Defendants clamor for diversion in S.F. Behavioral Health Court. Not everyone gets in.

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On the first Friday of April, mechanic James Matlock took a rare day off work.

It wasn’t a day of respite. Instead, he sat in San Francisco’s windowless Behavioral Health Court at the Hall of Justice for seven hours, hoping to see his son diverted away from a criminal trial and toward psychiatric help. 

He’s smart, said Matlock of his 35-year-old son, Kevin. Maybe even too smart. On medication, he’s the “sweetest person.” His family paid the cost of his prescription for six months. Then, they could no longer afford it. 

That was several years ago. There have been periods of stability since then; for the past two years, Kevin has worked as a security guard. But he’s also been in and out of city treatment programs, Matlock said. 

“Like clockwork,” his father sighed, there’d come an “incident” that broke the spell.

This time was the most serious yet. On Jan. 26, Kevin was arrested on charges of evading an officer and reckless driving under the influence. 

“It’s sad,” Matlock said. Now, “his fate is in another person’s hand.” 

If Kevin is eligible for mental health diversion, his medication will be covered, and he will avoid the up to three-year state prison sentence that he could face. But acceptance isn’t guaranteed. 

At the front of the courtroom on that Friday, half a dozen defense attorneys argued before a judge that mental illness was the root of their clients’ criminal charges. Prosecutors argued that the public-safety risk the defendants posed was too great to release them to treatment. 

Friends and family asked that loved ones be granted a chance to do better.

‘A new purpose for living’

San Francisco has 14 collaborative courts where judges, defense attorneys, the district attorney’s office, and mental-healthcare providers all agree to divert defendants with extenuating circumstances to treatment.  

Behavioral Health Court, located at 850 Bryant St., is specifically for those with serious mental illness.

Since its creation in 2002, almost 1,000 people have been accepted. On average, the program monitors 140 clients at a time. Eligibility is determined on a case-by-case basis, though the court said it does not take on defendants who commit “certain violent charges,” meaning, usually, severe violence.

Approximately three-quarters of participants have successfully graduated from the program. On average, this takes between 18 months and three years, and, according to the court, “heavily depends on the severity of the diagnosis and legal case.” 

The use of cost-saving diversion programs like Behavioral Health Court have fallen markedly under the tenure of District Attorney Brooke Jenkins, despite state policy that expanded eligibility starting in 2024. Still, every year, hundreds of people enroll across the city.

Legal professionals and social workers said a shortage of beds and case managers often slows down the process.

In August 2022, the city estimated that nearly 9,000 of the 19,000 people who experienced homelessness in the prior year had a substance-use or serious mental-health disorder. There were some 2,550 residential treatment beds at the beginning of 2024, and no new beds were added this year. 

At 10 a.m. on that Friday morning, Matlock was waiting on a wooden bench in the hallway, playing Solitaire on his phone. He had arrived three hours earlier, but was told cases wouldn’t be called until 10:30 a.m.

The father watched flustered newcomers run inside the courtroom, then slowly walk back out: A woman rolling a cart piled high with bags, a man swinging a cane in one hand and headphones in the other, a family with a stroller. Across from him, two people split a breakfast sandwich. 

One of them, Elizabeth, started the program after she was arrested for domestic violence last year. “Thanks for showing up,” the man eating the other half of the sandwich told her. “Everything’s trying to get you not to.” 

The 29-year-old transgender woman has been struggling with severe depression and post-traumatic stress disorder since she was a teenager, she later said. Through her court treatment program, she receives medication and meets with a therapist and case manager twice a week. 

Elizabeth said it’s helping her find balance: “Sometimes we know we have problems, but [we need] somebody serious telling us, ‘You need to get on your treatment, you need to get yourself together.’” 

Today, she’s in court for a regular check-in with the judge. 

By 10:30 a.m., everyone is seated. Elizabeth is turned backwards, showing off photos of the Chihuahua puppies she fosters — her spare time is spent transporting stray dogs to the Bay Area — when San Francisco Superior Court Judge Charles Crompton emerges. 

He commends her for keeping up with her support groups and appointments. His praise is succinct, but tender: “Good job.” 

The structure and accountability of Behavioral Health Court is essential to recovery, according to Elijah Donaldson, who completed the program in 2023 and now works at an affordable housing organization. It creates “guardrails” for people who most need help, Crompton said. 

When Donaldson meets other people going through the program, he tells them to stay busy. “Find a new purpose for living your life, instead of going into these stores and stealing and going back on drugs.” 

He does have a critique, though: The court’s limited follow-up with graduates. In his experience, relapse, even for those who excel while in treatment, is not uncommon.

‘Trying, trying, trying’

And, even for those who get diverted from jail, relapsing happens. Since 2002, about a quarter of the court’s total participants, 490 people, have failed to graduate. They are typically arrested on a new charge or sent back to criminal court. 

The court did not have data on graduates’ recidivism rates.

“People shouldn’t think of the diversion as a free ride or getting off easy,” Judge Compton said. “In a lot of ways, it’s harder than going to jail.” 

Sitting atop Behavioral Health Court since 2014, Crompton has also seen the bulk of recent mental health diversion petitions. 

Mental health diversion is slightly different than Behavioral Health Court: It’s capped at two years, while participation in Behavioral Health Court is indefinite, but both give defendants a chance to go to treatment instead of trial. Unlike in the collaborative program, where acceptance involves many parties, a defendant’s acceptance to mental health diversion is decided by the judge alone. 

On the day Matlock was there, these petitions filled the afternoon calendar. 

Kevin Matlock’s teachers used to say he was “special,” his father recounted during the noon lunch break. Now he wishes he realized what that had meant: “I could have gotten him help earlier.”  

According to court records, Kevin fell asleep drinking vodka in a Mission parking lot on the day of his arrest. When he woke up, he reportedly drove around the lot and attempted to hit an employee before crashing into a pillar. His Dodge burst into flames. 

Matlock sighed: “Maybe now he can get some help.” 

Back in the courtroom, the father rubbed his head as he listened to other people plead for mental health diversion, waiting for his son to appear. 

A 62-year old man with a prior homicide conviction, facing allegations that he targeted and attacked a Black woman in Dolores Park, was denied. 

A 19-year-old facing allegations that he chased and robbed two women at gunpoint was also denied. 

A man with geometric tattoos covering his face, a list of prior convictions, and allegations that he stabbed someone in the back was denied, too. 

Judge Crompton cited concerns about this last defendant’s compliance, contrary to the defense attorney’s claim that his client is “trying, trying, trying to do the right thing.” 

It was 2:20 p.m. when a deputy approached Matlock, who had his head in his hands, to ask who he was there to see. Kevin, he was told, would not be appearing. 

Court records indicate that Kevin’s appearance that Friday was waived because he refused the court’s recommended treatment plan. At the time, this was unclear to Matlock, who thought there had been a scheduling error. 

The decision to reject treatment, Crompton said, is “heartbreaking” every time it happens: “Sometimes you have to give up on it for now and say, ‘In the future, hopefully you’ll be ready and you’ll come back and we’ll try again.’”

Kevin’s second opportunity in Behavioral Health Court is scheduled for the end of the month. 

A week after his son’s first date, Matlock remained confused about the process. The father is back at work, resigned to “wait and see.”