VISALIA — Carol Allen combed through the three-ring binders she kept to document her son's turnstile existence in the mental health system, seeking answers to why his life ended with a shotgun blast by police.
The voices of paranoid schizophrenia that first afflicted her son James Allen, 25, four years before his death should have resulted in comprehensive treatment, Carol Allen and her husband George said during an emotional interview at their home.
A 2010 incident in which James stabbed himself 23 times, including slashing a wrist and both Achilles tendons, should have resulted in more than a five-day stint at a mental health facility, the Allens said.
There were dozens of episodes, many physically threatening and one a perilous drift in which James was rescued nude in the mountains.
But it was Carol Allen's own 911 call last fall that led to a fatal resolution of her son's illness. Visalia police shot James outside the family home on Oct. 18 after he threatened his mother with a knife and she dialed for help.
"The police failed us. The courts failed us. … The mental health system failed us, and James," said Carol Allen, weeping as she fingered through the binders to verify dates and the lengths of hospital stays.
The Allens believe an answer could be found in Laura's Law, a controversial measure that Tulare County officials are hesitant to implement. It grants judges limited powers to institutionalize mental health patients without their consent if they have an ongoing pattern of psychiatric holds, jail time or violent behavior.
The Allens granted an interview because they read a special report in The Bee about the peer-wellness approach Tulare County has adopted to treat those with serious mental illness.
The approach, in which recovering mental health patients counsel fellow patients to stick with their medications and navigate the treatment system, gave the Allens hope that other families may have mental illness adequately addressed. At least, before it reaches their son's crisis level.
But the Allens also are deeply frustrated.
They said the county has invested so fully in the altruistic model that it has failed to look at solutions for patients like James, who they insist posed dangers too immediate for peer support.
Laura's Law is being strongly considered for implementation by counties up and down California — from San Francisco County after a mayoral pledge to reduce homelessness, to Orange County as a political reaction to the fatal police beating of a mentally ill homeless man.
Some experts say employing the law may only feed more patients into a system without enough mental health facilities to care for them. They also believe forced treatment is rarely successful. Some mental health advocates charge that the law violates a patient's civil rights.
"Certainly, I feel for the family," Tulare County Mental Health Director Timothy Durick said. "But Laura's Law is (about) more than just one individual.
"Truly, the jury is still out on whether it's effective," said Durick, who cited two recent studies that found any type of involuntary treatment is not successful.
Nevada County, about 50 miles northwest of Sacramento, remains the only jurisdiction to fully implement Laura's Law, which the Legislature gave counties the option to adopt in 2002.
The law is named for Laura Wilcox, a 19-year-old Nevada County mental health volunteer who was fatally shot by a patient who had resisted his family's efforts to force treatment.
The only jurist to use the law is Nevada County Superior Court Judge Thomas Anderson, who called it "an effective tool to basically save lives."
Anderson explained that he seldom orders a patient into the involuntary treatment that many mental health professionals call ineffective. But he adds that he does utilize the court's powers of persuasion.
A so-called "black robe effect" has caused about 44 of the 55 patients who have stood before him under Laura's Law to consent to treatment, the judge pointed out.
"The whole goal of using (Laura's Law) is to get voluntary compliance," the judge said. "The court is being a bit coercive in a civil format. It's whatever power and respect the individual has for the court that makes a difference."
There also is a potential fiscal tug of war between patient-empowering visions like Durick's, and Laura's Law.
The California Department of Mental Health determined in 2007 that counties could use money from the nearly $11 billion raised by the Proposition 63 "millionaire's tax" to implement Laura's Law.
Most county mental health directors, including Durick, have used the money to instead implement their patient-driven treatment systems. Now, they are faced with the prospect that they may have to share the funding pot with Laura's Law.
The Allens wonder why the money can't be spent wisely, and on both approaches.
They believe in a patient-driven wellness model much like Tulare's, except in extreme situations like their son's, where Laura's Law seems more appropriate.
"You will probably be able to help 80 to 90%" with the Tulare wellness approach, George Allen, a chemical engineer, said.
"But there has to be more than one model," he added.
Indeed, the family tried to work within the existing system. But the Allens ran into a fundamental roadblock: getting James into county-based treatment.
Because James was on the couple's private insurance, he didn't qualify to be part of the county system in the first place, and had to be taken to private mental health providers.
Several refused to see James, citing high patient loads, his frequent marijuana use, or an outright fear of James.
To get James in the county system, the Allens said they would have had to kick him out of the house and cut off all financial support.
"In other words, make him homeless, and have him go on his own to Tulare County mental health," said Carol Allen, a dietitian for dialysis patients.
Ruling out leaving their son to the streets, the family sought a conservatorship agreement for James. That would have allowed one parent to make treatment decisions for him, including involuntary commitment if a qualified psychiatrist determined James was incapable of taking care of himself.
When they made the attempt, James had a trump card.
"He threatened suicide," Carol Allen said. "And we believed him."
During their attempt at conservatorship, a Tulare County judge ordered the county mental health department to evaluate James. Durick said his office never received the court order and has not determined how it got lost.
If the evaluation had taken place, Durick said, the county still would not have had the power to make James a patient in the system.
The evaluation could have been used only in the Allens' bid for the conservatorship agreement, had the couple gone through with it.
"If he had been a Medi-Cal recipient, we certainly would have seen this individual," Durick said. "Our hearts do go out to the Allens for the loss of their son."
The couple has filed a tort claim that reserves the right to sue the county.
The family also has filed a tort claim against the city of Visalia for the police shooting. The incident is under investigation by the Tulare County Sheriff's Office, which will determine if the Visalia officers committed justifiable homicide.
Even before the night James was killed, George Allen was regularly confiscating knives from his son.
Initially, James would threaten the family with kitchen knives, but he began to acquire switchblades and military-style weapons.
He used such a kitchen knife during the 2010 incident, and a switchblade during the one that resulted in his death.
"He said someone had come in through the back door and done that to him," George Allen recalled of the 2010 incident that left their carpets blood-stained. "He had this other personality that was very malevolent and didn't like him."
The Allens said they tried in vain to remind their son of their own love, and to get him the help he needed.
They were left instead with the frustrating paper trail that Carol Allen hopes other families won't have to keep like tragic photo albums.
As she paged through the binders, several now spread on the floor before her, she had trouble locating a given date. She said to her husband softly:
"There's just too many notebooks, honey."
Gonzales is a senior reporter with the Center for Health Reporting, an independent news organization that partners with news media to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation. Gonzales can be reached at (626) 457-4217, email@example.com or @JMGonzalesCalif on Twitter.