Lawsuit that prompted better care for mentally ill inmates ends

An 11-year lawsuit that helped transform how California cares for people who have committed crimes and struggle with mental illness has come to a quiet conclusion.

In a five-page order issued last Monday, Judge S. Raj Chatterjee of Contra Costa County wrote that the state created a new treatment program for people who are arrested and deemed to be incompetent to stand trial, added more than 2,000 state hospital beds to care for them, and secured a permanent source of funding.

Taken together, the state’s efforts “demonstrate a commitment to providing substantive services,” the judge wrote.

Neither the state nor the attorneys for the inmates issued statements or press releases when Chatterjee released the opinion. But Dr. Katherine Warburton, the Department of State Hospitals’ medical director, cited Chatterjee’s decision as she spoke during last week’s California Health Care conference held by Capitol Weekly in collaboration with the University of California Student and Policy Center in Sacramento.

The case began in 2015 when the ACLU of Northern California, public defenders, disability rights attorneys and the Sullivan and Cromwell law firm sued the state accusing it of failing to provide care for people who were adjudged to be incompetent to stand trial because of a mental illness or developmental disability.

A superior court judge sided with the inmates’ attorneys in 2019, concluding that the state needed to provide care within 28 days of a determination that an individual cannot understand the nature of court proceedings or assist in his or her defense.

A state court of appeals upheld the 28-day standard in 2021, and the California Supreme Court declined to hear the state’s final appeal, leaving the lower court decisions in place.

“Too many of these defendants’ due process rights continue to be violated due to lengthy waits in county jails,” then-Court of Appeal Justice J. Anthony Kline wrote in the 2021 case, Stephanie Stiavetti vs Stephanie Clendenin, director of the Department of State Hospitals.

“We credit the state for taking some steps that were in the right direction and that have been really important–even if they did it under pressure, and at great resistance,” Emi Maclean of the ACLU of Northern California said in an interview.

The issue of how to handle people with significant mental illness who commit crimes has been a problem for decades in California and other states.

Chatterjee, appointed to the bench by Gov. Jerry Brown, wrote that California increased the number of beds for people deemed to be incompetent to stand trial from 271 in the 2014-15 budget year to 2,745 beds, and has plans to add more space.

Additionally, the Department of State Hospitals, which is responsible for restoring individuals to competency, started a new program to provide care for such prisoners in jail if space in state hospitals is short.

Between November 2024 and February 2026, the Department of State hospitals treated 6,222 people who were adjudged to be incompetent to stand trial. Of that number, only 183 had failed to receive care within 28 days.

Such numbers show that the Department of State Hospital’s “has demonstrated a good faith commitment to compliance with the Constitutional minimum,” the judge wrote.

It hasn’t been cheap. The initial court 2019 ruling against the state was at the start of Gavin Newsom’s time as governor. In January, when he proposed his final budget, Newsom reported that California had spent $2 billion since 2021 to reduce the waiting times for people who were jailed and needed care because of a mental illness.

The issue of how to handle people with significant mental illness who commit crimes has been a problem for decades in California and other states. Their treatment or lack of it was one focus of a landmark 2011 U.S. Supreme Court case that forced California to dramatically reduce prison crowding.

Then Justice Anthony Kennedy, writing for the majority, cited instances in which prisoners with mental illnesses were held in cages the size of old-style phone booths for hours at a time because there were no cells for them. California’s prison population, which exceeded 170,000 inmates two decades ago, sits at about 90,000 now.

Separately, numbers of people with mental illness arrested for often minor crimes spiked, with responsibility for their care falling to the Department of State Hospitals. There, clinicians stabilize them to the point where they can understand court proceedings and assist in their defense.

In a 2021 book she co-edited titled Decriminalizing Mental Illness, Warburton cited factors leading to the increase: rising homelessness and use of methamphetamine, combined with untreated psychosis.

In 2020, she found, 65.5 percent of the people determined to be incompetent to stand trial, who were admitted to Napa State Hospital, were homeless at the time of their arrests. Many of them had committed relatively minor crimes.

Once restored to competency, they are returned to court. But because their crimes often are minor, judges conclude that they have served enough time behind bars and have no choice but to release them–often back to the streets where they are rearrested. In 2016, Warburton wrote, more than half had been arrested 16 times or more.

Although the Supreme Court issued its decision in 2011, the federal court in Sacramento still oversees health and mental health care in state prisons.

Judge Chatterjee did not require that a monitor continue to track the treatment of people deemed to be incompetent to stand trial. Rather, he wrote, if the state backslides, a new suit could be filed.

Stephanie Stiavetti became the lead plaintiff in the ACLU case after learning that her brother, identified by the initial “N” in court filings, had languished in jail in Contra Costa County awaiting care for his mental illness.

In an email, Stiavetti said she has “mixed feelings” about Chatterjee’s decision because it does not require that the state’s compliance with the decisions be monitored.

“That said, I am grateful for how far this case has come and for the meaningful changes that have occurred along the way. It was absolutely worth it, and the legal team at the ACLU has once again moved the needle in the right direction,” Stiavetti wrote.

Acknowledging that the Department of State Hospitals has made “substantial strides,” Stiavetti wrote: “The progress we have seen shows what is possible when systems are held accountable, but it also underscores why sustained attention–such as supervision–remains so important.”

MacLean of the ACLU noted that while Chatterjee did not order ongoing monitoring, attorneys for inmates could bring a new suit if the state fails to adhere to the 28-day standard.

The lawsuit helped ensure people who are arrested and have a mental illness get care within 28 days. But it leaves unresolved the bigger question of how to help them once they are released.

At last week’s conference, Warburton noted that 70 percent of the people restored to competency and released commit new crimes within three years.

“The state hospital bed is one of more the expensive places for a person to be,” Warburton said. “So we’re not doing anything for the taxpayers. We’re not doing anything for public safety, and we’re not doing anything for these human beings. So we really need to focus on getting people into meaningful treatment before they end up in that cycle.”