When Jennifer Su pulled up to the traffic island where Adrian Gutierrez often panhandled, she saw the soft-spoken man she knew to be grateful to accept a sandwich or slice of pizza now spiraling into a fit of rage, shouting obscenities at himself and no one.
She called 911, pleading with the dispatcher to take Gutierrez to a psychiatric facility. But upon returning to the intersection in Pacheco, a small, residential community near Concord, she found the troubled man talking to himself and begging for money, his condition rapidly deteriorating.
After Su, who met Gutierrez through her son’s struggles with homelessness, learned that he had been briefly booked into county jail on drug possession charges, she sent a desperate email to the public defender representing his case.
“The weather can be over 100 (degrees) and he will still have a heavy coat on as if he’s insensate to heat,” she wrote. “Whenever I see Adrian, I feel he will die soon if he doesn’t get help.”
Three months later, those fears were realized. On a chilly morning this January, a friend who sometimes stayed with Gutierrez beneath a nearby freeway overpass found him lying cold and motionless on the concrete. The coroner’s office said his autopsy is pending. He was 38.
To prevent more people like Gutierrez from suffering on the street, all California counties must now adopt new reforms aimed at making it easier for the court system to compel those with severe mental health and addiction issues into treatment. They include a voter-backed initiative last November to toughen penalties for drug possession and a recently enacted state law that creates a new civil process to get people into treatment programs.
As counties phase in the reforms, the failed attempts to help Gutierrez in the months and years leading up to his death reveal the need for new approaches to connecting many thousands of the state’s most vulnerable residents to treatment. At the same time, they highlight the challenges that already overburdened local behavioral health and justice systems face in managing a potential inpouring of patients and defendants.
Some civil rights advocates worry the new court processes will accomplish little except to land more people in jail and conservatorship. But Dr. Maria Raven, chief of emergency medicine at UCSF Health, said the changes could improve decades of policy that has tended to prioritize people’s personal liberties over their acute needs.
She warned, however, that the success of the new measures hinges on the level of investment in treatment, social services and supportive housing.
“I’ve seen, throughout my career, initiatives like this, and I haven’t seen them work on a large scale because we don’t have the resources,” Raven said. One of the reforms, Proposition 36, doesn’t come with new funding.
Before his death, Gutierrez was well known to Contra Costa County’s court and behavioral health systems. At one point, a judge ordered him into a drug treatment program, only for him to end up using again on the street, according to court records. Friends and relatives described other failed attempts by various outreach teams to help him into treatment or housing.
County officials and Gutierrez’s public defender declined to discuss details of his case.
Growing up in the Concord area, Gutierrez was a kind and cheerful kid who graduated high school with good grades, his cousin Joseph Ramirez remembered. But once Gutierrez’s mother died about 15 years ago, he became overwhelmed with grief and fell into homelessness, Ramirez said.
Cheryl Martinez, a close friend who once lived on the street with Gutierrez, recalled how a caseworker helped him find an affordable housing complex in Oakland. However, homesick in a strange city, he soon moved out to reunite with his homeless friends back in Contra Costa County, Martinez said.
“You know how people get institutionalized? You also get that way being on the street,” Martinez said.
In 2017, Gutierrez was charged with methamphetamine possession and agreed to enter a rehab program, according to court records. But 18 months later, a judge issued a warrant for his arrest for failing to complete his treatment plan. It’s unclear why Gutierrez flunked out of the program. The case was eventually dismissed in the “interest of justice.”
Gutierrez faced similar misdemeanor drug charges last year. But that time, he was sentenced to 20 days in jail and a year of probation.
Behavioral health researchers say that while court-ordered treatment can provide the needed push to help people get clean, they also point to research showing a lack of conclusive evidence it leads to better outcomes than voluntary treatment. They say that even with the threat of jail time, it often takes drug users multiple attempts before they’re ready to complete a rehab plan or accept supportive housing.
Another challenge is the shortage of thousands of treatment beds and behavioral health workers statewide. However, a new $6.4 billion mental health bond is estimated to add roughly 6,800 drug and mental health beds and 26,700 outpatient treatment slots statewide in the coming years.
One of the new reform measures, Prop 36, increases jail sentences to up to three years for a third drug possession conviction but gives repeat offenders the option to complete a treatment program instead of incarceration and have the felony wiped away.
In Contra Costa County, District Attorney Diana Becton opposed the proposition because it lacks money for treatment and will likely slash funding to the very programs being asked to accept more patients. Still, the DA’s office has so far charged at least 18 drug offenders under the new law.
Ellen McDonnell, the county’s lead public defender, worries the measure could mean less funding for the small team of caseworkers her office employs to support defendants with drug and mental health challenges.
She’s more optimistic about CARE Court, a new program enabling family members, health care workers, law enforcement and others to refer those with severe mental health and drug issues before a judge, who can then order a treatment plan. Since launching in December, 31 people have been referred to the program in the county.
Although McDonnell said CARE Court is designed to be voluntary and “meet people where they are over time,” participants who refuse to undergo treatment could be appointed a legal guardian, known as a conservator, with the authority to force them into locked facilities.
It’s unclear if anyone sought to refer Gutierrez to the fledgling CARE Court before he died. Su called on officials to better educate the public on how the program can hopefully save lives.
“It’s really important that 911 operators, police, hospital workers, that they’re aware that this is a resource,” she said.
