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Forced mental health care saved one man's life. Another felt traumatized. This is the complexity of treatment.

San Diego Union-Tribune - 9/25/2023

Editor's note: This article includes discussions of suicide. If you're struggling with thoughts of hurting yourself, call the national crisis hotline at 988.

From a distance, each story looks the same.

A man had suicidal thoughts. Someone who knew him grew worried. A forced hospital stay followed and today he lives largely independently.

But the circumstances leading to those moments, and their lasting effects, are vastly different.

San Diego will soon be one of the first counties in California to launch CARE Court, which could make it easier to push people with serious mental illnesses into treatment, and its success will require family members, judges, police officers and doctors to make tough decisions about other people's conditions.

It also joins an existing mental health system that allows certain individuals to involuntarily receive treatment in locked psychiatric wards.

Two men, both residents of the city of San Diego, say they know what that's like.

Neither would necessarily have ever been a candidate for CARE Court. Yet their experiences offer hope and caution for the newest attempt to rein in the region's mental health crisis.

Tom

Tom Dillree, 58, isn't sure what triggered it all.

Growing up in San Diego's Mission Village neighborhood, Tom thinks he might have been depressed as a teenager. But nothing serious, Tom said in a recent interview.

That changed in his 40s.

One day around 2011, Tom returned to his City Heights home to find the furniture rearranged. At least, he didn't remember putting it there. Someone must have moved it.

He recalled thinking: Perhaps strangers are secretly living with me.

Voices in his head emerged about the same time. They said: You're a horrible person.

People around him noticed something was off. His ex-wife likely grew worried after Tom drove their teenage son aimlessly around for hours, he said. Tom's mother, Nancy Dillree, didn't think he was sleeping much, she recalled in a phone interview.

Some of Tom's memories are muddy. Yet he clearly remembers believing that friends and family found him embarrassing.

After months of growing paranoia, Tom mounted a bike, turned onto Texas Street and tried to drive into traffic, he said. Nobody hit him. He went home, filled the bathtub and pushed his head underwater. After a few moments he pulled out.

The next time he saw his ex-wife, she and her husband said Tom needed a hospital.

He didn't want to go. A hospital felt like a different kind of end, and Tom wondered if he'd be permanently locked up. Nonetheless, he climbed into the backseat of their Toyota Highlander.

Nancy remembers getting the call.

She rushed to the emergency room at Sharp Memorial Hospital only to find Tom upset that she'd come. He believed police were on their way and didn't want his mom to see him arrested.

As they waited, Nancy found it hard to breathe.

A doctor eventually said Tom should be taken to Sharp Mesa Vista, the city's largest private psychiatric hospital. Nancy was conflicted. A facility like that offered protection, yet no mother wants their "child incarcerated in a mental health facility," she said.

Tom was again opposed. The place felt like jail.

He was admitted in early June 2011 for "suicidal ideation and psychotic depression," according to medical records from Sharp that Tom authorized to be shared with The San Diego Union-Tribune.

The first few days inside, Tom said he spit out their medication, and notes made by a hospital staffer confirm he initially refused at least one drug. Tom "appeared odd and guarded, paranoid in nature," the records say. Other patients wouldn't stop screaming, and Tom said he was once grabbed by a guy who believed himself to be Hitler. ("I wasn't loving that.")

Nancy visited as soon as she could.

She left her purse, keys and phone behind, walked through a locked door and into Sharp's day room. Tom didn't seem to want her there. She didn't stay long.

But Nancy returned again and again. So did pastors and other loved ones, both said.

Tom started swallowing his medication. He attended therapy and considered everyone coming to see him. Maybe he wasn't hated.

The paranoia didn't vanish, nor did the voices, yet both seemed to recede.

Tom was released after more than a week with a diagnosis of major depressive disorder, records show. He said a different provider also believed he had schizoaffective disorder.

More therapy was ahead. Tom moved back in with his mom and still sometimes asks if something in his head is real. Medication remains a part of his life.

But years later, he's never had another debilitating episode.

"Forced treatment really was what saved my life," he said. "I probably would have eventually succeeded in killing myself if not for that."

It took a while before Nancy felt she could breathe easy.

"I love him so dearly," she said. "I'm just amazed at him."

Adam

Adam Philip does not consider himself clinically depressed.

