In 2008, San Francisco police were called to transport a woman with mental illness to a hospital. Instead, they shot her seven times. This is the story of how police became our nation's mental health care workers, and how Teresa Sheehan's family fought for her before the shooting — and since.

Posted on

On Thursday, Aug. 7, 2008, a social worker named Heath Hodge arrived at a three-story residence in San Francisco's Mission District. Hodge was employed by a nonprofit called Conard House, which runs several cooperatives for adults with mental illnesses throughout the city. As Hodge climbed the stairs to the bedrooms on the second floor, one resident in particular was on his mind.

Teresa Sheehan was 56, Japanese-American, and about 250 pounds. She had been with Conard House for over three years. Her diagnosis was schizoaffective disorder, which combines the swings of mania or depression with schizophrenia's psychosis. Hodge had heard from other residents that Teresa had stopped attending house meetings, eating, and changing her clothes. She had also not been taking her medications for some time, potentially for as long as a year and a half. According to her family, she had long disputed that she had a mental illness.

Teresa's room was at the end of a hallway. When Hodge knocked on her door she didn't answer. With a property manager's help, he unlocked it. The room was small and cluttered. It had a window at the far end. Teresa was lying on her twin bed with a book over her face.

Startled, rising, Teresa told them to get out of her room. She shouted that they had no right to be there and that she had a knife. Hodge later testified he didn't see a knife at that time. He also testified that she threatened to kill him; the property manager didn't hear this.

In California, as in much of this country, treating people with psychiatric disabilities without their consent is hard to do. As a social worker, Hodge had a card authorizing him to place someone like Teresa on an involuntary psychiatric hold (which is known colloquially as a "5150," referring to the California statute number). But he can only do so under a few, extreme circumstances: if an individual is gravely disabled or a danger to him or herself, or to others — like if she threatened to kill someone.

Otherwise, even if he believed Teresa Sheehan needed psychiatric care, Heath Hodge couldn't force her to receive it. Because of laws protecting patient privacy, he also couldn't have told a trusted family member or other caregiver what was going on. Teresa's older sister Patricia lives about 15 minutes away from that house.

Hodge went to his car to retrieve a pink 5150 form and called the San Francisco Police Department's nonemergency line. He walked down the block to buy a bottle of water and, surprised at how quickly the first officer arrived, jogged to meet her in front of the house.

Kathrine Holder had been with the force for seven years. When Hodge explained the situation, she said she wasn't too familiar with 5150s and called a superior. Sgt. Kimberly Reynolds, a veteran of 17 years, soon joined them. Hodge briefed her as well and the three entered the house.

The officers knocked on Teresa's door, identified themselves as police, and entered her room. According to the officers, Teresa leapt from her bed. (Teresa later said she opened the door herself.) She screamed that they had no right, that they had no search warrant, and that she had a knife.

She grabbed it: It was serrated, with a six-inch fixed blade. Her family say she used to cut fruit in her room because she didn't like using the communal kitchen. Teresa later said she'd eaten that morning. She managed to get the door closed. Holder radioed for backup.

Teresa later explained her actions in a deposition: "I didn't want to be detained and hospitalized on the fact that I wasn't in my right mind. Because I was. I was functioning [in] life well enough, and I didn't want them disturbing me and hospitaliz[ing] me at a cost to the taxpayers and cost to myself."

Reynolds thrust her torso against Teresa's door, attempting to break it down, and ordered Holder to take out her pepper spray. She was unable to get the door down, so Holder, who was larger, volunteered to do it, and Reynolds held the pepper spray instead. They heard sirens. Reynolds then told Hodge to go downstairs to let the backup officers in. When the door finally broke in, they found Teresa still standing, still screaming threats, still holding the knife.

Reynolds pepper-sprayed her but it didn't do anything, perhaps because of Teresa's thick glasses. Then, because she felt cornered and feared for her life, Holder discharged her firearm, "two or three times." She aimed at Teresa's torso. When asked how much time had passed between the door opening and her first shot, Officer Holder later said, "I would be shocked if it was over five seconds."

Still, Teresa did not drop her knife, and Reynolds fired her gun several times as well: first at Teresa's torso, and finally a shot into her temple. Reynolds recalled Teresa was still standing when she shot her in the head; Holder said Teresa had fallen on the ground. Teresa's eventual civil suit against the officers calls this final shot an "attempted execution."

Teresa was transported to the emergency room. There were 14 bullet holes in her body. She had to have two hip surgeries. Her family say they didn't know anything about the extent of her injuries until they finally saw her the next day. They just remember a doctor telling them that each of those bullets should have killed her. They remember that he called her survival a miracle.

"Woman Shot After Brandishing Knife," read the story two days later in the San Francisco Chronicle. It described the threat against Hodge and said he was a social worker. It mentioned the threats against the officers. It included the word "knife" four times. It made no mention of the fact that Teresa Sheehan had a mental illness, or that she was having a psychiatric emergency, or that that was why police had been called.

