“What is your emergency?” responded a voice, captured on video footage from a camera in the cell. It was a deputy about 50 feet away, in the control room of the women’s mental health unit where Upton, 21, was being held.

“It’s not an emergency, but —” she began, then the deputy cut off the call before she could finish. Charged with a misdemeanor, Upton was awaiting a court-ordered evaluation to determine whether she was competent to stand trial.

She took a few more listless steps, the video shows. She paused beneath a buzzing fluorescent light, then picked up a white bedsheet and said, “It’s time to hang myself.”

She was found, limp, 20 minutes later. In the interim, the camera recorded the young woman preparing to end her life. But no guards, who were tasked with monitoring the video feed, noticed until it was too late.

Upton was the first of 19 detainees at Riverside County jails to die in 2022. That total, the highest the department had reported in at least three decades, ranked the jail system among the most lethal in the nation that year.

The deaths, attributed to homicide, overdose, natural causes or suicide, reflected troubling patterns: neglect by jail employees, access to illicit drugs, and cell assignments that put detainees at increased risk of violence or did not allow for close oversight.

The suicides — at least three of the deaths, but most likely four — offer particular insight into some of those institutional problems and lapses, an investigation by The New York Times and The Desert Sun found.

The county Sheriff’s Department failed at times to adequately monitor detainees and intervene when they attempted suicide. Guards did not always enforce rules prohibiting detainees with mental illnesses from blocking cell windows and cameras, which hinders the required safety monitoring. The department has often isolated detainees with severe mental illness, which can exacerbate suicidal intentions.

And, the investigation found, the department has omitted pertinent facts about the deaths in communications to the families of the dead and to the public.

The department has assumed no responsibility for these deaths. California’s attorney general last year opened an ongoing civil rights investigation into the increase in deaths in custody, and Riverside County agreed to pay more than $12 million to settle lawsuits linked to detainee deaths going back to 2020. At least a dozen cases are still pending.

The county sheriff, Chad Bianco, did not respond to interview requests or comment on detailed questions about the news organizations’ findings. But on an episode of his podcast this summer devoted to inmate deaths, he said that it can be extremely difficult at times to prevent suicides, and falsely claimed that there had never been any allegation that the department had “somehow done something wrong, or mishandled inmates, or mistreated inmates, or caused their death.”

The president of the deputies union declined to comment.

To understand how the suicides occurred, The New York Times and The Desert Sun interviewed dozens of people including current and former jail employees, relatives of the dead, independent medical examiners and civil rights lawyers. The news organizations also reviewed court documents, including arrest records, detainee medical and mental health records, and department notes on jail housing decisions.

Many of the details in this article have never been publicly reported, including the jail security camera footage reviewed by a reporter — material that is rarely seen by outsiders. The department has not released that footage or a dozen other videos requested by the news organizations under the California Public Records Act.

The suicides strongly suggest that, despite a federal class-action suit a decade ago that exposed deficiencies in mental health treatment in Riverside County jails and resulted in new court-ordered requirements, problems persist.

One detainee in 2022, who told guards that he was suicidal, was cleared after a medical check to return to his cell without any suicide-watch protocol. He was found dead about an hour later. He had been in custody for one day.

Another man, who suffered from schizoaffective disorder, had been mostly segregated from other detainees for two years when he was found hanging, and later died. To conceal his actions, he had covered his cell window and camera without any intervention from guards.

There were 14 deaths in Riverside County jails in 2023. No suicides were reported, though the cause of death in five of those cases is still “pending investigation,” according to the California Department of Justice. Earlier this year, a man hanged himself while another detainee tried to alert jail guards but couldn’t get their attention.

That suicide and a separate drug overdose prompted Capt. Alyssa Vernal, then the head of the jail, to warn staff members that they were failing to maintain basic jail operating standards — including some of the same lapses identified years ago by the federal court.

Vernal, who did not respond to requests for comment for this article, wrote in an internal email reviewed by the news organizations, “It has become obvious we are not keeping house or following the rules we should be.”

‘Kept saying she was fine’

When she was 19, Alicia Upton hit the road and left everything behind. She piled into a friend’s car in West Virginia and embarked on what would become a cross-country trip.

In an interview, her mother, Nichole Thompson, recalled believing that she was going on a fleeting adventure before settling back home. “She was resolute when she fixed her mind on something,” said Thompson, a librarian who raised Alicia and her older sister in the Appalachian town of Lost Creek.

From a young age, Alicia was an animal lover who would bring home rabbits and raccoons she hoped to keep as pets. At 14, she sold the Xbox she had gotten for Christmas to buy a horse, which she trained herself. To raise money for the road trip, she sold her four-wheeler and some goats, but not the horse, which she left in the care of a friend.

Upton had shown no signs of mental health problems when she left home, her mother said. She had gone to counseling years earlier after the suicide of a close friend, and her mother felt that she was resilient.

The road trip took Upton to Florida, Texas, and across the country through New Mexico and Arizona. Finally, she called home from Hemet, a former farming town now sprouting strip malls and tract houses. It is near the western end of Riverside, one of the state’s fastest-growing counties, which extends from the Arizona border almost to Los Angeles.

She sounded happy, her mother recalled. She said California was beautiful. As the weeks wore on, though, she mentioned that the car needed costly repairs and that she was often looking for places to sleep.

“I walked a fine line, trying to coax her to come back, but also let her have her freedom,” Thompson said. While some companions left for new destinations, Upton stayed put.

As the months turned into a year, it became clear to Thompson that her daughter was living on the streets. “She always knew coming home was an option,” Thompson said. “If I pushed her, I felt she would disconnect. She just kept saying she was fine.”

Soon, Thompson became concerned that her daughter might be struggling with drugs. She recalled Upton saying irrational things on the phone, like describing seeing relatives who were thousands of miles away.

Eventually, Upton was arrested twice for minor offenses — shoplifting and trespassing. Both times, she was released. But a third arrest was different.

On April 19, 2022, a woman found Upton on her land in San Jacinto. She later told deputies the young woman appeared to be looking for something. When the landowner found a knife on the ground, the two had a confrontation. Upton left and no one was injured. But she was arrested nearby and charged with possession of drug paraphernalia and making criminal threats, both misdemeanors.

The paper trail of Upton’s incarceration describes her as distraught and combative on arrival at the Robert

Detention Center in the city of Riverside. Of the five jails in the county, it is the facility where detainees who need mental health care are most often sent. Reports from the booking note that she did not sign several required documents. One jailer wrote on the signature line that she could not be trusted with a pen.

