Mental Illness and Criminal Justice in Santa Barbara County

Nobody yet has asked to be born. Maybe Nicolas Holzer should have been consulted.

I say this because for at least 25 years, Nicolas Holzer has been gripped by the unshakable belief that he’s the most evil person who has ever lived. He holds himself personally responsible for a slew of deaths occurring on four continents, including the AIDS epidemic, the assassination of Nelson Mandela ​— ​who, by the way, died peacefully in bed ​— ​and an airline crash that killed 600 passengers, and he claims that when he was still in high school, he drowned a 14-year-old Goleta girl in her bathtub and ran over an Isla Vista jogger, not once but twice. (Investigators can find no evidence to substantiate either claim.) On a grander scale, Holzer ​— ​who is now 49 ​— ​believes he is responsible for the A-bombs dropped on Hiroshima and Nagasaki 73 years ago.

Not every family has a Nick Holzer. But every family has its stories. A cousin of mine was arrested during the drought of the early ’90s for setting a Ventura Chinese restaurant on fire. He’d stopped taking his medications. He’d stopped body surfing, his therapy of choice. When he saw a straw sticking out of a fast-food cup underneath a pine tree, he wondered what would happen if he lit it. He quickly found out. He was a big hunk of a man dressed in bright-orange clothes. It never occurred to him to hide or run. I remember how badly my head hurt talking with him through the Plexiglas window at the Ventura County jail. Nobody could possibly have so many thoughts flying so fast at the same time. It wasn’t his first run-in with the law. He’d been arrested before, trying to stick up an adult bookstore. At family reunions, we liked to laugh at how he forgot to bring his gun. The cashier he tried to rob ​— ​a seasoned tough guy ​— ​did not.

Big joke.

Same thing with an uncle who got thrown in jail after noted jazz musician Charlie Byrd refused to play his hit song, “The Girl from Ipanema.” Byrd owned a nightclub in Washington, D.C., where I grew up, and had played that song four billion times before. When Byrd balked at four billion and one, my uncle ​— ​usually red-faced with mirth and joviality ​— ​popped his cork. A bouncer got involved. Then the police. My uncle soon found himself behind bars. He went on a hunger strike. Using his feces, he scrawled protest slogans on the wall. Charges would be held in abeyance if he got treatment. He agreed. The diagnosis bipolar hadn’t been invented yet. He was, we were told, manic-depressive. In our household, mental illness was not recognized; it was just another variant of feeling sorry for yourself. My uncle checked himself in to what was said to be a nice place. On the way back from church service one Sunday, he jumped off a bridge. We’re not sure whether the fall killed him outright or whether it was the water below. In either case, he never got up.

Big joke.

I say all this because four years ago Nick Holzer killed his entire family. He stabbed his father first with a kitchen knife, and then his two young sons in their beds. When his mother burst in, he killed her too. Finally, he killed the family dog. It was barking. Much would be made of the dog in the trial that was to follow. The slaughter was so intimate and horrific that it defied even the most morbid curiosity. Even so, I spent the better part of six weeks covering the Holzer trial this summer. I’m still mulling over why.

Several times while sitting in the courtroom, I found myself wanting to hit Holzer upside his head. “Eat a bullet,” I would think. Like a lot of people battling serious mental illness, there’s little about Holzer that engenders sympathy. It’s a mean disease that way.

A Deal from Hell

It was never remotely a whodunit. Holzer called 9-1-1 just moments after exterminating everyone in his parents’ Goleta home a little before 11 p.m. on August 11, 2014. In excruciatingly calm detail, Holzer told dispatchers exactly what he had done. Arrested without incident, he has since confessed numerous times. Though his explanations have varied, his core story has never wavered.

To atone for being the worst person in history, Holzer was compelled to become just that. He would later tell psychiatrists this was all part of a deal he’d struck with God. If he killed his family, they would be saved from the eternal damnation to which he was already condemned.

He didn’t want them to suffer. He stabbed his parents and children more than 100 times. The first knife broke; he had to get another. It was, he told everyone afterward, “the most wretched thing” he ever did. “I hated doing it,” he said. But it was something he “had to do.”

