ago, he hasn't been arrested a single time, and he hasn't returned to the mental ward at San Francisco General Hospital.
He got into court because he finally committed a crime that had serious repercussions he was charged with attempting to derail a train, a felony. Initially he was let out on probation, but when he continued to get arrested, the district attorney's office decided to throw the book at him and send him to state prison. That's when the staff at the Behavioral Health Court found him, and invited him to join the program. Winters was told that if he participated, he would likely avoid his prison term entirely, and his probation could be reduced. That was enough incentive to sign up.
But some advocates for the mentally ill worry about the mental health courts that are popping up all over the nation. The National Mental Health Association published a report in 2004 discussing the possibility that mental health courts are forcing patients to accept treatments and medications that they wouldn't accept under other circumstances. The report noted that many of the courts impose "treatment compliance" as a condition of release from jail, and failure to comply can result in sanctions such as incarceration. "The qualified right of a person with mental illness accused of a crime to refuse a particular treatment, including a particular medication, should be protected," the report concluded.
However, Winters' case seems to show that sometimes, a little coercion is just what the doctor ordered. It's hard to get a paranoid person like Winters into treatment, notes his caseworker, Kyong Yi, because he often won't trust people who offer help, and gets nervous when he's told to take pills. "That's what's great about behavioral health court," says Yi. "Using that legal leverage, they could get him in the door where he wouldn't go otherwise."