She was given a mental health rating of “severe” and placed in the women’s mental health housing unit, where each cell was monitored by camera. She was not prescribed any medication. When asked if she had ever attempted suicide, she would not answer.

But, deputies wrote in her file, she said she had “multiple personality disorder” and “stated that she ‘always kinda wanted to die.’”

A surge in jail deaths

Long before Upton was sent to the jail, the Sheriff’s Department had struggled to treat mental illnesses among the nearly 3,700 detainees it housed on any given day.

In jail and prison systems across the country, the population of people with mental health needs has surged in recent decades. More than half the detainees in California’s jails have such problems, a 2023 study found. As Riverside County’s jails began to operate as de facto mental health facilities, some detainees who claimed mistreatment took action.

Four sued the county in federal court in 2013, in what would become a class action, claiming the department was not providing adequate care.

When a judge ordered experts to inspect the claims, Dr. Bruce Gage, then chief of psychiatry for the Washington State Department of Corrections, found multiple problems. Some detainees were not receiving prescribed medications. Others were being medicated indefinitely on mere suppositions of mental illness. It was unclear whether the call buttons in the cells even worked.

Gage reported that the jails didn’t monitor suicidal detainees who were awaiting transfer to psychiatric facilities. The jails had no protocol in place to transition someone who was no longer considered suicidal into less-restrictive living conditions. Detainees either were in a general population and could be outside their cells for hours a day, or confined for all but 15 to 45 minutes.

“Riverside County jail system is amongst the most restrictive correctional settings I have visited,” Gage wrote. Those struggling with mental illness, he added, are “placed at greater risk of harming themselves under these conditions.”

Based on the reports, in 2016 a judge ordered a remedial plan that included ongoing inspections of the facilities and the threat of court intervention. Gage noted that the department had faced a staffing shortage since the 2009 recession, but emphasized that basic standards of care were required by law.

Sara Norman, one of the plaintiffs lawyers in the case, said that the jail had made progress in improving medical care, but less so with mental health care. “We have been concerned for years about the dearth of programming and group and individual therapy for people struggling with mental illness in the jails,” she said.

Meanwhile, the county system experienced an increase in jail deaths over the past decade. Among them was a man in 2020 who had been arrested for drug possession and was to be released with a citation for a later court appearance. Instead, he died after being violently extracted from his jail cell by guards while experiencing symptoms of psychosis. His relatives received $7.5 million this year to settle a lawsuit.

The surge of 19 deaths in 2022 made Riverside’s rate the second-highest in the state, behind Kern County, which had a much smaller jail population. Among the nation’s 15 largest jail systems, Riverside was the second-most deadly, with a rate more than twice that of Chicago, Philadelphia and Dallas.

While some people at the Riverside jails were serving criminal sentences, most — including those who died by suicide — were detainees awaiting trial or other resolution of their cases.

Robert Robinson, 41, was arrested in September 2022 for trying to cash a fraudulent check at a casino. Because he was a gang dropout, he was considered a likely target of violence and was housed alone.

He told jailers while being booked that he was having suicidal thoughts, according to a lawsuit filed by his relatives. He was placed in a cell without a camera and was not put on suicide watch, records show.

The next day, he told deputies he was suicidal, and he met with a medical provider and a mental health nurse, according to court documents. Both cleared him to return to his cell alone. About an hour later, a deputy discovered that he had hanged himself.

Riverside County settled the civil suit with his relatives this past August for $1.8 million, with no admission of wrongdoing. His family did not respond to requests for comment.

Aaron Aubrey, 28, had an extensive history of mental illness and violence. During his three-year incarceration awaiting trial on a murder charge, he was housed in a mental health unit. He spent significant time in isolation after he was charged with killing another detainee in 2020.

In December 2022 a guard saw that Aubrey had blocked his window and covered his camera, but took no action, according to the coroner’s report. During another security check 40 minutes later, the detainee was found hanging. He died six days later at a hospital.

And this year, Reynaldo Ramos, 55, hanged himself even as a cell neighbor twice tried to alert guards over the intercom, according to a complaint filed with the county by the man’s relatives. The guards didn’t respond, the complaint said.

The claim attributed that account to an anonymous letter sent to the family’s lawyer and separately to a reporter for The Times and The Desert Sun, containing those closely guarded details. A person who had reviewed jail surveillance video of the unit also described the failed alert efforts.

Ramos, who had been given a mental health rating of severe when admitted to the jail on drug charges, was discovered unresponsive during a routine safety check, according to an internal incident report provided to the Times.

‘Man down!’

In the days after Upton’s arrest, her mind continued to fray.

On April 28, 2022, a judge ordered her to undergo a mental competency evaluation. Her criminal case was suspended, and with it the possibility of bail, until the findings were reported. When she was admitted to the jail, she had briefly been placed in a safety cell, without access to items that could be used for self-harm. Soon after, she was placed in the mental health unit.

That evening, the surveillance video showed, she was restless. Her cellmate was asleep on the top bunk as Upton paced and looked out of the cell door’s window. Meal trays were stacked at the foot of the bed and clothes were scattered nearby.

At 8:13 p.m., she pressed the intercom button, but got only a few words out before the deputy hung up. Moments later, Upton can be heard in the video saying she intends to hang herself.

She looped the bedsheet around her neck and, for a few minutes, tried anchoring it. She smacked her head three times. She looked toward the camera. At one point, it sounded as if she was weeping.

Sitting on the bottom bunk, she tied the sheet above her and tightened it around her neck.

At 8:18 p.m., Upton raised a middle finger to the cell camera. Over the next few minutes, the video captured her final movements. By 8:22, she was still.

It all unfolded in view of the deputies who were supposed to monitor the feed from her cell. A guard at a workstation near the control room was responsible for constantly tracking the video footage of the unit, according to three former jail employees speaking on the condition of anonymity for fear of reprisals from the department.

Meanwhile, a deputy in the control room reminded a trainee to occasionally scan the images. They looked up at the feeds from the roughly 40 cameras, two of the former employees said. Spotting Upton, the deputy shouted over the radio, “Man down!”

She had been hanging by the bedsheet for 16 minutes before guards flashed lights signaling an emergency, video footage shows. Two deputies and a jail nurse entered her cell and began resuscitation efforts, but it was futile.

The next morning, back in West Virginia, Upton’s mother woke to pounding on her door, she recalled in an interview. It was a local deputy, who told her to call the Riverside County Sheriff’s Department.