After being held about a week, Teresa Sheehan, who had no prior criminal record, was charged with five felonies: making "terrorist threats" against Hodge and two counts apiece of assault with a deadly weapon and assault of officers of the peace.

Here is the question, the question that, despite seven years of litigation that have followed, has not been answered: Did the officers do the right thing?

Behind a closed door, did Teresa Sheehan pose a threat to herself or others, one that necessitated police interference? Or did the police, knowing that she was in the throes of a psychiatric crisis, and therefore irrational, paranoid, and potentially violent, have an obligation to accommodate that disability — by standing down, by calling for help, by buying time?

It's a question with tremendous stakes. The systematic defunding of America's mental health care infrastructure over the last half century and shifts in law surrounding involuntary treatment have produced an epidemic of people with severe mental illness who are unwilling to receive care and/or unable to access it. They've instead become vulnerable to untold, numerous horrors. They've filled the streets. They've filled emergency rooms. They've filled prisons. And if the prison has become the psychiatric hospital, the police officer has become the psychiatric nurse. This benefits no one involved: not individual officers, nor their departments, nor the taxpayers who pay for their mistakes. And it certainly doesn't benefit the likes of Teresa Sheehan, nor her sister Patricia, who came home to a red light on her answering machine that night.

Government agencies do not reliably track the number of Americans killed by police. They do an even worse job of keeping track of what percentage of those have a psychiatric disability. A 2013 estimate by an advocacy group and the National Sheriffs' Association guessed that the figure is at least half. A recent Washington Post report found that of the 462 people who have been shot to death so far this calendar year by police, 124, or about a quarter, were "in the throes of mental or emotional crisis." Looking at California specifically, a BuzzFeed News examination of all people killed by police there in 2014 found that approximately 16% had a confirmed history of mental illness.

The large variation in these numbers may be due to differences in methodologies, as well as data being extremely difficult to obtain. In addition to no or poor department tracking and patient privacy laws standing in the way is the fact that people with severe mental illness often have compounding problems like drug addiction, poverty, and poor physical health. Many have also often lost all meaningful connections to friends or families. Many of those friends or families may have no interest in discussing these matters for any number of reasons. Regardless of the exact number: It is way too high.

Horrific stories about police killing people with mental illness are all too easy to find.

When Teresa Sheehan's case reached the Supreme Court this spring, there was no clear consensus among the justices as to what the police officers should have done when faced with that closed door. On a legal technicality, they declined to rule in this matter and kicked the case back down to the lower, district court — which means the Sheehans' lawsuit against the city and county of San Francisco may finally get a jury trial.

But as Justice Sonia Sotomayor said when this case was argued, the question of what should be done about people with mental illnesses as it applies to their interactions with police — and, one could argue, generally — is one we can no longer stand to not address. That is, she said, "Unless we want a society in which the mentally ill are automatically killed."

"I listened to the message and I thought, Is this right?" Patricia Sheehan, 65, recalls of the night of Aug. 7, 2008. She called back, full of dread. "The person on the other end said, 'I just want to tell you that your sister has been shot.' I dropped the phone."

She and another of Teresa Sheehan's sisters, Frances, 59, are sitting in Patricia's modest and tidy apartment in one of San Francisco's western neighborhoods on a foggy May day. She has poured us Japanese tea and served coconut cookies in little plastic wrappers, and, Frances has explained, with a slight frustration in her voice, that while we'd all hoped Teresa herself would join us, she had called earlier and said she'd rather be alone today. Most days these days, they say, Teresa would rather be alone.

Frances was on a flight up early the next morning; she lived in Orange County at the time, where their mother was in hospice. Their brother John soon joined them. (Their final sister, JoAnn, lives in Virginia and would come later.) The five Sheehan siblings grew up on Okinawa where their father was a civilian officer. He was raised Irish Catholic in New England and met their mother, a Japanese local, after the war. The sisters joke that, had he not met her, he was supposed to go home and become a priest.

They recall that the Okinawa of their childhoods was not quite America and not quite Japan. There were wide expanses of lawns between homes. When the siren sounded every day at 5 p.m., you had to stop what you were doing and salute, even if you were driving in your car. "It was regimented but in a nice way," Frances says. (At several points in our conversation they emphasize that they've always respected military and police and have several ties to the uniformed services in their family.)

The second oldest, Teresa Sheehan was "the brains of the family," as Patricia puts it. She had a natural scholastic aptitude; she got excellent grades but barely seemed to study. Her former friends and classmates also recall, first, that she was smart; one calls her a "genius." She was in the honors society, did the paper and student government.

She was also their family's "heart," Patricia says. "She's very, very kind to everybody."

"She has the patience of a saint," Frances nods. "Saint Teresa."

After high school graduation, Teresa Sheehan entered Colgate University in upstate New York as a member of the class of 1970. It was the first year that school admitted women, they tell me, with withered pride.

Teresa flew across the planet, away from life on Okinawa, and her family, to study religion and philosophy. It was during the next few years that something happened to Teresa's brain, something changed. It's impossible now to know whether anything triggered it; her sisters say Teresa has never spoken to them about what, if anything, happened at school.

