Sightings of Mark Rippee on the streets of Vallejo are all over his sisters’ Facebook account.

Someone spotted him sleeping by a furniture store. Someone walked him to a gas station for coffee. Someone prayed for him at Nation’s Giant Hamburgers.

Rippee, 56, developed schizophrenia after a motorcycle accident more than three decades ago caused a brain injury and blindness. He has delusions that he’s an alien, or is being chased by the Ku Klux Klan, or can’t collect his lottery winnings, his family says.

In September, he stepped into traffic and was hit by a car, they say, then developed a brain abscess. After weeks in a hospital and a board-and-care facility, he walked out. His 62-year-old twin sisters, Catherine Hanson and Linda Privatte, weren’t alerted and couldn’t find him.

Complicating matters, Hanson is bedridden with blood cancer; Privatte is legally blind. They’ve come to depend on a Facebook community, “Mark of Vacaville,” to keep up with their brother’s situation.

The existence of the 2,000-plus group is at once a testament to compassion and an illustration of a system that often leaves the most vulnerable to fend for themselves despite severe psychological disorders.

Families watch in desperation as loved ones cycle among homelessness, emergency rooms and jail cells. Short courses of medication may lead to the quieting of voices, which, in turn, leads to a release to the streets.

Everyone struggles with the same underlying question: What should be done?

“When we allow people to deteriorate on the streets, or interface with law enforcement that leads to incarceration, what are we doing?” asks Dr. Jonathan Sherin, director of the Los Angeles Department of Mental Health. “We’ve lost our compass.”

State lawmakers are watching a controversial new pilot program to expand involuntary psychiatric treatment in San Francisco. But critics say forced treatment can violate civil rights, and that the real problem is a shortage of supportive mental health services.

Some families struggling to care for a loved one are aware of the downsides of involuntary treatment. They recognize that conservatorship — in which a court-appointed conservator manages another person’s living situation, medical decisions and mental health treatment — is no panacea, and should be a last resort.

Rippee, who has experienced involuntary holds, puts it this way: “I don’t need to be in a locked-up facility. It was like I was a hostage.”

In recent years, Rippee’s sisters have redoubled their decades-long effort to get him help. They worry their own health problems might someday leave no one to fight for him.

“Every winter we wonder,” Hanson said. “Is this going to be the year that he dies?”

In 1967, California transformed the treatment of people with mental illness.

Until then, a family member could, with relative ease, call police to force someone into mental health treatment. Conditions in state hospitals were frequently abhorrent: Patients rarely bathed and were subjected to lobotomies and electric-shock treatments. Many were locked away for life.

Republican Assemblyman Frank Lanterman and Democratic state Sens. Nicholas Petris and Alan Short proposed a radical overhaul, which Gov. Ronald Reagan signed into law in 1967.

When the Lanterman-Petris-Short law took effect a few years later, it imposed strict time frames on involuntary confinement and limited it to those deemed a danger to themselves or others, or gravely disabled.

Within a few decades, though, Petris noticed growing numbers of people with serious mental illnesses appearing on the streets and in jails.

In a 1989 oral history, Petris lamented that while the law had promised funding to treat people with mental illness in the community, Reagan diverted tens of millions of allocated dollars back to the general fund.

“It emptied out the hospitals,” Petris said, “but there was no follow-up treatment.”

In the half-century since, the debate about helping people like Rippee has centered on that law, which will be the subject of a state auditor’s report this spring. Several recent bills have sought to modify the law, focusing on redefining the term “gravely disabled.”

More than 5,000 people in the state were on permanent conservatorships, and close to 2,000 were on temporary conservatorships, as of the 2016-17 fiscal year, according to data collected by the Department of Health Care Services. The data are incomplete.

In 2018, lawmakers agreed to create a narrow, five-year pilot program that makes it easier for San Francisco, Los Angeles and San Diego counties to conserve homeless individuals with serious mental illnesses or substance-abuse disorders. It allows courts to conserve individuals who have been placed on temporary psychiatric holds eight times in a year.

A second law, passed last year, expanded the rules to allow 50 to 100 people in San Francisco to be placed under conservatorship.

Civil rights advocates have serious concerns: In 2018, Susan Mizner, the disability rights program director for the ACLU, described conservatorship as “the biggest deprivation of civil rights aside from the death penalty.”

She said the pilot program would give police incentive to repeatedly detain homeless individuals. So far, only San Francisco has adopted it.

Disability rights advocates insist that maintaining the standards outlined by the Lanterman-Petris-Short law is essential to protect civil rights. Most people with serious mental illnesses aren’t refusing help, they say. Appropriate help just isn’t available.

Some worry that public dismay about the current homelessness crisis will encourage lawmakers to strip people of their rights. Advocates like Curtis Child, director of legislation at Disability Rights California, said the solution isn’t more conservatorships but creating affordable housing and robust mental health services.