She remembers asking, “Does this mean she’s dead?”

Yes.

“I thought my heart would stop,” she said.

The sheriff is the coroner

In Riverside County, the final accounting of how people die depends to a large extent on Sheriff Bianco.

A veteran of the department, Bianco was first elected sheriff in 2018. He has cast himself as a right-wing firebrand at odds with the state’s left-leaning legislature and governor. He has also criticized Atty. Gen. Rob Bonta’s investigation of jail deaths as a “political stunt.”

California is one of just three states that allow elected law enforcement officials to oversee coroners’ offices. Until recently in Riverside County, that meant the Sheriff’s Department typically investigated deaths at its jails while also supervising the pathologists conducting the autopsies. (This year, the department began outsourcing those autopsies.) The final report about the cause of death is signed by the sheriff, who also serves as the coroner.

The state Legislature has considered bills to separate the offices but none have passed. The California Medical Assn. has long advocated a separation, saying that the consolidation of the responsibilities of sheriff and coroner is an “immense conflict of interest.”

The New York Times and The Desert Sun found discrepancies when comparing the department’s public death summaries of the 2022 suicides against jail records turned over in civil suits, the video of Upton’s death and information provided by current and former employees.

Mario Solis, who had a history of mental illness, was jailed after a scuffle with a grocery store security guard over a stolen bag of Skittles, according to court records. In September 2022, his mother, Sara Solis, was told that he had died alone in a cell — but not much else. About six months later, she received the department’s summary report.

It included findings from an autopsy conducted days after Solis, 31, died in the mental health unit of the jail in Murrieta. Inside his mouth and throat were two pencils, a toothbrush, a plastic cap and bars of soap, the report said. It also noted cut marks on his arms.

A deputy coroner wrote that Solis had “an unspecified mental health history” and had been prescribed two psychiatric medications.

Sheriff Bianco attributed Solis’s death to suffocation and blood loss after his jugular vein was punctured. He certified the death as an accident.

More than a year later, a lawyer representing the Solis family in a suit against the county received a trove of information the Sheriff’s Department had not previously disclosed. Jail medical staff had treated Solis for schizophrenia, including with antipsychotic medication. On three occasions, he said he was suicidal and talked about stabbing himself with a pencil.

During a chaotic five-month incarceration, he was transferred 10 times among four county jails and did two stints in intensive psychiatric treatment.

From the start, Solis had pleaded for help and medication, his scribbled notes show: “I am not well. Please help me before things worsen,” one read. In another, he requested a psychiatric visit, which was arranged but later canceled.

On Sept. 2, 2022, Solis was ruled incompetent to stand trial and ordered to a hospital for treatment. The next day, he was found unconscious in his cell. He had lacerations on his wrist and neck, a nurse wrote. His neck was red and bruised. His mouth and nose were bloody.

Photos of the cell show flooding from the toilet that soaked books and trash. One wall was filled with erratic writing.

The department’s reports do not explain why Sheriff Bianco determined that the death was accidental.

Bianco has accused media outlets and advocacy groups of misrepresenting the jail deaths to the public, including on his podcast episode on the topic, which was promoted on the department’s social media channels. Without naming names, the sheriff said that a detainee who had died after swallowing objects, including a pencil, had a “propensity to eat things.”

“They suffocated themselves, basically,” Mr. Bianco said. “But we don’t believe it was a suicide.”

In 1,600 pages of jail medical notes, there is no mention of Solis habitually swallowing harmful objects, as the sheriff claimed.

“This is not someone who accidentally died,” Hugo Solis, one of Solis’s brothers, said in an interview. “He killed himself in despair. And the sheriff knows that.”

A forensic pathologist and a medical anthropologist reviewed the coroner’s report for this article. Both said that, aside from the mention of Solis’s psychiatric history and prescriptions, it was unclear whether the coroner staff had reviewed his extensive mental health records or knew about his suicide threats. Both said that information was crucial for determining whether the death was a suicide.

Dr. Judy Melinek, a board-certified forensic pathologist, asked, “Why was he left alone and unsupervised after showing severe signs of mental health deterioration?”

‘It was their job’

Thompson, Alicia Upton’s mother, said she was stunned at how little information the Riverside County Sheriff’s Department would share about her daughter’s death.

For weeks, she said, she struggled to learn even basic details about the events leading up to the suicide. She asked to see any reports and obtain any surveillance video, though she wasn’t sure if she could bear to watch it. But the department declined to provide much of the material she requested.

Thompson sued the Sheriff’s Department last year, saying that it had failed to monitor and protect her daughter. In its response, the county denied that deputies had failed to monitor Upton at the time of her suicide. However, according to two former employees, two jail workers faced discipline for lapses.

When a reporter described to Thompson the footage from the jail cell, she said she had long suspected that her daughter had been desperate for help — but had been ignored.

“It was their job to keep her safe,” Thompson said. “It was their job to monitor her. They didn’t care to do it.”

Christopher Damien is a reporter with the Desert Sun, reporting about law enforcement in Southern California’s inland and desert communities. He is part of The New York Times’ Local Investigations Fellowship. This article is co-published with the Los Angeles Times. Justin Mayo and Ana Facio-Krajcer contributed reporting. Julie Tate contributed research. This article was reported in partnership with Big Local News at Stanford University.

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.

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“This event over exceeded my expectations,” Regional TANF Manager Harold Arres said. “The youth were not only willing but excited to participate.”

Chance, who lives in Dallas and is a member of the Three Affiliated Tribes of the Fort Berthold Indian Reservation, travels throughout the United States and Canada to work with Native communities in efforts to inspire, heal, motivate, and energize. He has a talent for using his energy and humor to spread a simple message, “Use your personal talents to lead you to greatness.” He promotes healthy living and lives his life alcohol and drug free.

Tribal Unite was formed about two years ago to unite Tribes through encouragement, leadership and spirituality. “We need to support each other,” Chance said. “We visit at least 20-30 Tribal communities across the United States every summer. We’ve had the privilege of working with Soboba at various conferences and it’s truly an honor to finally come out here.”

He has been serving tribal communities and organizations for over 20 years as a motivational speaker, event MC, and professional development trainer/facilitator. Chance is also a stage, television and film actor who appeared in “Killers of the Flower Moon,” a movie that earned 10 Academy Award nominations this year. He is the principal founder of Tribal Unite with the vision to utilize multiple platforms to encourage tribal interests. For more information, www.chancerush.com.