That was the deal.

The Right and Wrong Way

Everyone involved has agreed Holzer was crazy. The only question throughout the trial was whether Judge Brian Hill should find him insane as defined by California state law. Contrary to popular misconceptions, the insanity defense is about the hardest trick in the legal playbook to pull off. Statistics show that it succeeds only one quarter of less than one percent of the time.

Holzer’s defense attorney, Christine Voss, needed to prove her client was incapable of telling right from wrong ​— ​legally and morally ​— ​when committing the murders. The burden of proof falls on the defense, not on the prosecution.

For six weeks, Voss and the prosecutor, Assistant District Attorney Ron Zonen, called competing psychologists, psychiatrists, and other expert headshrinkers to the witness stand. Some were impressive, some self-important, and others either quacks or merely saying what they were paid to say. One made a point to include the word “phenomenology” in every utterance. Another argued Holzer, who graduated with honors in history and geography at UCSB, had been rendered incapable of abstract thought because of a phantom blow to the head while still an infant. To be fair, psychiatry remains more art than science, so it wasn’t surprising that none of these experts could agree on a diagnosis.

Holzer had been hospitalized three times since 1995 for acute psychiatric distress, twice involuntarily. On two occasions, he was found to be psychotically catatonic. On two occasions, he attempted suicide by cutting himself. He had asked his father to kill him at least once, chewed broken glass in front of his sister, and grabbed her by the throat and attempted to strangle her. In blinking lights, he saw special messages meant just for him. People were out to get him; neighbors, he was certain, were throwing dog poop into his yard.

His family was consumed by the unholy hell of Holzer’s illness. Even though highly accomplished and affluent, his parents discovered that finding a qualified mental-health specialist was a crapshoot. The last psychiatrist they hired turned out to have been repeatedly disciplined for writing too many prescriptions to the wrong people. With Holzer, however, he refused to write any prescriptions at all. He testified he had hoped to talk Holzer out of his delusions.

Like many people with serious mental-health issues, Holzer insisted he was fine. In fact, as Zonen pointed out during the trial, Holzer had managed to go nearly 10 years without medications or any obvious incidents. In this time, he got married, worked five years for Raytheon successfully, had two sons, divorced, and went through a protracted custody battle. In 2007, a court-ordered psychological expert gave Judge Thomas Anderle the green light to award Holzer sole custody of his two kids. That Holzer’s wife was a Mexican immigrant who spoke limited English, didn’t drive, and worked low-wage jobs no doubt factored into the decision.

But this picture was deceptive. Immediately upon filing for divorce in 2006, Holzer moved back home with his parents, stopped working, spiraled downward, and got angrier and angrier.

By the time Zonen and Voss concluded closing arguments, Hill was ready to rule, impatient almost. In a police videotape of Holzer’s interrogation after the murders, one detective asked him: “And you knew, in the grand scheme of things, that it’s not the right thing to do, right?” And Holzer replied, “Right.”

Judge Hill would hang his hat on this exchange. He ruled Holzer was not legally insane at the time of the crime. Holzer was profoundly mentally ill, the judge concluded, but he could still tell the difference between right and wrong. With that decision, the law required Hill to impose four life sentences without possibility of parole ​— ​one lifetime for each life taken.

Had Hill ruled Holzer was legally insane, Holzer would no doubt have been sent to Patton, one of the state’s badly overcrowded psychiatric hospitals. There he would have stayed the rest of his days or until his sanity was restored, whichever came first. The last criminal defendant in Santa Barbara found not guilty by reason of insanity was David Attias, the UCSB student with a well-documented history of mental illness who, in 2001, gunned his car down the densely populated streets of Isla Vista, killing four people.

Attias was released from Patton after 10 years, a clinically restored ​— ​albeit intensely supervised ​— ​man. No incidents have been reported since his release. But for Zonen, the math remains unacceptable. “Four dead people!” he exclaimed, the same number Holzer killed. “Ten years!”