“It’s still political failures that are trying to be masked with solutions that may decrease the visibility of individuals on the street,” Child said.

Even if state law changed to allow more people to be conserved, a shortage of placements and “a gross lack of funding” for county programs means there would be nowhere to send many of them, said Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians and Public Conservators.

Earlier this year, a proposal to increase the amount of funding for public guardians by 35%, or $68 million, failed.

County conservators receive no direct state funding, and in the past five years have received a huge influx of clients diverted from the criminal justice system, Hughes said. Some counties went from five referrals a month to 30 or 40.

“They are drowning,” she said.

Simultaneously, the number of facilities that can take them is shrinking, said Chris Koper, a legislative analyst for the organization. That leaves many conservatees in a “placement pending” status, stuck in jails or hospitals.

Most state hospital beds are now reserved for people in the criminal justice system, and inmates with mental illness can wait for months or even years in county jails before a bed opens up. Five years ago, an average of 343 inmates with mental illness were awaiting placement. Last year, the average was 819.

“The easiest legislative fix is to expand conservatorship,” Koper said. “It then will appear that the Legislature is trying to do something. But as is often the case with social problems, the wound is so much deeper than that. And the wound will require a lot of money.”

In Solano County, where Rippee lives, Director of Health and Social Services Gerald Huber noted that few facilities in the state accept people with traumatic brain injuries. And they always have wait lists.

“Where are they going to put him?” his sister, Hanson, said. “There’s no place.”

In 1987, Mark Rippee, then 24, was optimistic about a budding career in construction and never went anywhere without his guitar. Then one night on a Vacaville country road, a car swerved into his lane. To avoid it, he steered his motorcycle into a dark field and smashed into an antique grain harvester.

Surgeons attempted to piece Rippee’s body back together. His father was overwhelmed, Hanson said, and asked her to take over medical decision-making.

A neurosurgeon recommended Rippee be transported to a state rehabilitation facility where he might need to spend his entire life, his sisters said.

Instead, Hanson said, their father grabbed the legal decision-making papers and shredded them. His only son, he insisted, was coming home.

“This is how we lost complete control,” she said.

Under his mother’s care, Rippee healed somewhat, his sisters said, though he was completely blind, suicidal and had severe brain damage. He was briefly able to take computer classes.

Then, his sisters said, the delusions crept in: He heard voices in the air conditioner. He tried to jump out of a car on a freeway overpass.

After Rippee threatened to kill his mother with an ax, family members said, they felt it was no longer safe to have him live with them. Gradually, he ran out of options. Local motels refused to rent to him. He ended up on the streets.

In the past 15 years, Vacaville police say they have arrested Rippee 25 times, charging him with unlawful camping and public intoxication.

On April 24, 2018, Privatte told the Solano County Board of Supervisors that her brother had attempted suicide more than 20 times, and that other people beat and robbed him regularly.

“It’s not because I want to lock my brother up and be done with him,” she said, crying. “It’s because I want him to be safe.”

“What can we do to help?” asked Supervisor Skip Thomson. “Because what we’re doing is unacceptable.”

Privatte showed up repeatedly begging the board for help. This spring, she received an email from Thomson’s office on behalf of the county, explaining that her brother could not be conserved in part because each time he was placed on an involuntary hold, he stabilized to the point that he legally had to be released.

“This is not a situation that we have ignored nor that we condone,” the letter said. “Simply the law requires stringent standards to impose conservatorships — standards that so far we cannot meet.”

In October, mental health leaders from around the state gathered in Sacramento to talk about the future of the Lanterman-Petris-Short Act. They discussed how counties lack the resources to build out a continuum of care.

Sacramento Mayor Darrell Steinberg asked his colleagues if the debate around involuntary treatment might be reframed to insist that people have both a right and an obligation to come indoors.

“Our North Star needs to be to end this horrific situation,” he said.

A few weeks later, a reporter found Rippee at a Vallejo strip mall, asleep on a patch of concrete littered with dirty socks and desiccated orange peels.

After Rippee woke up, he requested a coffee the way he likes it — a lot of sugar, a little coffee. He was friendly and talkative, his facts smoothly interwoven with delusions.

He talked about the beauty of classical music. He recalled delivering pies for his parents’ business. Then he toggled to concerns about the KKK chasing him.

“I’m trying to stay ahead of those guys,” he said.

Ultimately, Rippee said, he wants a home with a shower and someone to care for him. He doesn’t want to be in a locked facility, but he does wish he could live inside.

“At night it gets cold. I just sit there and shake,” he said.

“To leave a blind man outside, you know, I just figured the county could do better than that.”

Jocelyn Wiener is a contributing writer to CALmatters, a nonprofit, nonpartisan media venture explaining California politics and policy. This story was supported by a grant from the California Health Care Foundation.