Arres has seen Chance at several UNITY conferences in the past and said, “He’s got some great things to say to the youth and today was no exception. After speaking with our youth, a lot of them stated they enjoyed Chance’s words of encouragement. The youth were optimistic about their futures after hearing him speak.”

The 28 youths who attended enjoyed lunch before listening to an introduction by Chance, followed by an ice-breaker activity to start off with fun. Rush said the focus for the day would be on spirituality, leadership, mental health and opportunities.

He told the young people to “work strong in your community.” He said it’s okay for adults to have expectations for their children, but encouragement has to be the priority.

Chance requested two volunteers to illustrate the message of “whatever you lean toward, it will lean back.” Mkilawish Arres and Exequiel Minott stood back-to-back and as he asked one to lean backwards, the other had to do the same to maintain solid footing.

“Whatever you’ve got going in your young life, remember that Soboba youth run things. You are number one. I want you all to get down to business. You’re not the future, you’re the now. The future is in the unborn,” he said.

He told the youth that they should have a game plan and stick to it. “Everybody has a purpose while they’re here. We get on you and tell you what you should and shouldn’t do. We throw everything at you because we know that youth are ready to go,” he said. “You have to be ready to level up when the time comes.”

Chance admitted that even as an adult and all he has experienced, there is still so much for him to learn. He told the youth that with all the programs they attend, people know who they are. “You have a reputation. It’s a good one so keep it strong and take ownership of it,” he said.

He told them to always remember everything they have been through as Native people. “It’s a privilege to be who we are,” he said. “We were put on this earth to do great things, do something powerful. There is great energy in this room, there’s something powerful in this room.”

Chance told them to get ready. “Some of you are going to be put in some amazing places but it’s going to take hard work of being solid to be successful.”

He said younger siblings and other children are looking up to them and they should be a good example. “You don’t have to be perfect and ladies and gentlemen, you are not going to be perfect until you get home with Creator,” he said. “But while we’re down here on Mother Earth, let’s go all out and make an impact, make a difference in other people.”

Fifteen-year-old Mkilawish Arres was impressed with the things that Chance had to say and learned not to wait “for people to tell me what I can do.” The soon-to-be high school junior will be spending the summer working and playing sports.

Abby Rush is a member of the Three Affiliated Tribes of Fort Berthold. She resides in Tulsa, OK where she is pursuing her M.A. in English Literature and Language. Abby pursued her poetic voice at a young age and has grown with her craft for over a decade. She seeks to tell the stories of Indigenous people through her work, always uplifting Native voices in her writing and outreach endeavors. Abby is dedicated to spreading her message of wellness through writing across Indian Country.

She shared with the audience at Soboba a video of a recent TEDx Talks she had done at the University of Tulsa, discussing how more light needs to be shed on the violence faced by American Indigenous women, the pervasive PTSD within Indigenous communities, and the alarmingly higher violent crime rates they endure compared to the rest of America. She shared how she promotes wellness through storytelling and poetry.

She made it clear that her stories don’t speak for everyone, but she encourages others to share their thoughts through the written word. “Your people came through their own trials and tribulations; we are here because our ancestors survived,” Abby said. “I started to think about my voice and the power it could yield. I’m a writer, a poet and maybe you’re an athlete or a musician. All of us have gifts we can use to build relationships.”

Abby, 25, shared that she struggled with mental illness a couple of years ago and didn’t want to ask for help. But she decided to take the advice she always shares with young children and that is to not keep things bottled up inside and to reach out to others when needed. “Push your ego and pride down and ask for help,” she said. More information can be found at www.AbbyRush.com.

Her TEDx Talk about the plight facing American Indigenous women can be viewed at www.youtube.com/live/AeYpZ0edhT0?app=desktop.

High school senior Zachary Guacheno said he enjoyed all the different talks. “There were a few things I learned and will keep in mind for the future,” he said.

The afternoon was filled with fun activities and frequent breaks between segments. This allowed the youth to socialize and enjoy the music provided by Rudy Indigenous. The Oklahoma based DJ and motivational speaker is Choctaw and Kickapoo. With a primary focus on personal growth and wellness to spread positivity throughout Indian Country and beyond, Rudy uses his skills in music and public speaking to help create, uplift and support the stories of Indigenous people and communities across the United States. For more information, please visit www.RudyIndigenous.com.

Nowaniiki Resvaloso, 13, had fun with all the games. His takeaway from the talks is “that we are not the future” but rather the powerful present, as Chance emphasized. Joeann Walker, who just completed her freshman year of high school, also enjoyed the activities. She learned it is important for her “to put myself out there” and plans to do that more.

There were seven TANF staff members present to assist with the event who will be able to encourage and reinforce the messages in the future. The three staff members from Cahuilla were JJ Sanders-Alto, Howard Matthews Jr. and Andrea Candelaria. Joining Arres from the Soboba office were Nancy Gallegos, Maria Hernandez, Mayra Campos and Annalisa Tucker.

“A highlight for me was seeing the engagement and enthusiasm in our youth,” Arres said. “This year, our youth are really stepping it up and getting involved and contributing to our events. This event was a great opportunity for them to do so.”

Parks & Recreation Director Andy Silvas also oversees the Soboba Youth Council and was pleased with the success of the event. A highlight for him was seeing the youth get involved with all the activities that were presented. “I expected the kids to lose interest at some point, but they stayed engaged,” he said. “We would definitely like to host similar events in the future.”

Aniyah Brittain, who is headed to seventh grade, said her plans this summer are to have fun and relax. She enjoyed the event and said, “I liked that they said I can be whatever I want to be in the future.” Shania Guacheno, also an upcoming seventh grader, said she liked how people at the event were nice. “I want to try to be successful like them,” she said.

Arres said they are considering doing more of these hands-on wellness type events in the near future. “We are also looking forward to inviting Chance Rush and Tribal Unite to host another event sometime next year,” he said.

For more information, www.tribalunite.com.

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In the Columbia Mailman Psychiatric Epidemiology Training (PET) Program, fellows receive five years of funding and an invitation to think slowly and deeply about high-stakes issues in the field. During the program’s weekly seminar, faculty offer further food for thought. “For the first three, sometimes four years, we encourage fellows to make a presentation that doesn’t include data—focus on what interests you, what bugs you; tell us what you care about,” says Professor of Epidemiology Katherine Keyes, who codirects the program. “The scholars we produce know how to generate important questions with high-quality study designs underlying them.”