The age of onset of severe mental illnesses like schizophrenia and bipolar disorder can make them particularly difficult to identify and treat. Whereas other brain disorders present early on in a person's development (autism) or late (dementia), these disorders tend to strike in the late teens and early twenties. This is often right as a young person has become legally independent, left their support system, and entered something new and stressful, like the workforce — or a newly integrated university 7,500 miles from home.

The early 1970s were also a particularly inauspicious moment in American history for someone like Teresa Sheehan to start presenting with symptoms of mental illness. As psychiatric researcher and advocate Dr. E. Fuller Torrey outlines in his history of the last century in American mental health care, American Psychosis: For hundreds of years, state psychiatric hospitals provided asylum for those with mental illnesses; many of them were in desperate need of reform. President Kennedy, whose sister Rosemary likely had a mental illness before she was clandestinely lobotomized, believed in this cause but fell sway to a school of thought that mental illnesses were a social, rather than a medical, problem. To fix them, the thinking went, America needed community mental health centers that would prevent such illnesses.

Federal dollars to state-sponsored mental health care trickled to a halt in order to encourage the ascent of these centers, which, it turns out, were based on junk science. In coming years, conservative leaders like Richard Nixon, many of whom weren't fans of psychiatry in general, let Kennedy's ineffectual program lapse. The prejudices against state mental health care spending remained. America began eliminating hundreds of thousands of psychiatric beds, and soon began shuttering state hospitals.

As the country's population rose, so did its population of people with mental illnesses, bolstered by veterans returning home from conflicts overseas. States were happy to no longer pay for their treatment, but no one else filled this role — and no one took the blame for this, either. As Torrey writes: "The mental illness treatment system had been essentially beheaded." He argues that it wasn't deinstitutionalization itself that was the mistake. "The mistake, rather, was our failure to provide continuing treatment and rehabilitation for these individuals once they left the hospitals."

California was at the bleeding edge of these changes. It had already closed more than half of its state mental hospitals by the time Ronald Reagan assumed the governorship in 1967; he took care of much of the rest. (As many have noted, it is ironic that the man who later attempted to assassinate him while he was president, John Hinckley, had severe, untreated mental illness.) In this era, too, a series of decisions to do with civil liberties made it much harder to involuntarily commit and hold people with mental illnesses; the first of these was passed in California, also in 1967.

The Golden State soon became the first to witness increased rates of homelessness associated with deinstitutionalization, increased rates of incarcerated mentally ill, and increased instances of — sometimes very publicized — violence committed by people with mental illnesses who were not receiving treatment. Other states followed. By the 1980s and 1990s, the number of individuals with serious mental illnesses "who did reasonably well," as Torrey summarizes, "was a minority." People with severe mental illnesses have life expectancies that are about a decade or two shorter than that of the general population.

Still, no governmental agency — local, state, or federal — is taking real responsibility for the care of individuals with severe mental illness. As has been the case for the Sheehans, caring for them has fallen on their families instead.

One summer while she was in college, Teresa Sheehan went to stay with her older sister rather than go home to Okinawa. By then Patricia was living in Brookline, Massachusetts, in a small apartment with two roommates. Teresa didn't mention she was having trouble in school other than the fact that she wasn't sleeping. "She said she couldn't sleep for days," Patricia recalls, which was weird because as a teenager Teresa had been a "slug." By midsummer, the roommates were fed up and, at Patricia's request, their father told Teresa to come home. She never returned to Colgate.

Frances, who was still in high school, remembers coming home one night and finding Teresa in the kitchen. "She kept saying that she saw somebody present with us, but there was nobody," she says. She reassured Teresa that she wasn't crazy and said not to worry. Though Frances recalls Teresa did go to a Japanese hospital a time or two, if their parents knew more about what was going on with their sister, they mostly didn't tell the kids. "We didn't know about mental illness or anything."

After their father's retirement, Teresa moved with her parents and little brother to the Sacramento area. Still, Teresa's illness wasn't really discussed. Their father was in charge of such things. "He didn't want us to worry about it. Nothing negative ever," Frances says, though the burden of caring for Teresa did weigh on him.

"As much as you can take care of Teresa," Patricia says.

"She's stubborn," Frances adds.

"She is so stubborn," Patricia agrees from across the table. "That is her worst quality. That's the worst trait for somebody with her illness."

For a while when they were in their twenties, Patricia, Frances, and Teresa lived together in an apartment in Novato, north of San Francisco. Teresa worked as a secretary in the city. But by now what they termed her "oddities" were becoming the rule. She'd wear strange things. She'd sleep for days. Or she'd just lie around and read intellectual books, books on physics, books in other languages, what Frances calls "books I wouldn't think to read."

At some point Teresa lost her job. At some point her sisters told her she had to move out. At some point Teresa was acting so strange that Patricia called the police. This is probably the first time Teresa was involuntarily committed. Afterward, Patricia says, "She was angry. She was very angry at me. I didn't visit her. I was angry with her."