The Great Competence Question

On any given day, Judge Hill confronts criminal defendants whose mental competence to stand trial is in question. If he decides that a defendant is so psychologically impaired they can’t assist in their own defense, they are declared “Incompetent to Stand Trial,” or IST. Then the judge must postpone the trial until competence is “restored.” The restoration process is long, complicated, and extremely expensive. It’s also one of the great, unsung civil rights issues of the age.

Persons declared ISTs and charged with misdemeanors typically get sent to the county psychiatric health facility (PHF or “puff unit”), a residential treatment facility. Those charged with felonies in this county usually get shipped off to two state psychiatric hospitals, Patton in San Bernardino County or Atascadero in San Luis Obispo County.

Last year, the Department of State Hospitals (DSH) housed roughly 13,000 patients at six psychiatric hospitals. Once admitted, a patient typically gets evaluated after a month. Twenty-two percent are ISTs. About 20 percent have been declared legally insane by a judge or jury, 13 percent are too sexually violent to be released, and 18 percent are too mentally disordered to be released.

Today, 90 percent of patients in state hospitals are being held in connection with some criminal offense. Thirty years ago, it was only 50 percent. That’s a pretty clear metric illustrating the collision between the mental-health and criminal justice systems.

Even though California added 660 psychiatric beds over the past five years, it’s not enough. At any given time, there are 754 mental patients waiting to get admitted. The ISTs are the single largest group. None have been convicted of the crimes with which they’ve been charged, let alone sentenced, and they are forced to wait many months in their county jails of origin.

The DSH declined to say how long the wait is for ISTs in Santa Barbara County Jail, citing the threat of litigation. But anecdotally, the situation in Santa Barbara has gotten notably worse. Five years ago, ISTs reportedly had to wait 40-70 days to get transferred to state hospitals. Now it’s not uncommon for the wait to last 100-120 days.

The ISTs are in hospital until they have been restored. Last year, that took ​— ​on average ​— ​155 days. That’s about 10 days less than the year before. Those who can’t be restored wind up getting “conserved,” costing the patient’s county of origin $230,000 a year.

Although one of the smaller counties ​— ​roughly one percent of California’s population ​— ​Santa Barbara ranks 12th out of all 58 counties in the number of IST patients referred to state hospitals. Last year, Santa Barbara referred 55 patients ​— ​half of whom were homeless. Ten years ago, it was only 23.

The good news ​— ​admittedly perverse ​— ​is this increase gives Santa Barbara a leg up in competing for $100 million Governor Jerry Brown and the State Legislature set aside this year for mental-health programs. According to Santa Barbara County Sheriff Bill Brown, 85 percent of that money will go to the 15 counties with the worst IST problems.

Waiting for Room in the Pen

Brent Fox, mentally ill enough to have been hospitalized three times in the past 13 years, had to wait 135 days before the Department of State Hospitals found a bed for him. By then, Fox’s mental health had profoundly deteriorated. He was barred from attending a court proceeding because he’d smeared himself with his own feces. He had lost 40 pounds. Nevertheless, an evaluator at the county jail argued Fox had not crossed the threshold for “acuity.” A very exasperated judge ordered a second acuity test. This reflected Fox’s severe psychological state. Still, another judge had to threaten state hospital administrators with contempt of court if they didn’t find a bed. Fox was finally moved to Atascadero a month ago. In these times, this was considered a major breakthrough.

Fox’s parents, however, are not celebrating. His mother hardly recognizes her son anymore. The State of California is, in fact, suing the county because of the conditions under which some inmates with mental illness have been treated in county jail. (The county has since hired a new contractor in the hopes that it will provide better psychiatric care for inmates.)

On April 5, Fox had been acting out again, so his parents called 9-1-1 fully expecting, as had happened before, specially trained mental-health crisis workers to arrive. In Santa Barbara County, only these workers are allowed to decide if a person requires involuntary hospitalization. In all other California counties, law enforcement officers can also determine if someone appears to be a threat to themselves or others ​— ​known in the parlance as a 5150. This is a custom of the county, not a legal decree. With only 16 beds, Santa Barbara’s psychiatric hospital space must be rigorously apportioned.