When it comes to asking important questions and identifying data sets robust enough to answer them, PET faculty members lead by example. Consider their inquiries into racial disparities in mental health diagnoses in the United States. “At the end of the day, we know that Black folks and people of color have very different lived experiences in this country and that has affected their health outcomes,” says former PET fellow John R. Pamplin II, MPH ’14, PhD ’20, now a Columbia Mailman assistant professor of epidemiology. (Read a Q&A with Professor Pamplin.) Racial differences have been well documented in asthma rates, cardiovascular disease, diabetes, maternal and infant health outcomes, even overall lifespan—and perhaps nowhere so starkly underlined as in COVID-19–related disability and death. Pamplin’s own doctoral research investigated differences in depression and suicidality, topics Keyes, MPH’06, PhD’10, herself a former PET fellow, has also investigated for more than a decade.

More recently, a contingent of PET faculty that includes both Pamplin and Keyes has turned their attention to the role of structural racism in the incidence of schizophrenia. “When it comes to schizophrenia and psychosis, there’s evidence that folks from marginalized racial groups—in particular, folks with Black, African, or Caribbean racial/ethnic identity in Denmark, the Netherlands, the United Kingdom, and the United States—have a higher prevalence of schizophrenia,” says Pamplin. “Those prevalences aren’t as elevated in places where those groups are dominant. It has to do with racial marginalization.”

Going back to the late ’80s and early ’90s, when he was a PET fellow, Ezra Susser, the Anna Cheskis Gelman and Murray Charles Gelman Professor of Epidemiology, investigated the role of maternal nutrition and famine in the etiology of schizophrenia. Over the last three decades, his work on schizophrenia has also delved into how paternal age and complications during pregnancy and birth affect adult-onset schizophrenia, as well as comparative analyses of international data. He sees structural racism in the U.S.—laws and systems of life that affect racial differences in such determinants of health as access to fresh vegetables and safe housing, even how healthcare is delivered and paid for—as a powerful theoretical framework for understanding disparities. “It’s not just for unpacking what’s going on,” he says. “It suggests that you also need changes to that system. Ideally, you would change the structures, and if you can’t change them, at least mitigate the effects.”

Prior work to untangle the causal components of disparities in psychiatric diagnoses—especially such multifactorial conditions as schizophrenia—has been suffused with bias and bad data. Consider the search for genetic explanations, says Pamplin. “The genetic variation among Black people is greater than that between Black and white folks,” he says. “That should give us pause as to whether genetic differences are the relevant factors to explain racial differences in health.” Susser—co-director of PET for 25 years, then director 2015–2020, and now again codirector with Keyes—urges humility in the quest for insights, particularly given the history of racism in psychiatry.  While diagnostic criteria—and treatment—for schizophrenia have come a long way in the last 50 years, race-based disparities persist in the rates at which people are diagnosed.

Susser and Pamplin began discussing the topic early in Pamplin’s doctoral studies—even after discounting for diagnostic bias, each had a hunch there was more to the story. At the time, however, solid epidemiological datasets weren’t available. In 2023, the American Journal of Psychiatry published Susser’s editorial(link is external and opens in a new window) with Els van der Ven, a clinical psychologist at the University of Amsterdam, on an analysis of ethnoracial differences in the incidence of treated psychotic disorders among nearly 6 million people insured by Kaiser Permanente Northern California.  “Despite the salience of Black-White disparities in schizophrenia,” they write, “the scarcity of high-quality population-based incidence data in the United States and the absence of measures of diagnostic bias (overdiagnosis of Black people) in incidence studies have limited our progress in understanding the underlying causes.”

PET scholars have a nearly 60-year legacy of responding to contemporary public health challenges, says Keyes, from HIV to young adult mental health and homelessness. “Structural racism is a huge determinant of population mental health, especially for racially minoritized populations,” she says. “We have a responsibility to develop measures, insights, into how these processes work.”

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Starting Saturday, July 16, every person in every community nationwide can dial “988” to reach trained crisis counselors who can help in a mental health, substance use or suicide crisis. Learn how 988 can help you in a crisis and what it might mean for your community with these FAQs.

988 is the first step in reimagining our crisis response, but there’s more work to do to ensure everyone receives the help they need — and deserve — in a crisis.

Too often, people with mental illness do not receive a mental health response when experiencing a mental health crisis. Instead, people in crisis often come into contact with law enforcement rather than a mental health professional. People in crisis deserve better. The lack of a robust mental health crisis system leads to tragic results. One in four fatal police shootings between 2015 and 2020 involved a person with a mental illness, and an estimated 44% of people incarcerated in jail and 37% of people incarcerated in prison have a mental health condition — and people with mental illness are booked into the nation’s jails around 2 million times every year. Millions more end up in emergency departments that are often ill-equipped to address mental health crises, often waiting hours or days to access care.

NAMI is committed to advancing efforts to reimagine crisis response in our country. We believe that every person in crisis, and their families, should receive a humane response that treats them with dignity and connects them to appropriate and timely care. NAMI is calling for a standard of care for crisis services in every community that includes — 24/7 call centers that answer 988 calls locally, mobile crisis teams and crisis stabilization programs — that end the revolving door of ER visits, arrests, incarceration and homelessness.

In 2020, the nation took a significant step forward with the enactment of the National Suicide Hotline Designation Act, a bill NAMI advocated for that created a nationwide three-digit number (988) to assist people experiencing a mental health or suicidal crisis. The Federal Communications Commission (FCC) determined that this number would be available — by both phone and text — in July 2022, and is now available in communities across the country.

988 FAQs

What is 988?

988 is the new three-digit dialing code connecting people to the existing National Suicide Prevention Lifeline (now the 988 Suicide and Crisis Lifeline) where compassionate, accessible care and support is available for anyone experiencing mental health-related distress — whether that is thoughts of suicide, mental health or substance use crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support.

The goal of the 988 Suicide and Crisis Lifeline is to provide immediate crisis intervention and support. When someone calls 988, a trained crisis counselor will answer the phone, listen to the caller, understand how their problem is affecting them, provide support and share resources, as needed. These crisis counselors will be able to resolve the urgent needs of the more than 80 percent of callers on the phone. For the remaining 20 percent, community services will differ, although NAMI is advocating for a full range of crisis services in every community. This work is ongoing (see FAQs to learn more about how 988 works and what to expect when you reach out to 988).

You can reach the 988 Suicide and Crisis Line by calling 988, texting 988 or chatting via Lifeline’s website.

Is this number only for suicide-related crises?