Her sisters say they don't know all the jobs she's had and lost. They don't know all the places she's lived and had to leave. They mention one halfway house, another house owned by a dentist, one staff room at a hotel. They don't know if she's been homeless. Frances would sometimes get a call and have to write a check for several months of rent owed to somebody or another. Patricia would sometimes find Teresa standing outside her job, once with a birthday cake. "My friends would joke, 'Do we dare eat it?'" Patricia would sometimes drive around at night looking for her sister.

Even if they could, Patricia and Frances say they wouldn't want to know all of the places their sister has lived. They wouldn't want to know all that she has been through. What they do know: Teresa is shy. She is private. She has a great memory — you go to a restaurant and she'll tell you what you were wearing last time you were there and what you ordered.

Patricia is a strong woman, more stoic than Frances, and yet her voice breaks only ever so slightly when she says, "I just think that if I ever heard some of her stories it would probably kill me."

Psychiatric disabilities become harder to treat the longer they are untreated. Experts now agree that early intervention, a swift response to a first episode, and then consistent, supportive care is the best way of preventing a mental illness from effectively ruining a person's life.

Whereas a person can survive without treatment for a time, they will have occasional episodes during which things become especially bad, in which case they will require hospitalization until they are stable.

But Teresa didn't believe she had an illness, and still does not. This is a not uncommon symptom of severe mental illness. As a family, the Sheehans' options in terms of helping her were — and remain — few.

Teresa Sheehan's family guess that the longest she's ever been in a psychiatric facility is about three weeks. For the most part, her involuntary psychiatric stays have been within the 72-hour period typically allowed by California law. This is often weeks before a psychiatric medication has had a chance to take effect — let alone for a physician to assess whether it is the correct medicine or dosage; these medications often are accompanied by debilitating side effects.

The Sheehans could have forced Teresa to receive longer-term care only if she had committed a felony and been confined to a psychiatric hospital after having pleaded insanity. They didn't have the money to pay for a private facility, which can run thousands of dollars a week.

Instead, Teresa Sheehan's mental health care has been a patchwork of emergency rooms and outpatient programs. She has seen countless nurses, countless doctors. She's been prescribed, and stopped taking, countless medications. She is not wrong, in other words, to be skeptical of mental health care.

Frances remembers they were once at a hospital together and some new psychiatrist wanted to talk and Teresa said, "Why should I talk to this person? They're just going to be there a short while. Then I'll have to start all over again." Even when she'd get in a relatively stable situation, like the cooperative sponsored by Conard House, Teresa didn't receive proper care, the sisters say. How, they ask, did they let her go a year and a half without taking medication?

(In an email, a representative of Conard House cited privacy law in denying all interview requests for this story. He wouldn't say whether Heath Hodge still worked for them. Attempts to contact Hodge otherwise weren't responded to.)

When their father died in 1988, Teresa read a eulogy at his funeral. Patricia hands me a copy of it, saying that the priest had asked them afterward whether Teresa was a professional writer. It is poignant and stunningly well-written. "He was a man of attitude," Teresa wrote. "It never did to just wake up each morning. He roused us with the exhortation to 'Rise and Shine.'"

I ask how Teresa's illness affected their mother — that her daughter, one who'd shown so much potential, was so lost.

"She was devastated," Patricia answers. "She used to always say to me, 'If something happens to me and I don't know who you are, just put me in a nursing home, because I won't care. But take care of your sister.'"

From across the table, Frances repeats the mantra: "At the end of the day, take care of Teresa."

When it became clear that Teresa was going to survive the shooting, the Sheehan siblings made the decision to not tell their dying mother what was happening. Frances would instead tell their mom she had business trips when she made frequent trips up to San Francisco. (Their mother in turn told Patricia she suspected Frances was lying to her.)

Teresa was shackled to the hospital bed and an officer stood by. Her family wasn't allowed to touch her, let alone hug or kiss her. They weren't allowed to talk to her for more than a few minutes on the phone. They say she was not formally charged for a week and was then assigned a public defender who would represent her in the impending criminal litigation.

Patricia's home became the de facto base of operation in the ensuing months. They survived, she says, by "cooking and drinking." Meanwhile Frances, the more business-minded of the two, dove into advocating for her sister. She had Teresa sign a form making her Teresa's attorney-in-fact, which allowed her to gain access to Teresa's medical records. She was on the phone and emailing — the hospital, the police, city hall. "All I know is I start from the top and I work my way down," she says. There was no time to be sad. "My sister's life is on the line."

After a few weeks, Teresa was transferred in the night to the San Francisco County Jail. Teresa's metal jail bed was low, not compliant with the Americans With Disabilities Act (ADA), her sisters say, and though she told guards she was in pain, her complaints weren't taken seriously. She finally collapsed while one of her attorneys happened to be present; they later learned that the metal rod had broken away from the screw in her fractured femur. It had to be reoperated upon.

