A Sonoma County woman fought to help inmates with mental health disorders, but some are still jailed past California’s legal deadline

Last August, the California Supreme Court declined to review a case called Stiavetti v. Clendenin, essentially upholding a lower-court ruling that limits county jail stays for defendants deemed “incompetent to stand trial” to no more than 28 days.

After 28 days, defendants who are unable to understand the proceedings against them or assist in their own defense are to begin receiving state-sponsored “substantive services” to restore them to competency.

In his Stiavetti ruling, 1st District Court of Appeals Justice J. Anthony Kline found that extended stays in jail were so detrimental to some people’s mental health that they constituted a violation of the accused’s due process.

Yet, seven months later, little has changed.

According to data from March 31, the most recent available, an estimated 1,320 defendants in California had been on the wait list for California Department of State Hospital facilities for more than 28 days, according to statistics provided to The Press Democrat by the department.

In Sonoma County, there were 33 inmates who had been declared incompetent being held at the Sonoma County jail as of March 1, and all had been there longer than the mandated 28 days, according to data obtained by The Press Democrat through a public records request.

Sonoma County officials said they could not calculate the length of time the longest-held defendant had been locked up, because subjects often slip in and out of competency.

However, analysts on every side of the issue contacted by The Press Democrat agree that similar scenarios are likely playing out all over California, and all say the cause is an overloaded state mental health care system that can’t handle a burgeoning number of defendants with competency issues.

Joy tempered by reality

The logjam is both frustrating and inspiring to Stephanie Stiavetti, the woman who gained a small piece of immortality as lead plaintiff in the lawsuit.

“For as much as reality has tempered the joy we felt about the ruling, that’s not a reason to stop,” said Stiavetti, who is currently enrolled in a master’s program in mental health counseling at Sonoma State University.

“I am so excited to see the next generation to fight for this cause.”

It will be an uphill climb. The state mental health system is so overloaded that county jail has become a disturbingly long-term housing solution for many defendants who have been declared incompetent.

In the first six months of 2017, those deemed incompetent spent an average of 86 days between trial court commitment and admission to a Department of State Hospitals facility, according to calculations by the late Dr. Bruce Gage, a forensic psychiatrist with expertise in corrections who served as an expert witness for the plaintiffs in the Stiavetti case.

“I had a client, from his arrest date until the time he was released, he spent 398 days in county jail before being assigned to a state hospital,” said Karen Thompson, an attorney in the Sonoma County Public Defender’s office.

Like many observers, Stiavetti is convinced that people with serious mental health issues aren’t meant for the county jail setting, which emphasizes discipline over treatment and, compared to state hospitals, has fewer psychological and pharmaceutical resources.

The opaque judicial process and the “culture of abuse” at several stops in the carceral system, Stiavetti said, plunged her younger brother — known as “N” in court documents — further into crisis.

“He doesn’t have a sense of appropriate conduct in jail,” said Stiavetti, who is 44 and lives in Sacramento.

“They tell you to sit down and shut up. My brother is not one of those people. He’d ring the bell because there was no toilet paper. They’d tell him not to. He’d ring it again, and they’d beat the (expletive) out of him.”

John Wetzler’s daughter, Amica, had a similarly troubling experience at the Mendocino County jail. Diagnosed as paranoid-schizophrenic, she would have black eyes and cuts when he showed up to visit, Wetzler told The Press Democrat. She lost 20% of her body weight in 4½ months at the jail.

Mendocino County Sheriff’s Lt. John Bednar said that while the county jail has a number of inmates who are in various stages of being restored to competency, none of those who have been assigned to a state facility has exceeded the 28-day mandate.

Bednar said he could not address a specific inmate’s mental health, but “in general, there are hurdles that impact our ability to treat mentally ill persons that are incarcerated.”

One such hurdle involves the fact that defendants with mental health issues cannot be forced to take medications except under very specific circumstances, such as exhibiting self-harm or violent behavior toward others. Even in those cases, the drugs that are prescribed typically have only short-term effects and do little to address long-term behavioral issues.

In Wetzler’s case, he said his daughter’s condition improved immediately when she finally was transferred to Napa State Hospital.

“She had a good diet there,” said Wetzler, who spent six years on the Mendocino County Behavioral Health Advisory Board.

“She had almost daily attendance with mental health workers. She was forced to take medication through a Riese hearing, which can require that medication be administered, and got on her meds. It was an amazing turnaround.”

Wetzler and other experts interviewed by The Press Democrat note because they are incompatible with other inmates, jail detainees who have been declared incompetent often spend time in solitary confinement, potentially increasing their paranoia and feelings of isolation.

‘Not a mental health facility’

Sonoma County Assistant Sheriff Eddie Engram disputes that assessment, at least in the county jail here.

“There really is no solitary confinement,” said Engram, who is running for Sonoma County Sheriff and faces two other candidates in the primary. “The mental health unit is single-occupant cells. Solitary confinement is a thing of the past and movies.”