No, 988 is a number to call for suicide, mental health and substance use-related crises or any kind of emotional distress — not just suicide-related crises.

What is a mental health, substance use or suicide crisis?

A mental health or suicidal crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to function well in the community. For example, a person in crisis may experience one or more of the following: actively thinking about suicide or self-harm; erratic, unusual, risky or harmful behavior; delusions, paranoia or other psychotic symptoms; or extreme withdrawal from everyday life.

Can I only call or text 988 if I am experiencing a life-threatening crisis?

No, you can call or text 988 for yourself or a loved one if you are in any type of emotional distress. However, if you are not in a crisis, there are other services that may meet your current needs better, including a peer-support Warmline for emotional support or the NAMI HelpLine (1-800-950-NAMI or helpline@nami.org) for information, resources and support.

How can I reach 988? Only by phone?

You can call 988, text 988 or chat via the Lifeline’s website (988lifeline.org).

What happens when I call 988? What information will I receive, or does the Lifeline only offer

immediate crisis support?

The goal of the 988 Lifeline is to provide free, confidential, immediate crisis intervention and support. When you call or text or chat 988:

1. You’ll hear a message that you’ve reached the National Suicide Prevention Lifeline – you are in the right place! If you are a veteran, you can press “1” to reach the Veterans’ Crisis Line or “2” to reach the Spanish subnetwork for the Lifeline.

2. If you don’t select either option, a trained crisis counselor will answer.

3. The counselor will listen to you to understand how your problem is affecting you or your loved one.

4. The counselor will provide support and share resources and referrals.

In some communities, the crisis line may be able to connect you to additional services or follow up with you to ensure you’ve connected with care (note: not all communities have this capacity).

Can I only call 988 for myself, or can I call for someone else I know or see in crisis?

You can call or text 988 if you are concerned about someone else in distress who may need crisis support.

What languages are offered through 988?

The Lifeline currently provides live counseling services via phone in English and Spanish. Translation services are available in an additional 150 languages. Text and chat are currently available in English only.

Are there services available for a person who is hearing impaired?

In addition to text and chat services, teletype (TTY) is also available. TTY users can use their preferred relay service or dial 711 then 1-800-273-8255.

Will there be culturally competent support available?

As the workforce for the Lifeline network is being expanded, there are ongoing efforts to improve cultural competency training for Lifeline crisis counselors. However, as of now, not every counselor may have had this training.

Are there youth-specific supports available?

There is not a youth-specific hotline or dedicated crisis counselors for youth callers, although some states may have their own youth crisis line separate from the 988 Suicide and Crisis Lifeline network. Regardless, staff are trained to support anyone in a crisis. Expanded Lifeline trainings are being implemented to ensure 988 call centers can provide appropriate, culturally competent care, specifically focused on communities that are at higher risk for suicide, including youth.

Note that some states have youth crisis response teams in place, and there is a growing movement to provide more youth-focused crisis services across the country.

Will I be charged a 988 fee for calling the number?

No. The support and services received from 988 crisis counselors is provided free of charge. However, standard messaging and data rates may apply to those who text 988 from their mobile phone.

Do I need insurance to get help when dialing 988? Medicaid or Medicare?

No. The support and services received from the 988 crisis counselors is provided free of charge, regardless of whether you have health insurance coverage.

Will 988 show up as a call on my phone bill? Is a call record created?

It will depend on your phone service whether a call or text to 988 will show up on your phone bill. Contact your phone service provider to learn more about how calls to 1-800 and other toll-free lines appear on your bill.

Does 988 collect my information/data? What do they do with that information?

All contacts with the 988 Lifeline from people seeking help are confidential. According to the Lifeline FAQs, information about callers/chatters/texters will not be shared outside the Lifeline without documented verbal or written consent from the person seeking help, except in cases where there is imminent risk of harm to self or someone else, or where otherwise required by law.

The Lifeline protects all the confidential and identifying information shared. During your contact with the 988 Lifeline, you may voluntarily share certain information about yourself that could be identified, and that information may be documented in notes about your conversation. The center may also have access to the phone number or IP address you used to contact the Lifeline. You will never be required to provide other identifying information to receive help from the Lifeline. The Lifeline may use de-identified and aggregated data for reports to stakeholders, funders and policymakers about the numbers and types of conversations they have with people in crisis. They might also reference the general aggregate demographics of people seeking help from the Lifeline.

Why are we getting 988 and how will it work?

What is different after July 16, when 988 goes “live”?

988 “going live” marks the beginning of an easier way nationwide to access the National Suicide Prevention Lifeline through this easy-to-remember three-digit number. It also marks the formal expansion of the Lifeline to include helping people in mental health and substance use crises in addition to suicide crises. July 16, 2022 is the deadline for every U.S. telephone provider to direct calls and texts to 988 to the pre-existing Lifeline network. The Lifeline has around 200 local call centers and national backup centers across the country to answer these calls.

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gov.ca.gov | Contributed

The nation is experiencing a mental health crisis. Today, California announced $518.5 million in grants to help provide services and housing options to those with severe mental illness or substance abuse problems, including for those who are living on the streets. The latest funding will help Governor Newsom’s CARE Court proposal, taking a new approach to homelessness and taking stronger action to get people off the streets and into a place where they can get the care they need.

The funding will provide treatment beds for more than 1,000 people at a time, plus behavioral health services for many more. It is part of a $2.2 billion effort to expand mental health housing and services across California, especially for people experiencing homelessness.

The Governor announced the latest grants during a meeting with families who have loved ones dealing with serious mental illness, many of whom have been homeless.

“The crisis on our streets is at a breaking point. Too many Californians are struggling with mental illness and substance abuse, and many of them end up on our streets. We need to change the way we deliver help to those who need it, and these grants are an important step in changing our approach to homelessness and serious mental illness,” Governor Newsom said. “California won’t look away any longer; we’re helping our fellow Californians now. That’s the California Way.”

The Governor’s meeting in Sacramento with members of the National Alliance on Mental Illness (NAMI) included families who are caring for loved ones struggling with behavioral or mental health disorders and could be helped by CARE Court. The Governor heard their stories and talked about the historic actions that California is taking to address this crisis.

CARE Court will provide Californians suffering from untreated schizophrenia spectrum and other psychotic disorders with community-based treatment, services, and housing, and is intended to serve as an upstream intervention for the most severely impaired Californians.