Most worrisome, though, were her wounds, which needed to be cleaned daily. "Our concern was they were throwing her in there so she could get an infection and die," Frances explains.

Frances called a meeting with jail and hospital officials and set a stack of files of people she said had died of infections in jail on the table. "I said, 'Each one of the cases that I have, they died in the county jail. I'm just going to let you know right now, if anything happens to Teresa, I'm going to hold you legally, personally, professionally responsible for her death.'" The Sheehans say Teresa was transported back to the hospital soon after.

Their mother died on Halloween. Patricia asked the guards for extra time with Teresa that day, and they gave it to her. Several times the sisters emphasize that not everybody they've interacted with throughout this ordeal was bad; in fact many people were really helpful, really generous. That day, she says, the guard even let her give her sister a hug.

"It was a really emotional trial for me," Teresa's public defender Kleigh Hathaway remembers, though her involvement with Teresa's story ended six years ago. Even during jury selection, after they'd excused the dozens who weren't picked, she sent a couple of paralegals out into the hall, as she often does, to gauge how they felt. People were apparently irate, asking whom they could write to say to drop the charges: "They were calling my client 'the victim,'" she says. "They were asking, 'Don't the police get more training?'"

She rushed to prepare for their trial, which was set to begin in mid-November, jumping through hoops to try to get police training records. Then there was the matter of her defendant.

"She'd completely decompensated," Hathaway says. "She was really, really paranoid and scared because of her mental illness prior to this incident, and this incident fulfilled any paranoia she would have had." She recalls it took weeks before Teresa would talk to her. She made it one of her paralegals' job just to help get Teresa dressed each day before court. "I did the trial holding my breath and hoping she wasn't going to say something that was completely crazy."

Frances bought a full-figured dummy and adhesive dots — she used to teach day care, she explains — and they had an expert mark on her body where the bullets entered and exited. They managed to get photos they'd clandestinely taken of Teresa's wounds included as well. They called an expert in police mental health training. Through the trial, the Sheehans remember, advocates from the San Francisco chapter of the National Alliance of Mental Illness sat in the courtroom, as did a reporter from the local now-defunct Japanese-American paper.

The trial lasted several weeks and the jury deliberated for one. Teresa was found not guilty of making terrorist threats against Heath Hodge, and the jury was hung on the other four counts. The Chronicle reported that it was 11–1 on the assault charges against the officers and 7–5 on the weapons ones. It quoted one juror as saying that she hoped the prosecutors wouldn't retry the case: "This woman has had enough."

After the criminal part was over, Frances remembers, "I went home and I slept for three days. I cried and I cried." She hadn't had time to mourn their mother, she explains. Or Teresa. "I'd never really cried for my sister Teresa. I was too busy."

In January 2009, the district attorney's office announced it was not going to try the criminal case against Teresa Sheehan again.

That August, a year after the shooting, the Sheehans filed their civil case against both the city and county of San Francisco and Sgt. Reynolds and Officer Holder individually. They were represented by the firm of John Burris, known for defending civil rights violations. One of the bases for their suit was that the officers had violated the ADA when they busted down Teresa's door a second time.

"With the door closed, what threat was she to you?" one of her attorneys, Ben Nisenbaum, asks. Teresa was obviously disinterested in interacting with the police. By opening the door, they more or less guaranteed the situation would escalate. "What consideration did you give to Ms. Sheehan's mental state? You knew she was schizophrenic, you knew she was off her medication, you knew she had grabbed a knife," he says. When they opened the door a second time, "Why would you think she would act normally?"

Put your weapon away. Lower your voice. Don't expect the person in psychiatric crisis to react rationally or nonviolently. Secure the scene but wait for backup before moving in. Seek the assistance of mental health professionals. Most importantly: Buy yourself time. De-escalation tactics, often called the Memphis Model or Crisis Intervention Team (CIT) training, are lauded by experts as being the best practices police can employ in these situations. They also run contrary to much of what police academies teach about using control — and potentially lethal force — to take control of individuals in fast-moving, uncertain situations.

Since it pioneered this program in 1988, following the fatal shooting of a mentally ill man, the city of Memphis has experienced a dramatic reduction in deaths of this kind. Some other departments across the country have adopted it, but many would argue not enough. The Washington Post's recent analysis of those Americans with psychiatric disabilities who've been killed so far this year by police found that "More than half the killings involved police agencies that have not provided their officers with state-of-the-art training to deal with the mentally ill."

The Memphis Model was not standard in the San Francisco Police Department in 2008. A 2013 KQED investigation showed that of those shot by San Francisco police between 2005 and 2013, 14 of 51, over a quarter, had a confirmed mental illness.

When they were deposed, both Officer Holder and Sgt. Reynolds did not have strong or specific recollections as to what sort of training, if any, they had received with regard to how to interact with people who were experiencing a psychiatric crisis.

They did explain their logic that morning. They said they didn't know whether Teresa could have escaped the room via a fire escape and been a threat to the public. There could have been someone else in the room. She could have harmed herself. She could have had another weapon or she could have stabbed them through the door.