Yet the 48-year-old knows depression.

"I hate to say this out loud, but I've wished I was dead since I was thirteen," he said in an interview near his home. "Philip" is his middle name, and Adam spoke on condition that his surname not be used. "It's not that I have desire to take my life, I would have done it — I just don't enjoy being alive."

Adam grew up in Palm Springs and moved to the county years ago. A medical provider once thought he might have bipolar disorder, but the diagnosis later changed to autism, Adam said.

Family relationships have often been fraught. In 2019, Adam said he sent a Facebook message to a step sister. (The note's now inaccessible in a long-dormant account.) In it, he lashed out at the sister's brother, who Adam accused of beating him when they were kids.

That brother's "livelihood" should be taken away, Adam said he wrote.

The message appears to have been taken as a threat. On Nov. 13, in the late afternoon, somebody contacted the San Diego Police Department, according to a call for service report obtained through a records request. Three officers were dispatched to Adam's home for a "psychological follow-up."

Adam, who lives alone, said he was in pajamas and preparing for dinner when he heard a knock. He opened the door to see several cops.

They spoke through a security gate. The police asked about the Facebook message, Adam recalled.

Section 5150 of California law allows people to be held against their will if they're deemed a risk to themselves or others, regardless of whether a crime has been committed.

Adam said there was no threat.

An officer asked if Adam had any thoughts of killing himself.

He could have responded "no." There was not a plan to take his life. Yet Adam is constantly thinking about suicide. He suspects everyone has similar thoughts from time to time and that wondering whether life's worth living is a normal response to a flawed world.

In an attempt to capture that nuance, Adam said he quoted to the police the French writer Albert Camus: "There is only one really serious philosophical question, and that is suicide."

At 5:16 p.m., police initiated a "5150 hold."

An officer ordered Adam into their vehicle, he said. Adam remembered handcuffs squeezing his wrists, and he wondered if neighbors would see.

The police drove him to Scripps Mercy's emergency room, he said. (A spokesperson for Scripps declined to confirm any stays, even with patient permission.)

At 6:30 p.m., Adam texted his doctor, who he'd been scheduled to meet with the next morning. "Doctor urgent matter immediate response required," he wrote, according to a copy of the message kept on his phone. "Contact me or Scripps Mercy Hospital psychiatric evaluation thank you."

Sixteen minutes passed without a response.

"Urgent," Adam texted again.

He waited in the ER. Hospital staffers stopped by with varying requests, and Adam said nobody seemed to believe he wasn't a threat.

It took a long time before he got a bed, according to Adam, and officers didn't close out the call until almost 10:15 p.m., about five hours after the hold began. (The police department didn't respond to a request for comment.)

Around the same time, Adam sent another message to his doctor. "Well I guess it's pretty obvious I won't be making it to your office at 11 a.m. tomorrow."

It took several rounds of sedatives to get him asleep, only to be awoken by a woman moaning in another room, Adam said.

Finally, he met with a doctor the next day who agreed Adam could go. Early afternoon on Nov. 14, he texted, "They release me."

Years later, the experience still enrages him. It damaged his faith in the medical system. He questions whether police should ever respond to mental health calls.

"Don't go knocking on someone's door assuming you understand their personal history, psychology, the words they choose to use," he said. "It was one of the most violating experiences of my entire life."

Adam doesn't see his story as negating Tom Dillree's. Nor does Tom believe he can speak for anybody else.

One thing is clear: The rate that adults are placed on psychiatric holds in San Diego County has nearly doubled over the past three decades.

CARE Court begins Oct. 2. A legislative analysis estimates around 5,650 Californians will qualify.

Nancy Dillree, Tom's mom, hopes anyone struggling will ask for some form of help, regardless of the severity of their illness.

"Before, I had felt that mental health was a shameful thing," she said. "This convinced me that, no, anybody can suffer."

"You can't just keep battling it and it will go away," Nancy added. "It's not something you can do on your own."

Updates:

2:15 p.m. Sept. 25, 2023: The story has been updated with details from Tom Dillree’s medical file, which was sent to The San Diego Union-Tribune one day after the story initially published. Tom authorized Sharp Mesa Vista Hospital to share those records.

This story originally appeared in San Diego Union-Tribune.

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