Still, a jail is far different from most institutional settings.

“My understanding is that all clients in (the county’s Main Adult Detention Facility) at this point only get about a half-hour a day outside their cells,” said Heather Wise, a private defense attorney based in Santa Rosa.

“They’re locked down for 23½ hours. So they get a half-hour for everything — showering, calling loved ones, everything.”

Engram noted that the county facility’s 32-person mental health module offers behavioral counseling, medication and related services, and that other units can be configured to accommodate a smaller number of inmates with psychological issues.

Engram also acknowledges that deputies aren’t always equipped to handle people going through psychological breakdowns, at least compared with mental health professionals with years of clinical training.

“We’re certainly not a mental health facility,” he said. “Ideally, DSH (the Department of State Hospitals) would take individuals they’re charged with taking within the court order date. It’s a challenge for us to deal with.”

Because the Department of State Hospitals often has no room for incompetent defendants, Engram added, “Unfortunately, the jail winds up being the largest mental health facility in the county.”

Almost everyone agrees that the source of the problem is not county law enforcement. The trouble, they say, is an unwieldy and overburdened system of public mental health support.

“The greatest challenge for the state predates the Stiavetti decision,” Department of State Hospitals spokesperson Ralph Montano said in an email. “It is the growth in the felony IST (incompetent to stand trial) patients that has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population.”

The State Hospitals department has steadily increased bed capacity for incompetent patients within its hospitals, and its jail- and community-based treatment programs, from a total of 271 in 2014-15 to 1,380 in 2020-21, according to state numbers.

But the shortfall has only worsened. Part of that can be traced to COVID safety restrictions, which brought suspended admissions and the need for isolation units.

Even framing the problem can be complicated, because of the Byzantine process of state hospital commitments.

The incompetent-to-stand-trial label is applied by a court-appointed psychiatrist or psychologist when a defendant is judged “not able to understand the nature of the criminal proceedings or assist counsel in the conduct of their defense.” The goal at that point becomes restoring competency — working with the patient until he or she is able to understand and participate in the trial.

Detainees often get moved around from site to site. That process was hard on Stiavetti’s brother.

“They’d declare him unfit, and he’d sit in jail,” Stiavetti said. “Then they’d find him a bed. He’d be in the hospital for months and months, and they’d say he needs to see a judge. So, they’d punt him back to the courts. Then the whole process starts over. It’s distressing for people who don’t really understand why they’re being held.”

Though advocates are frustrated with the lack of action on Stiavetti v. Clendenin, the decision at least allows legal representatives to challenge a client’s jailing in court when services haven’t commenced within 28 days, said Thompson, the public defense lawyer.

Between November 2021and February 2022 she filed eight writs. She had a consolidated hearing for them April 29.

More money on the way

And there is real optimism things will get better.

The Department of State Hospitals convened a work group last fall to identity solutions for psychologically impaired defendants jailed on felony charges (not misdemeanors). The state has budgeted $93 million in 2021-22 and $571 million for 2022-23 to address those strategies, said California Assemblymember Jim Wood, chair of the Assembly Health Committee.

The budgeted state funds will be used for more holistic programs, such as early access to medical stabilization teams, statewide funding for medication support and infrastructure to increase the number of community residential beds dedicated to state hospital diversion programs, Wood explained in a letter to Wetzler, who lives in Little River.

“The overall approach is exactly the right one,” said Michael Risher, who was lead counsel for the plaintiffs in Stiavetti v. Clendenin when he was an ACLU staff lawyer.

“The experts say a huge proportion of people currently being sent to state hospitals can be treated in the community. Community treatment is much less expensive. It’s safe. And it’s much better for the people involved. They’re much less likely to end up back in jail or committing crimes.”

But any changes are likely to take some time to enact.

An Alameda County Superior Court judge granted the state a major extension in December 2021, and the Department of State Hospitals now hopes to be in compliance with the 28-day mandate by Feb. 27, 2024.

Meanwhile, hundreds of people judged incompetent to stand trial languish in incarceration without the psychiatric attention they need.

That gap is what led Stephanie Stiavetti to abandon a budding career as a chef, cooking teacher and food writer to dedicate herself to the thornier subject of mental health.

Stiavetti chose Sonoma State, in part, because it offers an accelerated two-year program. If all goes as planned, it will eventually allow her to be licensed for marriage and family therapy, as well as professional clinical counseling.

Right now, it’s a burden: four hours and 200 miles on the road, three or four times a week. That’s not to mention her tech job or her internship with Turning Point Community Programs in Sacramento.

“It requires a lot of wherewithal,” Stiavetti said. “And gas.”

She does it, she said, for the same reason she stuck with her court case through six years of legal proceedings, pushing into the headwinds of a massive and entrenched state bureaucracy.

“What am I gonna do, nothing?” Stiavetti asked. “Nothing is not an acceptable option. So, you do what you can.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.