Killing reveals mental health care fight Killing stirs involuntary-treatment debate

Former classmate and teammate, Wes Moyer, 22, with his friend Sarah Guzick, look at an old football picture of Wes and Daniel on July 6, 2012 in Alameda, Calif. Daniel Dewitt, 23, a consumer of the mental health system killed a man in the Oakland Hills after schizophrenic delusions got the best of him last February. less Former classmate and teammate, Wes Moyer, 22, with his friend Sarah Guzick, look at an old football picture of Wes and Daniel on July 6, 2012 in Alameda, Calif. Daniel Dewitt, 23, a consumer of the mental ... more Photo: Mike Kepka, The Chronicle Photo: Mike Kepka, The Chronicle Image 1 of / 28 Caption Close Killing reveals mental health care fight 1 / 28 Back to Gallery

In the 4 1/2 years that Candy and Al Dewitt spent trying to save their son, only to see him cycle in and out of psychiatric hospitals with schizophrenia, they came to a stark conclusion: Someone needed to impose the treatment he refused.

They told doctors, friends and peers in support groups of their fear - that, left alone, 23-year-old Daniel would fall prey to the paranoid thoughts in his head.

The morning of Feb. 19 offered a respite. They took their daughter's son to the Oakland hills with a hat, whip and boots for an Indiana Jones-themed photo shoot. Then reality yanked back.

"The worst thing you'd ever have expected could happen," Candy said, "finally happened."

Returning to Alameda, they found a stream of phone messages from friends who had been watching the news. "I'm sorry," the friends said, again and again, without elaborating.

Fearing the worst, Candy finally screamed: "He's dead!"

The truth was even more horrific. Daniel was in jail, accused of killing a total stranger the night before in the Berkeley hills as he searched for "Zoey," his imaginary fiancee.

Six months later, Daniel is at Napa State Hospital, ruled incompetent to stand trial for the slaying of Peter Cukor, 67. He is also at the fore of a pivotal debate in mental health, with his and Cukor's family saying the bloodshed could have been averted if he had been compelled to accept treatment instead of being set loose.

About 1 percent of adults in this country have schizophrenia, which can blur the line between what is real and what is not. Many lead rewarding lives and only a small percentage commit violence. But studies have linked violence and suicide with psychotic symptoms such as paranoid delusions.

Cycle of holds

Nine times since 2007, Daniel had been hospitalized involuntarily under section 5150 of the state Welfare and Institutions Code, meaning he was deemed dangerous, suicidal or gravely disabled - unable to provide for his own food, clothing and shelter.

His parents pushed for long-term treatment, but he was typically released within days.

"There is no family that yelled and screamed as loud as we did," Candy said. "What they really want to know is: Did he hit you? Did he damage something? They'll keep him as long as he's exhibiting that behavior in the hospital. If he's not, the revolving door continues."

Daniel's last hospitalization was two months before the killing. Alameda police initiated a three-day hold, and a physician at John George Psychiatric Pavilion in San Leandro said he needed two more weeks. But Daniel asserted his legal right to fight the hold and was released Dec. 13 after a special hearing.

To the Dewitts, the system deferred to a broken brain. Now, they have joined a movement pushing for controversial reforms that would expand involuntary treatment for people who frequently end up in jails or emergency rooms.

"All of the programs out there now are for people who want help," Candy said. "It's not Daniel's crowd."

Core standard

Leaders of the movement say some people with severe illness were left behind by reforms that swept through the mental health field in the 1960s, changes intended to cut costs and end mass institutionalization.

Advances in medication fueled a new vision of empowerment. California's Lanterman-Petris-Short Act, signed by Gov. Ronald Reagan in 1967, enshrined a core standard: People can be treated against their will only if they are dangerous, suicidal or gravely disabled.

But some say that isn't enough for people who can't recognize they are sick. According to the National Alliance on Mental Illness, half of the 2.4 million Americans with schizophrenia lack such insight.