(Requests to interview Officer Holder or any other officers affiliated with the case were denied by the SFPD. Sgt. Reynolds, who did not respond to interview requests, has since retired from the force and appears to have become a real estate agent.)

After the Sheehans filed their civil suit, the San Francisco city attorney's office made no moves to settle with them. Instead, in June 2010, it filed to have their lawsuit thrown out. The district judge who ruled in the matter was the Honorable Charles R. Breyer, brother of Supreme Court Justice Stephen Breyer (who would later recuse himself when this case reached that court).

At a hearing in April 2011, Judge Breyer appeared to be incredulous at the idea that the police should have waited for backup to come rather than break down Teresa's door, repeatedly calling Teresa "deranged."

"Well, they should have had an analysis as to whether she was suicidal?" he asked Ben Nisenbaum. "Like, 'Let's have a — let's give her some therapy to see whether she has thoughts of suicide'? She has a butcher knife, and she's screaming. And she's not coming out, and not taking care of herself."

Both sisters remember that day well. "It dehumanized her, the words he used," Frances says.

"I had to run out," Patricia explains.

Breyer threw out the Sheehans' suit. Two months later, they appealed.

In February 2014, the liberal 9th Circuit Court overturned Breyer's ruling in part, holding that police had an obligation to accommodate Teresa Sheehan's psychiatric disability. "This case involves a near fatal tragedy in which police officers attempted to help a mentally ill woman who needed medical evaluation and treatment but wound up shooting and nearly killing her instead," Judge Raymond C. Fisher began his opinion. "Fundamentally at issue is the constitutional balance between a person’s right to be left alone in the sanctity of her home and the laudable efforts of the police to render emergency assistance, but in a way that does not turn the intended beneficiary into a victim or a criminal."

Again, rather than settling with the Sheehans, or letting the case go to trial, the San Francisco city attorney's office continued to fight to have it thrown out. In May 2014, they filed to have it heard by the U.S. Supreme Court. The court agreed to hear the case in November of last year.

Imagine the amount of money the city and county of San Francisco have spent to date on Teresa Sheehan.

On Jan. 16, 2015, a group of activists were participating in a #BlackLivesMatter "die-in" near San Francisco's City Hall. Afterward, they joined a coalition of disability rights advocates and together marched inside to ask City Attorney Dennis Herrera for a meeting. They wanted his office to drop its petition to have the Sheehan case heard by the Supreme Court. If the court ruled in San Francisco's favor that the ADA did not apply to the arrest of Americans with psychiatric disabilities, this could potentially affect millions of Americans — and potentially Americans with other kinds of disabilities as well.

The group was told he had no time to meet with them and was asked to leave. They then sang protest songs. One of them, activist Bryndis Tobin, sings me the words of one song into the phone.

Tobin tells me she is from a long line of activists, grew up mixed race in a majority-white school, and is now an attorney. She read the city attorney's petition to the Supreme Court and was appalled. For Bryndis, this was personal: "My husband is [legally] blind," she explains. "And if he can't see what you're pointing at, the city's argument is if that officer felt a threat, regardless of anything else, then it was OK for him to shoot my husband, without ever giving him a chance to comply. It's totally OK for the officer to kill my husband and I can't even sue him afterwards."

Tobin argues these issues — needless violence at the hands of police toward people of color, and people with disabilities, psychiatric and otherwise — overlap. "The thing is in the African-American community, in the Latino community, in all the communities of color, nobody is confused about how incredibly dangerous it is to be disabled in this country. Nobody is confused by that at all," Tobin says.

The group got its meeting, which was held on Jan. 29. Among those afforded time to speak was Vinny Eng. Eng, like most of the people I spoke to, never expected to become an advocate for the mentally ill. His family had fled the Khmer Rouge, he tells me in a voice so sweet it is disarming, and his sister Jazmyne grew up to have post-traumatic stress disorder and schizophrenia. She'd long been stable when, three years ago, she suffered a psychiatric emergency in the Southern California clinic she'd attended for 10 years. Staff there called a nonemergency line at the sheriff's department. "Within eight minutes of the call my sister was shot twice by a deputy and killed at the clinic," says Eng. "This was within less than 15 seconds of visual contact." You can tell he's told this horrible story many, many times.

"The Sheehan case happened so long ago," Eng recalls imploring at that meeting with the city attorney. "The community dynamic is so different today than when the Sheehan case happened. Why are we arguing for the status quo when we have been advocating for so many years to bring progress, to ensure that someone who's having a psychotic episode and interacting with law enforcement has a safe, nonlethal outcome?"

Because, as people on all sides of this issue in San Francisco agree, things have been changing for the better. Following the Sheehan incident and a few others, the department sent representatives of Memphis to do ride-alongs. Then, in 2012, it implemented a 40-hour CIT training program on a volunteer basis. Lt. Mario Molina says that today more than 300 officers — over 20% of the patrol force — and also some Bay Area Rapid Transit police have been trained in CIT. He says they're only going to continue and that the goal is to train the entire SFPD.

