Part of a special report on homelessness and mental health in San Francisco, in the fall 2014 print edition. Stories rolling out online throughout the fall.
See accompanying story: Sentencing Reform Side Benefit: Behavioral Health Court Expansion
Five years ago, Kim Knoble said, she was misdiagnosed with bipolar disorder while living in a substance-abuse recovery center. Angry and frustrated with her treatment, she fled the program and landed on the streets of the Tenderloin.
Two years later, Knoble got a revised diagnosis: schizoaffective disorder. As opposed to schizophrenia, which refers to disordered thoughts, schizoaffective disorder affects both thoughts and moods. A new course of medication helped — for a while. Feeling better, Knoble said, she felt she no longer needed to take it.
Within days of stopping the medication, Knoble became agitated and once again had trouble organizing her thoughts. One day, she pushed an elderly man off a bus in Chinatown. He fell on his head.
Though the victim survived, Knoble faced a five-year prison term. While in jail, her attorney told her about San Francisco’s Behavioral Health Court.
Defendants can participate if a judge determines that their crimes are spurred by serious mental disorders. Instead of prison sentences, participants receive community mental-health treatment and close supervision. Between 350 and 400 courts have been established across the country.
Estimates of people in jails and prisons with serious mental illness vary, depending which illnesses are deemed serious. In one survey cited by the Council of State Governments Justice Center in 2012, 17 percent of 20,000 adults booked into five U.S. jails met criteria for a serious mental illness. The justice center, a nonprofit policy think tank based in New York, noted that post-traumatic stress disorder was not considered a serious mental illness.
In a survey by the U.S. Justice Department, 16 percent of state inmates were estimated to have a serious mental illness.
For Knoble, at least, staying out of jail proved to be the right outcome. She was ordered to appear in court once a month, meet with her case manager twice a month and prove she was sober.
She is still paying restitution to the old man on the bus for medical expenses. While her official prison sentence has not been reduced, Knoble said her lawyer is seeking a reduction to misdemeanor once her probation ends in June 2015.
Now Knoble has a full-time job and has returned to one of her passions: playing the violin. Until recently she also served as a peer educator for the Mental Health Association of San Francisco.
“This program saved my life,” Knoble said. Otherwise, “I’d still be in prison right now.”
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CORRECTION 12/2/2014: Due to an editing error, a photo in the print and online editions misidentified the subject as Kim Knoble. The woman pictured was Margaret McNulty, a participant in SOLVE, a program of the Mental Health Association of San Francisco.