“Governor Newsom has NAMI’s full support in getting CARE Court across the finish line,” said Jessica Cruz, NAMI CA CEO. “We’re here today to show our commitment to providing help, hope and health for those affected by serious mental illness by supporting initiatives like CARE Court which will provide much-needed help to Californians who need it most.”

“CARE Court has the potential to change the lives of thousands of families across the state,” said Harold Turner, Executive Director of NAMI Urban Los Angeles. “Organizations like NAMI urgently need this support so we can quickly begin helping our loved ones who are struggling with untreated mental and behavioral issues.”

The awards announced today are delivered through the Department of Health Care Services’ (DHCS) Behavioral Health Continuum Infrastructure Program (BHCIP) Round 3: Launch Ready grants. In all, $2.2 billion was provided by the Legislature and the Governor to construct, acquire, and expand behavioral health facilities and community- based care options while investing in mobile crisis infrastructure.

Grants were awarded in the following counties:

Alameda County – $18,405,122

El Dorado County – $2,852,182

Humboldt County – $4,170,560

Kern County – $3,138,065

Los Angeles County – $155,172,811

Madera County – $2,035,512

Mendocino County – $7,711,800

Monterey County – $3,558,670

Nevada County – $4,458,799

Orange County – $10,000,000

Placer County – $6,519,015

Riverside County – $103,181,728

Sacramento County – $30,553,889

San Diego County – $30,874,411

San Francisco County – $6,750,000

Santa Barbara County – $2,914,224

Santa Clara County – $54,074,660

Solano County – $14,332,411

Sonoma County – $9,751,915

Stanislaus County – $33,369,900

Yolo County – $12,500,000

Recipients of BHCIP Launch Ready grants include cities, counties, Tribal entities, nonprofits, and for-profit organizations statewide that serve target populations. Additional information on BHCIP Round: 3 Launch Ready awardees is available at BHCIP Grant Award Information.

The next round of funding will include more than $480 million focused on Children and Youth behavioral health issues. Awards will be made this fall. For more information about these grants, as well as other BHCIP rounds of funding, please visit the Improving California’s Infrastructure BHCIP grant information.

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I was a reporter for the Los Angeles Times working in the San Francisco bureau, and I had a deep interest in the collision of our mental health and criminal justice systems. Jenny was a source, a deputy public defender who had co-founded San Francisco’s acclaimed Behavioral Health Court and would help run it for 15 years. She’d seen countless clients revolving through the criminal courts because they were falling through the cracks of a decimated and fragmented mental health system. We knew right away that one day we’d work together on a creation of our own making, while forever remembering that deafening tuba solo.

In 2015, I left the LA Times to pursue the craft of longform audio. A few years later, Jenny left the public defender’s office to consult across the country and co-teach mental health and the law at UC Berkeley. With our window of opportunity open, we dreamed up a deeply reported narrative podcast that explores mental illness, confinement and liberty through California stories.

We knew there was excellent coverage out there already of modern-day tragedies and innovations. We wanted to make something different, to take a bigger-picture view of who is labeled as mentally ill, who is most likely to lose their liberty, and who is least likely to be treated with dignity.

The result is “November In My Soul.” The limited 10-episode podcast will examine California’s relationship to mental illness and confinement through a historical and intersectional lens. In paired episodes, we’ll take listeners on a journey to explore how some of our darkest history still influences our current crisis — and how dignity-based reforms can make healing possible.

Our podcast will reflect on the institutionalization, deinstitutionalization, and criminalization of people with mental illness through the overlooked voices of Black, Latinx, and LGBTQ people, as well as rural Californians and the elderly. Their collective experiences have ranged from benevolent warehousing to neglect to torture at the hands of the state. The most powerless among us are labeled deviant, vagrant, demented, psychopathic, schizophrenic — and criminal. Each episode will center the voices of those directly impacted and rely on their input and guidance while in progress. We also plan to offer up finished episodes to the community through live and virtual events to spark dialogue, healing, protest, and artistic interpretation.

We had the privilege of securing some production funding from California Humanities in March 2020, just as COVID sidelined us, but it must be matched and is not intended to be enough to get us to the finish line. Thanks to the 2022 California Impact Fund, we’ll be researching, scripting and producing shortened versions of two episodes exploring the pathologizing of LGBTQ people. The two half-hour shows will air on KQED’s The California Report Magazine, along with paired print pieces published through MindSiteNews, which shares its content freely to push in-depth reporting on mental health into the world. We hope to encourage community newspapers and websites to run the print pieces.

One episode explores a dark chapter of California history, when gay men were labeled mentally ill and committed to state institutions, where they were then subjected to experimentation without consent. The second examines the intersection of bias, pathology and confinement in our more contemporary transgender population. I am the sole grantee, and I will be doing the bulk of the reporting. But Jenny and I are co-directors, co-researchers and co-hosts. Her analysis, compassion and expertise are invaluable.

Lee Romney | Contributed

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NAMI graduates another Family-to-Family class, one of whom we spotlight

The National Alliance on Mental Illness (NAMI) has graduated another Family-to-Family class of loving care-givers.  

The NAMI Family-to-Family class is a free, 12-session educational program for family, significant others and friends of people with mental health conditions. It is a designated as an “Evidence-based program,” meaning that research shows that the program significantly improves the coping and problem-solving abilities of the people closest to a person with a mental health condition.

NAMI Family-to-Family is taught by NAMI-trained family members who have “been there,” and includes presentations, discussions and interactive exercises.  One of those trainers in NAMI Hemet-San Jacinto Executive Director, Brenda Scott.  “The NAMI family education course is a valuable tool for family members. This class supports families in a way that allows them to understand what their relative is going through and to be there in the best possible way for their family members. This class has been a life-changing experience for family members who have a relative with a mental health condition,” said Scott.

NAMI Family-to-Family not only provides information and strategies for taking care of the family member, but students also find out that they’re not alone…that recovery is a journey, and there is hope.

(Caring about people)

The group setting of a NAMI Family-to-Family course provides mutual support and shared positive impact—experiences, compassion and reinforcement from people who understand a student’s situation. Sharing personal experiences help others in the class. In the program, students learn about:

• How to solve problems and communicate effectively
• Taking care of themselves and managing their stress
• Supporting loved ones with compassion
• Finding and using local supports and services
• Up-to-date information on mental health conditions and how they affect the brain
• How to handle a crisis
• Current treatments and therapies, and
• The impact of mental health conditions on the entire family

We asked Family-to-Family course graduate Martina Keneally about her experience.  “I learned so much from this class.  I learned that the illness is not the person; I learned to be patient with a family member who has mental illness issues, and I learned about the different mental illnesses and how they work with the body and how everything is intertwined. I learned about taking personal responsibility and not enabling the person who has mental illness.  I now feel personally…useful.  The self-care skills are so important because we care so much for others that we sometimes forget about ourselves, so it was a great class,” said Keneally.

