When a Mentally Ill Child Becomes a Mentally Ill Adult

Jennifer Hoff looks up in sudden panic, tilts her cell phone toward her chin and says, "I wanna know if he has any shoes on." She returns to the sergeant on the other end of the line. "Can I ask you to just radio the officer in the street?" she pleads, her voice desperate. "Can I just ask him if Matthew is wearing any shoes?"

Kenneth M. Ruggiano

Now that her son, Matthew, is legally an adult, Jennifer Hoff can't get him the treatment she believes he needs

Kenneth M. Ruggiano

Photos of Matt Hoff

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More About

• Nomi Lonky
• Jeffrey Hoblin
• Philip Camacho
• Mental Health
• Homelessness

At 8:25 p.m. on Tuesday, Feb. 21, the Santa Ana Police Department called Jennifer to inform her officers had located her son, Matthew, after he went missing for 15 days. They found him wandering the street with methamphetamine and took the 18-year-old to the county jail. According to police reports, officers would discover that earlier that night, he had stolen $130 from a Subway sandwich shop after picking up a rock, wrapping a sweat shirt over it so that it looked like a weapon, and threatening an employee.

Sitting at a long, wooden dining table in her sprawling Ladera Ranch home, Jennifer nervously doodles on a piece of paper scribbled with the names of people with whom she's supposed to speak. The 38-year-old mother of three has pixie-brown hair and sunken doe eyes that squint as she speaks. As the sergeant updates her on the situation, she tries to insist the county's Centralized Assessment Team (CAT) evaluate her son for a 5150, California's code for an involuntary, 72-hour, psychiatric hold, granted to those who are a danger to themselves or to others or are "gravely disabled." Her husband, Gary, wearing shorts and an untucked white undershirt, shuffles around the room in silence.

"What exactly are you trying to explain to me?" she asks the sergeant on the phone, shaking her head. "You're going to explain to me the circumstances of why the CAT team is not going to be called out tonight?"

She listens, then interrupts: "He's a chronic, mentally ill young man who has been missing for two weeks. He has no residence. He has no identification on him. He has no income. He has no way to provide for his own medical care. He's living on the streets."

There's a pause, and then a pound on the table. "Quit yelling at me!" she screams. A dog barks.

"I want you to answer one question," she says. "If he is homeless and without the ability to provide food, clothing or shelter, is that not being gravely disabled?"

When he tells her it is not, she slumps back, defeated. "Okay, that's all I need," she answers.

Jennifer hangs up the phone and blinks her eyes in disbelief. "Too bad it's meth and not something that can get us more time," she says. "We always try to get more time."

Matthew, who has a lean physique and a sneaky, boyish grin, is diagnosed with bipolar disorder, PTSD and other psychiatric illnesses. On this night, it's two weeks before his 19th birthday. For the past 11 months, since turning 18, he has drifted through a circuit of hospitals, homeless shelters and jails. Just before he went missing, police arrested the teenager for check fraud, then released him from jail in the middle of the night without notifying his parents. When Matthew hadn't called home in a few days, the Hoffs plastered his photo on Facebook and shelter walls.

"Where are we at?" Gary asks with a look of exhaustion and numbness. "It's just gonna be the same exact thing once again."

The Hoffs find themselves in a dark chase with no end in sight. They believe that Matthew, who is off his medication, belongs in intensive treatment for his own safety and that of the community. But Matthew doesn't want treatment. And because he is 18, he cannot be forced into it by the county until he is considered an imminent threat or his condition gets worse—by which point it might be too late.

It's a Catch-22 that strikes many family members of patients—mostly young males—who are severely mentally ill and refuse to seek care. They've learned that as difficult it is to provide safety for a mentally ill child, it is exceedingly more difficult when that child becomes a mentally ill adult. Laws that previously gave parents control over their child's treatment disappear and are replaced by new laws that protect the individual's freedom and privacy. Barred from their child's medical decisions, parents find themselves in an abyss of helplessness and guilt.

"We can't just scoop him up—that would be kidnapping," Jennifer explains.

The Hoffs, along with a group of other parents, community advocates and psychiatrists, believe that in the name of individual rights, the pendulum has swung too far against individual needs. In an effort to help bridge the divide, many are urging Orange County officials to adopt Laura's Law, which authorizes a court—with recommendations from doctors and family members—to order outpatient treatment for those with severe mental illnesses such as schizophrenia, bipolar disorder and major depression. Individual counties must decide whether to implement the state law, and so far, only Nevada County has it fully in place. The law will expire at the end of the year unless state legislators choose to extend it.