"Most police officer–involved shootings happen within 90 seconds to two minutes of arrival of officers at the scene," Lt. Molina, who was a psychology major and then counselor before joining the force in 1995, explains. "Our officers need to slow down. Create that distance, create that time, that might help to resolve the situation without using force."

Vinny Eng is a part of the group that has helped institute this program and monitor it, along with representatives of the department, mental health professionals, and public health officials.

They also helped organize a first: On May 12 of this year, they held an awards ceremony for officers whose use of de-escalation techniques proved especially heroic. Nine officers were given awards, including one who spent hours literally talking a veteran with PTSD off a ledge. All the brass were there. It was, by all accounts, deeply moving. That, Lt. Molina explains, is how you do the near-impossible: change a department's culture.

Vinny Eng cautions against "scapegoating" police. He and every advocate and expert I spoke with, in San Francisco and nationally, acknowledge that the mental health care infrastructure, or lack thereof, is ultimately to blame for the present policing crisis.

One in four American adults experience mental illness. A lot of us know somebody, or have somebody in our family, who is estranged, who was put away, who hasn't been heard from in some time. Or who is dead. It's been demonstrated that there is a genetic component to the instance of these disorders, though, generally speaking, they are only starting to be understood, and more research is needed. The fact remains that severe mental illnesses are affecting American families of all backgrounds, races, and means. They are affecting some whose families are not at all equipped to handle them, and others who are patient or stubborn enough to at least try.

I ask Eng what is the biggest thing he'd like people in families that aren't affected by mental illness to know. He doesn't seem to think before he answers: "The most dangerous thing that anyone in the public can do is remain indifferent about this."

Teresa is now 63. Since 2009, Teresa Sheehan has lived in a single-room-occupancy hotel in the Tenderloin, a pocket of San Francisco where the sidewalks are lined with the shopping carts and plastic bags and the sounds and smells of people who are drug-addicted, mentally ill, and homeless — and often combinations thereof. Her sisters don't want her to be there but say they have no other choice; no other available facility could accommodate Teresa's physical disabilities that resulted from the shooting. They say she doesn't do a good job of taking care of herself. Her jaw was affected by the shot to her temple, but she hates the dentist. They together momentarily lament the declining state of her teeth.

They don't know whether she's receiving any psychiatric care or taking medication, but from what they've been able to tell, she's not. Patricia says the two of them drove up to visit their mother's grave earlier this year and Teresa talked nonstop the entire time.

As far as they know, she's gotten no counseling for the trauma of having been shot. They know that something that has affected her in particular is her allegation that she was not properly covered when she was loaded into an ambulance that day.

She's become much more withdrawn since the shooting, they say. More childlike. They repeat several times I shouldn't be offended that she didn't join us tonight. They tell me I can write her a letter if I like, and I do. I haven't heard back yet.

They say they mostly keep Teresa in the dark about the particulars of the litigation; they don't want to worry her or get her hopes up.

Oral arguments before the Supreme Court took place on March 23, 2015. A Seattle attorney named Leonard Feldman had heard about the Sheehan case after the 9th Circuit's decision and argued on the Sheehans' behalf pro bono. ("I've always been passionate about abuse of power issues," he tells me. "It seems to be most profound when you're looking at police officers and prison guards.") Frances and JoAnn were there. Afterward, Frances says, a law student who'd heard about the case came up to her and gave her a hug.

The next day, Teresa called Patricia and said, "'Guess what? I'm on the front page of the San Francisco Chronicle!'" Patricia recalls, laughing. Teresa bought two copies and had Patricia hold on to one, explaining she tends to lose things in her room.

The decision came down on Monday, May 18, 2015. The court punted, mostly. On the only interesting matter from the standpoint of legal experts following this case — the ADA's application during arrests — six justices joined in saying they could not rule, and sent the case to be tried by Judge Breyer's District Court. The Supreme Court did rule in a second matter, holding that the officers couldn't be sued as individuals by the Sheehans, a ruling that those following the case weren't surprised by (the liability standard that protects individual officers of the law is very high).

"S.F. Police Shielded in Ruling by High Court" was the San Francisco Chronicle's headline on May 19, a way of phrasing the news that confused even advocates close to the case, who incorrectly believed that the Sheehans had lost their civil suit. In fact, nearly seven years on, they have finally won the right to have it tried.

Frances Sheehan sounds exhausted on the phone the day after the ruling comes down. "I'm pleased that we are able to go to trial," she says. "Teresa's case will be heard in San Francisco. A jury trial."

The second bit of good news from the perspective of the Sheehans: As a result of the Supreme Court not ruling in that first matter, the 9th Circuit's ruling — that the ADA does apply to arrests of individuals with psychiatric disabilities — holds. "Teresa made case law," Frances says.

That same afternoon, I ask the deputy city attorney who'd argued the case before the court, Christine Van Aken, whether they plan to settle with the Sheehans. "I don't know the answer to that," she said. "We do feel very strongly that the officers didn't violate the ADA here."