Keneally has also learned from experience: a sexual abuse survivor, Keneally works with the Center Against Sexual Abuse (CASA) as well as taking classes at NAMI.  “I share my story now, to empower others.  I am a sexual abuse survivor, and I work with CASA as an advocate.  I can tell you from my past abuse and my life history that working with CASA and doing this kind of work is a calling.” Some would say that it’s a calling of the highest order, but Keneally sees it as her mission.  “I am an Advocate at CASA, so I do many crisis interventions, working closely with the police.  I had to be trained to do that kind of work, and so this NAMI class will help further my career.”  Keneally is working towards the day when she can become a certified Human Trafficking Caseworker with CASA, and she knows these NAMI courses will help further that career.  “We learned so much in this class that I want to take the second class as well, so that I can truly retain the information.”

NAMI invites any interested parties to come visit them at their 38th Annual Christmas Party, December 18 from 11am to 1:30 at the Hemet United Methodist Church, 520 Buena Vista Street.  Those interested can call 951 765-1850 or visit https://namichristmas2019.eventbrite.com

For further information on NAMI, to donate or take courses, please visit https://namimtsanjacinto.org/

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NAMI’s  NAMIwalks seeks greater awareness for mental illness issues

“NAMIWalks is NAMI’s (National Alliance on Mental Illness) largest and most successful mental health awareness and fundraising event. In 2018, 80 NAMIwalks events raised nearly $11 million to support local programs and initiatives that improve the lives of persons affected by mental illness.” So says the NAMIWalks brochure for the NAMIwalks event taking place October 26 at the Diamond Valley Lake Marina, 2615 Angler Avenue, Hemet.

But NAMI and its NAMIWalks is more than fun events and fundraising—much more. Brenda Scott NAMI-San Jacinto Executive Director says it’s about raising awareness of mental heath issues, and about bringing mental health and wellness out of the shadows. 

And Brenda Scott speaks from experience.

“When I was 14, my mother died by suicide. As her children, we were all stunned, but nobody talked about it. Later on my brother Bryan, who began self-medicating by taking drugs to cope with his problems, also died by suicide. When my son was 6, I started to see some behaviors that were concerning. It was at a doctor’s office, completely by chance, that I picked up a NAMI brochure. The NAMI classes were immensely helpful in the process of recovery for my son. I’m happy and thankful to say my son is doing fine, but we must bring greater awareness to this issue  and work on eliminating the stigma associated with mental health,” says Scott.

As Scott took more classes with NAMI she got a job with the county as a family advocate and then she began teaching NAMI classes: she worked for various NAMI programs and eventually the program was able to hire her as Executive Director.  14 years ago Scott became the first manager of the NAMIWalks Inland Empire walk.

“Our goal this year is to raise $100,000.00. As of October 17 we have 68 teams with 500 participants and we are at 65% of our goal,” says an excited Scott.

As for the future, Scott says the goal remains the same: “To continue to raise awareness of mental health issues in the community and to reduce the stigma of mental health issues.”

Those interested in donating to NAMI, starting a NAMIWalks team, or volunteering to aid in NAMI’s important mission may do so by contacting Brenda Scott at namiwalksinlandempire@gmail.com

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(Out of the shadows) This is part of what will be an ongoing series on the unfortunate “devils duo” of homelessness and mental illness, which will eventually focus on mental illness itself.

We start the series with the story of Matt, a homeless man who thought the word “homeless” was the last adjective that would ever be used to describe him. “I had a good job at Amazon. I had a car and I had a life. Then I got fired for being four minutes late back from lunch…and things went downhill from there,” says 39-year-old Matt Lujan, adding “Living in a dry riverbed is the last thing I thought I’d be doing.”

But live there he does. With his dad. “It started…this feeling that “I’ve got to do something. I’m better than this” started a few weeks ago when I realized that it was exactly one year that I had come here to get my dad out of depression and out of the tent where he’s living,” says Lujan. “I can’t stand it that this is where my dad is living. He’s got emphysema and this is no good.”

Would the unseen eyes of an unseen camp welcome outsiders? Would the elder Lujan care to take the word of yet another “handout” in place of what’s needed, which is a hand up? Those living in hell might welcome a drink of water, but even when the cup is empty…they’re still in hell. And in the heat of an August afternoon in Hemet, I felt as though I hadn’t much but a very small cup of water in an awful lot of hell, as we walked off the levy path into an unseen community.

I meant Lujan when reporter Dennis Fletcher asked my help in getting father and son out of the dry river bed on Soboba Road. “I realized that these people…they all just wait around for things to happen, but I’ve got to go out and make things happen…for my dad and me,” said Lujan.

I could see where the Valentine’s Day flood had cut a rut in the river floor. “It reached as high as the bottom of that tree,” said the younger Lujan, pointing to a spot approximately 6 feet from ground level. When asked if the authorities gave any assistance during the flood, Lujan said, “Well, about two weeks before the flood, they warned us that it was coming…but nobody paid attention. Like when I got carjacked. I told the police the car was stolen. They were ice enough to put an APB out for me. But out here…we don’t trust too many people. That’s why no one really listened about the flood.” When the floodwaters came, they came quick, hard and without regard for life, property…and puppies. “Yeah, we lost our puppy; got swept away. It came so quick, the water. My dad had already been depressed since my mom left, and I realized I had been depressed too. I had gotten too used to things being this way over the last year. Instead of pulling my dad up…the situation pulled me down…and I had to change that.”

Matt pulled himself together physically, mentally and emotionally. He realized how full of despair he had been, and realized that if he was going to change, he was going to have to regain his confidence and also learn to trust again: that’s when HSJ Chronicle’s Dennis Fletcher reached out a hand to help. In the Jack-in-the-box eating breakfast bought by Fletcher, a somber Lujan relayed an all-too-familiar story of how bad choices and bad consequences attract and feed off each other as they fuel mental illness and bring a once-productive member of the community to the point of living in a tent. 

We were about to see if Lujan’s father’s depression had gotten to the point where he would ignore if not reject-both verbally and physically-the help he needed. That’s where we pick up the story in part II. (Out of the shadows)

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