Editor’s note: This article includes discussions of suicide. If you are struggling with thoughts of hurting yourself, call the national crisis hotline at 988.
From a distance, each story looks the same.
A man is having suicidal thoughts. Someone who knows him is worried. A mandatory hospital stay followed and he now lives independently.
But the circumstances that lead to those moments, and their lasting effects, are very different.
San Diego will soon be one of the first counties in California to launch a CARE Court, which will make it easier to get people with serious mental illnesses into treatment, and its success will require members of the families, judges, police officers and doctors to make difficult decisions about the condition of other people.
It also interferes with the existing mental health system which allows some individuals to involuntarily receive treatment in locked psychiatric wards.
Two men, both residents of the city of San Diego, say they know what that is.
It is not necessary to be a candidate for the CARE Court. Yet their experiences offer hope and caution for the latest attempt to curb the region’s mental health crisis.
Tom Dillree, 58, isn’t sure what caused it all.
Growing up in San Diego’s Mission Village neighborhood, Tom thought 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. Maybe someone moved it.
He remembers thinking: Maybe strangers are secretly living with me.
The voices in his head came out almost at the same time. They said: You are a terrible person.
People around him sensed something was wrong. His ex-wife must have been very worried after Tom drove their teenage son around aimlessly for hours, he said. Tom’s mother, Nancy Dillree, didn’t think he slept much, she recalled in a phone interview.
Some of Tom’s memories are blurry. But he clearly remembers thinking that friends and family found him shy.
After months of growing paranoia, Tom got on his bike, turned onto Texas Street and tried to drive through traffic, he said. No one hit him. He went home, filled the bathtub and stuck his head under the water. After a few moments he pulled away.
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 ending, and Tom wondered if he would be permanently locked away. Nevertheless, he climbed into the backseat of their Toyota Highlander.
Nancy remembers getting a call.
She rushes to the emergency room at Sharp Memorial only to find Tom angry that she’s coming. He thought the police were on their way and didn’t want his mom to see him arrested.
As they waited, Nancy struggled to breathe.
A doctor eventually said that Tom should be taken to Sharp Mesa Vista, the largest private psychiatric hospital in the city. Nancy was conflicted. A facility like that offers protection, but no mother wants their “child locked up in a mental health facility,” she said.
Tom was again objected. The place looks like a prison.
The first few days inside, Tom said he spit out their medicine. The other patients would not stop screaming, and he was arrested by a man who believed himself to be Hitler. (Tom: “I don’t like that.”)
Nancy visited as soon as she could.
She left her purse, keys and phone, walked through the closed door and into Sharp’s room. Tom didn’t seem to want him there. He didn’t last long.
But Nancy kept coming back. So are pastors and other loved ones, the two said.
Tom began to swallow his medicine. He attends therapy and considers everyone who comes to see him. Maybe he wasn’t hated.
The paranoia hasn’t gone away, nor have the voices, though both seem to be fading.
Tom said he was released after two weeks with a diagnosis of schizoaffective disorder.
More therapy comes first. Tom moved in with his mom and sometimes asked if what was in his head was true. Medicine remains a part of his life.
But years later, he never had another debilitating episode.
“Compulsory treatment really saved my life,” he said. “I might have finally succeeded in killing myself if it wasn’t for that.”
It took a while before Nancy felt that she could breathe.
“I love him so much,” she said. “I was just surprised by him.”
Adam Philip does not consider himself clinically depressed.
But the 48-year-old knows depression.
“I don’t want to say it out loud, but I’ve been wishing I was dead since I was thirteen,” he said in an interview near his home. “Philip” is his middle name, and Adam spoke on the condition that his last name not be used. “It’s not that I want to take my life, I’m going to do it – I don’t like to live.”
Adam grew up in Palm Springs and moved to the county years ago. A medical provider once thought he had bipolar disorder, but the diagnosis later changed to autism, Adam said.
Family relationships are always fraught. In 2019, Adam said he sent a Facebook message to a step sister. (The note is now inaccessible in a long-dormant account.) In it, he beats the sister’s brother, whom Adam accuses of beating him when they were children.
The brother’s “livelihood” should be taken away, Adam said he wrote.
The message seems to be perceived as a threat. That Nov. 13, in the afternoon, someone contacted the San Diego Police Department, according to a call for service report obtained through a records request. Three officers were sent to Adam’s house for a “psychological follow-up.”
Adam, who lives alone, said he was in his pajamas and getting ready for dinner when he heard a knock. He opened the door to see several policemen.
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 are considered a risk to themselves or others, despite a crime being committed.
Adam said there was no threat.
An officer asked if Adam had any thoughts of killing himself.
He could have answered “no.” There is no plan to take his life. But Adam always thought about suicide. He suspects that everyone has similar thoughts from time to time and wonders if a life worth living is a normal response to a flawed world.
In an attempt to get that meaning, Adam said he quoted the French writer Albert Camus to the police: “There is only one serious philosophical question, and that is suicide.”
At 5:16 in the afternoon, the police started the “5150 hold.”
An officer ordered Adam into their car, he said. Adam remembered the handcuffs squeezing his wrists, and he wondered if the neighbors could see.
Police took him to Scripps Mercy’s emergency room, he said. (Spokesmen for Scripps and Sharp declined to confirm any stays, even with patient consent.)
At 6:30 in the evening, Adam texted his doctor, whom he was scheduled to see in the morning. “A doctor’s response is needed immediately,” he wrote, according to a copy of the message reviewed by The San Diego Union-Tribune. “Contact me or the Scripps Mercy Hospital psychiatric evaluation thank you.”
Sixteen minutes passed with no response.
“Urgent,” Adam texted again.
He is waiting in the ER. The hospital staff stopped by with various requests, and Adam said no one seemed to believe he wasn’t a threat.
It took her a while to lie down, according to Adam, and officers didn’t close the call until nearly 10:15 p.m., about five hours after the seizure began. (The police department did not respond to a request for comment.)
At the same time, Adam sent another message to his doctor. “Well, I think it’s clear that I won’t be in your office at 11 am tomorrow.”
It took several rounds of sedatives to put him to sleep, but was awakened by a woman moaning in another room, Adam said.
Finally, he met with a doctor the next day who agreed that Adam could go. Early afternoon on Nov. 14, he texted, “They released me.”
Years later, the experience still upsets him. This damaged his faith in the medical system. He questioned whether the police should respond to mental health calls.
“Don’t knock on someone’s door thinking you understand their personal history, psychology, the words they choose to use,” he said. “It was one of the most transgressive experiences of my entire life.”
Adam doesn’t see his story dissing Tom Dillree. Nor did Tom believe he could speak for anyone.
One thing is clear: The rate at which adults are placed on psychiatric hold in San Diego County has nearly doubled in the past three decades.
CARE Court begins on October 2. A legislative analysis estimates that about 5,650 Californians would be eligible.
Nancy Dillree, Tom’s mother, hopes that anyone who is struggling will reach out for some kind of help, no matter how serious their illness is.
“Before, I felt like mental health was a shameful thing,” she said. “It convinced me that, no, anyone can suffer.”
“You can’t just keep fighting it and it will go away,” said Nancy. “It’s not something you can do on your own.”