Kenyon Graham was a daily, if unsettling, presence in Oakland’s Temescal neighborhood, the place he usually wandered the streets undressed and shouting at nobody. He had spent years bouncing between jail, ineffective psychological well being applications and homelessness.
Final spring, 4 of his neighbors determined they have been going to alter that. They spent hours studying concerning the county’s psychological well being system, inserting cellphone calls and sending emails, amassing stacks of information from Graham’s court docket circumstances, attending his digital hearings and making statements to a decide. They gathered 80 signatures on a petition titled “Maintain Kenyon Graham and forty third Road neighbors protected.” They convened an emergency assembly with representatives from Metropolis Council, the county board of supervisors, the police division, the district legal professional’s workplace and the county’s psychological well being system – seemingly everybody who would have energy to provide 40-year-old Graham the kind of intensive, long-term care he wanted.
The neighbors’ message at that June assembly was clear: if nothing adjustments, Graham will kill somebody or find yourself useless.
Six months later, their worst worry got here true. Graham was crushed to loss of life with a skateboard whereas sleeping on the sidewalk close to forty fifth Road and Telegraph Avenue.
“The entire level of the efforts behind what we have been doing was making an attempt to forestall the precise factor that occurred,” mentioned neighbor Ellen Kim, 53, as she fought tears. “After my preliminary unhappiness, it was quickly changed by anger.”
The violent loss of life exposes gaping holes in a psychological well being care system that isn’t set as much as assist folks as sick as Graham. Kim and her neighbors fault the folks on the prime of that damaged construction, who they are saying didn't heed their warnings and act in Graham’s greatest curiosity. Specialists blame an absence of in-patient beds and different assets, in addition to an opaque community of hospitals, jails, social staff and courts that depends virtually totally on sufferers accepting voluntary care. And on the coronary heart of the case is a fancy, morally and legally fraught query: ought to society drive therapy on individuals who don’t acknowledge they need assistance?
There was a current push to ramp up involuntary psychological well being care within the Bay Space and past, a controversial enterprise that prompts considerations about defending the rights of our most susceptible folks. Gov. Gavin Newsom desires to overtake what he referred to as the state’s “essentially damaged system,” by funding extra beds in psychological well being services and launching a brand new Care Court docket that might order folks into therapy.
Within the meantime, the Bay Space is filled with folks like Graham, who're raveled and raving and might’t maintain themselves, however who're left to stay homeless, getting sicker.
“It’s undoubtedly irritating,” mentioned L.D. Louis, assistant district legal professional and vice-chair of Alameda County’s psychological well being advisory board. “You're employed very, very onerous to make change, to assist folks. And also you see what the necessity is, and also you push for it. And you’re pushing individuals who need to assist. They only don’t have something to assist with. In the event that they don’t have a mattress, they don’t have a mattress.”
The folks round Graham had identified for years that he wanted one thing totally different from what the county saved providing – a collection of voluntary psychological well being and habit applications that he might stroll away from at any time. Graham’s mom, who requested to not be recognized, despatched dozens of emails to the employees managing her son’s care, begging them to provide him extra intensive therapy. His probation officer mentioned in a 2020 e mail that Graham wanted to be “dedicated,” and promised to attempt to assist make that occur. Three months earlier than Graham’s loss of life, Assistant District Lawyer Michael Nieto prompt the court docket discover placing him in a locked facility.
It’s not clear why the county by no means acted on these recommendations, as Graham’s medical information are confidential underneath federal affected person privateness legislation. However what is obvious is that regardless of the purple flags, nothing modified.
Graham, who grew up in Marin County, was identified by most individuals as Goo – a childhood nickname that caught effectively into maturity. He was youthful than 5 when he began displaying indicators of psychological sickness, and 10 when he was despatched to a psychiatric hospital for the primary time. He finally was identified with bipolar paranoid schizophrenia.
His violent streak made him a nightmare to reside with rising up, mentioned his older sister, Nicole Amarante. She might at all times inform when he was going to a foul place mentally – his eyelids would flutter and he’d begin chuckling to himself. Amarante walked on eggshells to keep away from setting him off.
As an grownup, Graham abused and terrorized his mom. In 2010, he dragged her down the entrance steps of her home in Temescal, and punched her within the head so onerous she wanted bodily remedy, she mentioned. Although she didn’t report the incident to police, she stopped letting him into her home after that. Graham was later ordered by judges repeatedly to keep away from his mom’s block. However he got here again anyway.
Graham’s psychological state deteriorated additional after his father died in 2017, and he grew to become extra of a nuisance within the neighborhood. Between July 2020 and his loss of life in December 2021, officers responded to incidents involving Graham a minimum of 24 occasions, in response to the Oakland Police Division. Longtime neighbors Kim, Roy Alper, Don Stahlhut and George Spies nervous concerning the impression he was having on their tight-knit neighborhood, the place native residents collect on the sidewalk for “nook cocktails” as soon as a month. Kim and Alper fretted about their close by enterprise, the Temescal Works co-working house.
However in addition they nervous about Graham.
To 77-year-old Stahlhut, a former neighborhood organizer, Graham represented a chance to alter his personal conduct. He usually noticed folks in dangerous form residing on the streets, and like most individuals, he normally handed them by.
“I’ve actually walked away from folks on the nook right here and mentioned, ‘Nicely there’s nothing I can do, I’m getting out of right here,'” Stahlhut mentioned. “After which the extra I thought of it, I assumed, ‘Nicely, I’ve bought to strive.'”