What to do about it is thorny, said Ken Duckworth, the alliance's medical director. Some people can gain insight with treatment, he said. Some cannot, but can still be coaxed into care if shown it will help them. Others make what they see as a rational choice not to medicate, believing the benefits are outweighed by side effects.

"The question is: At what point is there an ethical obligation to bring treatment into people's lives?" Duckworth said.

In March, a group of prominent advocates proposed, among other changes, lengthening holds and altering the definition of gravely disabled to include an inability to make informed medical choices.

A key proposal is that California counties use Laura's Law, which allows court-ordered outpatient treatment of people with a record of mental health hospitalizations and violence.

Little-used law

Enacted in 2003, the law is fully used only in Nevada County - population 99,000 - where a man who had resisted treatment killed Laura Wilcox and two others in 2001. Officials there say the law saved taxpayers $500,000 in the past three years by cutting hospitalizations and jailings.

But other counties have balked, with some fearing abuses and others wary of high costs and lawsuits threatened by opponents.

Last year, San Francisco officials initiated what they described as a friendlier version of Laura's Law, but with a distinct difference - people must agree to participate. If they do, they're assigned a conservator who makes treatment decisions.

If Daniel had been subject to Laura's Law, "There would have been a multidisciplinary team assigned to work with him," said Carla Jacobs, who is leading efforts to implement the law. If he refused medication, "they would have had the ability to put him back in the hospital."

Supporters include Teresa Pasquini of El Sobrante, whose son has schizophrenia and has been forcibly held more than 30 times. She believes Laura's Law would enable the 29-year-old to live in the community, rather than his current home of Napa State.

"The system is trying to do what's right," she said. "It's not working, and it's costing my son his life and his freedom."

But where she and others envision positive change, many mental health advocates see a turn back toward institutionalization. The system has safeguards against violence, they say, but shouldn't try to predict it.

Eduardo Vega, who runs the Mental Health Association of San Francisco, said the focus should be on expanding and improving voluntary treatment, which some say has proved to deliver the best results. Programs such as Laura's Law, he said, were oversold as "silver bullets" for complex challenges.

"The real magic in some of the recovery-oriented programs is giving people an opportunity to give back," Vega said. "When the interaction is under the veil of a threat ... our basic nature is to push against that."

Typical kid

These questions were far off when Daniel became the second child adopted by Candy, an accountant, and Al, a truck driver whose father was Alameda's first black mayor. Daniel was a shy but typical kid - fishing, catching bugs, riding dirt bikes.

He was an all-league tight end and defensive end at Alameda High. Teammate Wes Moyer, who now plays at Yale, recalled a hard-nosed athlete whose gangly dexterity made it appear he would drop each pass.

"When he caught the ball, everybody would go crazy," Moyer said. "Everybody liked him a lot."

But as his senior year went on, Daniel's growing paranoia led him to do odd things, like burn candles to keep spirits away. He planned to attend college, but pulled out a week before he was set to leave. A meter-reading job lasted about a month and a half.

"He said, 'I can't do it any more - there's people following me everywhere,' " Candy recalled.

That fall, he broke down. He ended up pacing on a BART platform, where police officers flagged down by his parents wrestled him to the ground.

"That was the worst thing I'd ever seen," Al said.

Revolving door

A grueling journey had begun, but the Dewitts found they had little control. They drove that night to John George, the county's psychiatric hospital, only to find the staff couldn't tell them anything without consent from Daniel, who felt his parents had betrayed him.

He took medication for about a year after that, his parents said. Though he hated the side effects, he was able to spend time with friends and study sound production at an Emeryville college.

But a big school project stressed him, among other things. He quit the school and the medicine.

In the subsequent months, his parents struggled to cope as well. They joined support groups and at one point got Daniel an apartment in Oakland.

Meanwhile, Daniel grew more scared and agitated, thinking someone was following him or poisoning him. Sometimes he was so disturbed that his parents called police, prompting seven hospitalizations in 2010 and 2011.