There are also a limited number of mental-health specialists, so on April 5, two sheriff’s deputies showed up at the Fox family home in Santa Ynez instead. As soon as Fox saw them, he grabbed an umbrella, jumped on a table, and challenged the officers to a fight. One deputy accepted. A former high school football player, Fox, at 34 years of age, was tall and muscular. In the melee, both Fox and an officer sustained minor injuries. Fox was tased multiple times, hauled off to jail, charged with multiple felonies, and held without bail. Only months later would a judge reduce those charges to misdemeanors.

Had mental-health workers been dispatched initially, it’s highly likely Fox would have been 5150d and transferred to UCLA’s psychiatric hospital. His parents had secured private insurance coverage for just this eventuality. It would have kept one seriously mentally ill man out of jail. And it would not have cost county taxpayers a cent.

A Slow Road to Hope

From suicides to State Street, the issue of mental health is like an aerosol mist that’s everywhere. It suffuses almost every issue we as reporters write about. The courts, schools, hospitals, commerce, law enforcement, and whole families have been dragged into the growing morass that seems to be without solution. Now that may be changing ​— ​slowly.

Two weeks ago, Judge Brian Hill, a former criminal prosecutor, jumped into the fray. For the first time in county history, he found the Department of State Hospitals guilty of contempt for failing to find space for an IST. Santa Barbara County, he added, should have a standing contempt order against the DSH for any time it takes more than 60 days to find a hospital bed for a criminal defendant declared IST. Four other counties do. Such an order must be issued by the presiding judge, and the sanction, admittedly, is small, only $1,500. But beds are found faster in those counties.

Three years ago, a nationwide consortium of county governments ​— ​overwhelmed by cost and futility ​— ​launched what’s called the Stepping Up Initiative to get people with serious mental illnesses in treatment and out of jails. In Santa Barbara, these gatherings got off to an uncertain start. But sometime last fall, for the first time, there were real numbers for how many county jail inmates had serious mental-health issues ​— ​it turned that on one particular day, it was 52 percent. The national average is only 17 percent, according to Sheriff’s Commander Kevin Huddle.

This summer, a new state bill created a court-supervised program to divert mentally ill individuals charged with crimes related to their mental illness into treatment. Santa Barbara County adopted a Laura’s Law pilot program two years ago, in which caseworkers focus intently on a small number of service-resistant street offenders. This year, the county supervisors finally bankrolled Crisis Intervention Training (CIT) for all its sheriff’s deputies, teaching methods to de-escalate conflicts involving people with mental illnesses.

Still, there’s a very long way to go.

At the last Stepping Up stakeholders’ meeting, I found myself watching the faces of the parents, parents who had mentally ill sons and daughters, and who had been working on this for 30 years. For 30 years, they’d been arguing the same damn points. But now, in that low-ceilinged room, among bureaucrats and paper pushers, there was a gathering sense of real possibility.

Sheriff Bill Brown began highlighting the success of what is known as the San Antonio model. Launched 16 years ago, it now entails a 22-acre campus for people with mental illness, substance addictions, and dual diagnoses. Every imaginable service is provided. For law enforcement, it’s been a boon. It saves the San Antonio Police Department $600,000 per year in overtime costs. Reportedly, 100,000 people are diverted from jail annually, receive treatment, and have saved the county $100 million over eight years.

All this happened because the people of San Antonio finally recognized the problem of mental illness was everybody’s problem. One hospital kicked in $8 million; an oil company investor $10 million. Over time, it snowballed.

In Santa Barbara, we have 16 beds for acute psychiatric care. Only 16. The County of Santa Barbara has vast real estate holdings. It enjoys a great credit rating. No community on the planet has more nonprofits. Few have Santa Barbara’s private wealth.

Not every family has a Nicolas Holzer story. But every family has its stories. That we haven’t figured this out by now isn’t just crazy. It’s insane.