The 4 neighbors began assembly as soon as per week in Stahlhut’s yard. As they researched Graham’s historical past, a sample started to emerge. Graham, who had numerous convictions on his document – together with a 2016 assault cost for hitting a girl and taking her cigarette – would get arrested for behaving belligerently and violating his probation, and despatched briefly to Santa Rita Jail or John George Psychiatric Hospital. A decide would refer him to one of many county’s voluntary behavioral well being or habit therapy applications. After a couple of days or perhaps weeks of therapy, Graham would go away and find yourself homeless once more in Temescal. And the cycle would repeat.
In jail, Graham usually took his remedy and was extra lucid, his mom mentioned. When he was launched, he left with a listing of numbers to name for therapy – however he didn’t have the capability to name, navigate the cellphone bushes and arrange an appointment, she mentioned.
Final yr, a scathing report by the Division of Justice discovered Alameda County despatched folks with psychological diseases to jail or psychiatric services with out adequately treating them. This yr, a federal decide permitted a settlement to drive Santa Rita Jail to enhance its psychological well being care underneath court docket oversight.
When Graham was out of jail and residing on the road, he had social staff assigned to his case by Telecare, an organization that contracts with Alameda County to supply psychological well being companies. However they struggled to trace him down and break by the paranoia that prevented him from accepting assist.
“It’s very troublesome in sure conditions to assist somebody assist themselves,” mentioned Laura Wolff, regional director of operations for Telecare, who declined to touch upon Graham’s particular case.
Most therapy is voluntary, however voluntary care can’t assist those that are too sick to comprehend they want it — a medical situation referred to as anosognosia, which Alameda County estimates impacts greater than half of schizophrenic and bipolar sufferers. So Graham’s neighbors started advocating for the court docket to assign him a conservator who would management Graham’s remedy and therapy, and sure confine him to an in-patient facility. To qualify for a conservatorship, somebody have to be “gravely disabled” – which means they can not maintain themselves fed, sheltered or clothed – or pose a hazard to themself or others.
Conservatorships are controversial. They conjure harrowing photographs from the primary half of the twentieth century of the mass institutionalization of sufferers in dismal psych wards, or extra lately, Britney Spears and the “free Britney” motion. Teams like Senior and Incapacity Motion, a Bay Space group of individuals with disabilities, argue voluntary therapy is healthier.
However Graham met all the factors for a conservatorship, mentioned lots of those that knew him. He refused therapy, couldn’t dangle onto the garments or blankets folks gave him, and sometimes rejected meals as a result of he thought it was poisoned. Although his mom gave him a broken-down Ford Explorer to shelter him from the weather, he slept on the sidewalk subsequent to the automobile as a substitute.
Even so, Alper, Kim, Stahlhut and Spies rapidly bumped into roadblocks. Irrespective of how a lot proof they supplied of Graham’s incapability to take care of himself, it by no means appeared to achieve the fingers of somebody who had the ability to assist.
Louis, with the DA’s workplace and county’s psychological well being advisory board, wouldn’t focus on Graham particularly, citing the open prosecution round his homicide. However there are a number of methods individuals who may benefit from conservatorships fall by the cracks, she mentioned. For instance, when evaluating a affected person with an habit and a psychological sickness, a physician typically decides their main downside is drug use – which makes the affected person ineligible for a conservatorship.
However the greatest downside, Louis mentioned, is an absence of assets.
“There’s simply not sufficient capability,” she mentioned. “So what that does is it feeds actually dangerous habits as a result of everyone seems to be in fixed triage mode.”
Louis mentioned the necessity to unencumber beds for brand new sufferers encourages the county to apply what she calls “catch and launch,” the place the system holds, treats and medicates folks till they're simply barely steady, after which discharges them with out sufficient assist.
Alameda County has roughly 200 long-term psychiatric beds, with a typical wait time of two weeks, in response to Janice Adam, spokeswoman for Alameda County Behavioral Well being Care Providers, which oversaw Graham’s care.
As strain mounts to assist folks like Graham, a handful of recent options have surfaced. Alameda County provides two options to a standard conservatorship — “assisted outpatient therapy” and “neighborhood conservatorships” — each of which order sufferers to take part in therapy with out sending them to a locked facility. However their scope is tiny. Collectively, they serve a complete of 55 folks at a time.
Santa Clara County began an identical small program this yr.
On the state stage, Newsom desires to spend $1.5 billion over the subsequent two years to accommodate folks with psychological well being circumstances and enhance obligatory therapy by way of his proposed Care Court docket. However some consultants surprise if the brand new program would have the tooth to assist folks like Graham, who could flout even court-ordered therapy.
Graham was discovered useless round 12:45 a.m. on Dec. 13, blocks from his mom’s home. Joshua Stroman, who had been accused of hitting one other man over the pinnacle with a skateboard final summer time in Palo Alto, was charged along with his homicide. Stroman knew Graham, mentioned police, however they haven’t launched many further particulars.
After receiving the devastating information, Alper, Kim, Stahlhut and Spies returned to Stahlhut’s home to course of their grief and anger.
“It was Alameda County Behavioral Well being’s duty to forestall one thing like this,” Kim mentioned. “They usually failed massive time. And that's simply maddening.”
Adam, with Alameda County Behavioral Well being Care Providers, declined to debate Graham’s loss of life intimately.
“We acknowledge that any tragedy for a person or household, is a tragedy for a complete neighborhood,” she wrote in an e mail.
The neighbors couldn’t save Graham. However they hope his loss of life can encourage adjustments that can assist others like him.
“That makes our efforts really feel extra price it,” Kim mentioned. “We weren’t capable of assist Kenyon, however it will be wonderful if one thing totally different occurs.”