Sometimes, police let him be, concluding he didn't qualify for a hold.

Oakland police Officer Doria Neff, her department's mental health liaison, said such decisions are difficult. Officers, she said, generally have just two options: take the person to jail or to John George.

"There's nothing worse," Neff said, "than having to tell a family member there's nothing we can do."

When he went to John George, Daniel encountered a mental health system straining to help the many people who rely on it.

Limits of care

Guy Qvistgaard, the hospital administrator, said he sees about 250 admissions a month, most initiated by police. The average stay is eight days. The 69 beds are consistently full.

"It's crisis management," Qvistgaard said. "Years ago, when mental health funding was more abundant, we'd try to return the patient to a higher level of functioning. However, right now ... the limits of our treatment are to stabilize the person so we can move them to a lower level of care or discharge them."

Daniel was not released quickly after one hold in December 2010. He allegedly attacked a nurse at John George, and the hold stretched to six months.

He was sent to Gladman Mental Health Rehabilitation Center in Oakland, where his parents said he did well - playing his guitar, exercising and assuring doctors he would keep taking medication when released.

"But all along," Candy said, "he told me he wasn't going to take his medications. They said, 'But he's telling us he will,' and I said, 'He's not ready.' "

Prescriptions unfilled

Daniel was offered services when he was released in July 2011, his parents said, but never even filled his prescriptions. Instead, he fought in his own way, taking vitamins, eating chicken and fish, and running around Lake Merritt.

He was held in November and again in December, when a John George psychiatrist ruled he was in such bad shape that he needed at least two more weeks in the hospital. To his parents, what happened when Daniel opposed the hold was a critical mistake.

Under state law, he was granted an advocate and a hearing in front of an attorney appointed by the courts. Such hearings typically last less than an hour. In this case, the psychiatrist was overruled, and Daniel was discharged.

Qvistgaard said the hearings were another collision of ideals.

"Patients need to have rights, and at the same time, they need good clinical care," he said. "There are going to be times when the two systems have disagreements."

Last descent

In the weeks before the killing, Daniel isolated himself, his parents said. Rather than go shopping with his mother, he asked her to drop off groceries at his apartment. Sometimes he refused to open his door and asked Candy and Al to whisper so no one would hear.

Candy told her support group she feared a tragedy was coming.

According to police, Berkeley resident Peter Cukor confronted Daniel at 8:45 p.m. on Feb. 18 and ordered him off his property. Daniel instead said he was a psychic and "was told to go through the gate to find Zoey." After Cukor lost sight of him and walked down his driveway, police said, Daniel beat him with a flower pot.

Cukor's wife and two adult sons are seeking damages from the city, saying police didn't respond to an initial call for help. The family declined interview requests, but issued a statement urging Alameda County to use Laura's Law "to ensure that this can never happen to another citizen."

Daniel was charged with murder, but his parents' effort to compel treatment did not end. He was held at Santa Rita Jail, which had neither the capability nor the right to impose care.

Nor did treatment come when a judge ruled on April 13 that Daniel was mentally incompetent to stand trial. Daniel was ordered to Napa State, but a bed wasn't available.

Left untreated, his parents said, he banged his head against the jail walls in early May and was sent to John George - his 10th 5150 hold. It was there, on May 16, that he allegedly broke a deputy sheriff's jaw while being cuffed for transport to Napa State.

Fight goes on

The state's goal now is to prepare Dewitt to assist in his defense. But there's a final paradox: If Napa State restores his competency, he will probably be sent back to county jail, where he can again refuse treatment.

"The catch-22 is that once you're competent, you have all your rights ... which includes the right to refuse what's good for you," said David Cook, a county prosecutor who acts as a point person on mental health issues. "Often we just have a short window to get a case done."

At a recent hearing, Candy and Al were relieved that Daniel had not yet been ruled competent. Riding down a courthouse elevator, Al motioned with the long arms he once used as a 6-foot-8 basketball star.

"Keep rowing," he said. "Just keep on rowing."