On the morning of June 10, 2015, a few weeks after the Supreme Court's ruling in the Sheehan case, a congressman named Tim Murphy took the house floor. The Republican from Pennsylvania is the only practicing psychologist holding elected federal office. He wore a green tie and spoke as fast as he seemingly could as he outlined the nation's mental health care crisis:

"Over the last 30 years, we've shut down the old asylums and what we've seen is increase in incarceration, suicide, homelessness, emergency room visits, unemployment, substance abuse and substance abuse deaths. We have failed on all these metrics. Anyone — anyone — who thinks we are being successful in helping those with severe mental illness is delusional."

Murphy rattled off statistics: 10 million Americans have severe mental illness (of those, 1.3 million aren't receiving treatment). 1.3 million Americans attempt suicide each year. 40,000 succeed. We have a shortage of 100,000 psychiatric hospital beds. "This is what the American taxpayer buys for $130 billion a year?" he nearly shouted.

The bill he was reintroducing, the Helping Families in Mental Health Crisis Act (which previously failed in 2014), proposes to fix what he calls our "mess" of a federal health care system. It has bipartisan support, including that of Congresswoman Eddie Bernice Johnson, a Democrat from Texas who is a former psychiatric nurse. Another of the bill's advocates is Virginia state Sen. Creigh Deeds, also a Democrat. After his son Gus was diagnosed as bipolar at the age of 21, Sen. Deeds was unable to do anything but stand by as Gus refused treatment and deteriorated. In November 2013, when he was 24, Gus stabbed his father multiple times, and then committed suicide at their home.

Soon after the speech, Congressman Murphy talks with me about how his bill would address this public health crisis, which he says is no different than any other. "Serious mental illness is a brain illness and we have to stop acting as if you have to suck it up and it goes away. That is a myth." He reminds me that there was a time when you couldn't talk about cancer because of stigma; now we have huge marches, football players wearing pink shoes.

Congressman Murphy's bill would also relax privacy laws, giving families more access to information about a severely mentally ill person's otherwise confidential health care information. Murphy emphasizes this would be only in certain cases where individuals have demonstrated a repeated inability to care for themselves, and even then, only some information would be allowable: the name of a doctor, a diagnosis, the name of medications prescribed, the time and date of next appointment. "In other words, we give enough information to the caregiver, the responsible caregiver, so that they can facilitate that person's care." Advocates for the rights of people with mental illnesses oppose such measures. When asked specifically about what Congressman Murphy's bill proposes, a representative for the group Disability Rights California said in an email: "We believe it is discriminatory and violates civil rights."

When I ask about the odds that his bill passes the House and goes to the Senate — and eventually becomes law — Congressman Murphy says he doesn't like to think about odds. He says he's got the photos of the kids who were massacred at Sandy Hook on his desk. He says we can't go on not dealing with this.

"What has happened over the years, I've experienced myself, thousands and thousands of families are driven into silence. They hide these issues. They don't want to talk about them." Call your congressman, he says; write that email. "I think we have a very good shot if Americans speak up."

Patricia Sheehan says they're speaking up because they hope Teresa's story can serve as a wake-up call. "I think everything has been for a bigger reason. The community — everywhere in this country — we need to help people like her."

The apartment has begun to smell of roasting chicken. Every time Patricia crosses between the dining room and the kitchen she jostles a curtain of wooden beads. She pours wine. Frances tells me she's read about injectable psychiatric medications, which could help take the question of taking a pill every day out of her sister's hands.

Soon, caramelized carrots and onions bathed in chicken fat will be scooped onto plates alongside a salad with avocado and Bibb lettuce, and big hunks of sourdough. Across town, Teresa is alone in her room.

There isn't yet a date set for their long-awaited second trial. They also don't like discussing odds. But if they do get any money from the city and county of San Francisco, the Sheehans say they'd like to be able to get Teresa out of that Tenderloin SRO. They want to get her set up in a good, private facility — somewhere stable, somewhere with care and activities to keep her stimulated and, most importantly, medicated.

Not that they talk to Teresa about money or what they'd do with it. They don't want to get her hopes up. "The thing is there are times when it takes everything I have just to even see her," Patricia says. "Last time she was here," she goes on, "she said to me something about having lived there six years. She said, 'I don't think I'll ever get out of this place.'" Finally, after the hours we've been talking, her voice and composure finally break: "It broke my heart."

Frances nods. "Our lives still go on and we can do so many other things, but she sits there day in, day out, day in, day out."

Meral Agish, with assistance from Jeremy Singer-Vine, performed the analysis of police shootings in California for this story.

Want to read more stories like this? Sign up for our Sunday features newsletter, and we’ll send you a curated list of great things to read every week!



Sandra Allen is a freelance writer and formerly BuzzFeed's Deputy Features Editor. Her first book "A Kind of Mirraculas Paradise" is forthcoming from Scribner.

Contact Sandra Allen at sandraeallen@gmail.com.

Got a confidential tip? Submit it here.