Community violence and a visit to the doctor might seem like two totally unrelated topics. But for people living in violent communities, and the police who patrol them, it might be more closely related than you think. In the first report in a multi-part series on the links between health care and violence in the San Joaquin Valley, we learn what happened when one man’s health care interventions became law enforcement interventions.
Roger and Freddy Centeno were brothers and part of a big family living in Southeast Fresno. In all, there were nine kids, six girls and three boys.
Roger is 52 years old now but recalls that it was clear there was something different about Freddy.
Still, that didn’t keep him from being a popular community fixture, who neighbors would protect if they sensed something was wrong.
“As a matter of fact, people used to take care of him. People would try to start stuff with him but friends, people who knew his illness, they would actually defend him,” Centeno says.
"If we had would have known what would have happened to your brother. We would have never called police all those times. We would have just taken him to the hospital ourselves," Roger Centeno
Centeno’s brother had severe mental health problems including schizophrenia.
He had been in and out treatment with a stay at the Atascadero State Hospital.
When on his medication, he was fine.
But when he went off his meds, Freddy would have psychotic episodes which often forced the family to call 911 for help.
“My brother, we called police for him for help over 100 times in 7 years. Over 100 times. It’s on the record,” Centeno says.
Because of all those encounters, Roger says local police came to know Freddy and were helpful, friendly and would even stop Roger to ask how his brother was doing.
But that wasn’t a long-term fix for Freddy’s health issues.
Roger says his family begged the City of Fresno and the county for help but was told nothing could be done until quote ‘something bad’ happened, leaving them with no choice but to call the police when Freddy acted out.
“Like my mom says now. If we had would have known what would have happened to your brother. We would have never called police all those times. We would have just taken him to the hospital ourselves…but sometimes he was just so bad we had to call them,” Centeno says.
Something bad did happen last September.
Having gone off his medication, a shirtless Centeno approached a random house and claimed, according to police, to be an FBI agent. The woman inside called 911.
What happened next was captured on police body camera footage. The entire encounter lasted less than 10 seconds.
“Fresno PD. GET ON THE GROUND!” *gun shots*
Freddy was shot nine times. He survived for nearly a month before succumbing to his injuries.
Fresno police say that Centeno was holding a garden hose nozzle which has a similar shape to a pistol.
That fact does little to sooth of Roger Centeno who says the pain and anguish overwhelms his mother who blames herself for his death and wonders what could have been done to keep her son alive.
“My mom losing a son is like…it’s like…she cries every day. And for me to give her a little bit of comfort, I take her every other day, and I mean every other day, to the cemetery. She tells me ‘your brother wants to see me’ and I say ‘ok mom, let’s go’,” Centeno says.
This particular case ended with Freddy Centeno being shot by police. But that is just one small example of a person falling through the cracks of the Central Valley’s health care system.
Mental health treatment is a problem across the state. But in the San Joaquin Valley it is worse.
"But here is someone in a mental health crisis and they need help. If I had a heart attack, law enforcement would not be called," Christina Roup, Fresno NAMI
The Central Valley has less than half the number of mental health professionals per capita compared to the state average. It also higher rates of poverty and severe mental health illnesses.
And too often, law enforcement is being forced to be the first responders.
Dr. Brad Cloud, the Deputy Director of the Kern County Mental Health Department, agrees that the services are much too reactive instead of being proactive.
“And sometimes that leads up to these catastrophic events. And often, when you live with someone or you have known them a long time, you can see when they are a little bit off. Or you can see when they are starting to get worse,” Cloud says.
Cloud says it can be very difficult for individuals to access care and afford appropriate even with strong family support.
He is also critical of the ‘wait for something bad to happen’ approach that seems to be baked into the stressed health care system.
“Sort of ‘see I told you this was going to happen. Why couldn’t we have done anything to stop this?’. So you see that with the family,” Cloud says.
His county is one of few in the state to pursue a law that allows for families to have a relative enter court-mandated outpatient treatment to before ‘something bad’ occurs.
Advocates also say it is more common for people with mental health problems to be the target of violence. Adding physical injuries and compounding the other issues a person is dealing with.
"she cries every day. And for me to give her a little bit of comfort, I take her every other day, and I mean every other day, to the cemetery," Roger Centeno
Christina Roup with the Fresno Chapter of the National Alliance on Mental Illness says when that happens, even an otherwise healthy person can struggle to navigate or afford appropriate health care.
“To help them manage their wellness when faced with traumatic events such as domestic violence, assault, robbery, and some of the violent things they may be exposed to. If they can’t maintain and manage their mental health because they don’t have the resources for that, it may put them at risk for their own behaviors,” Roup says.
And when it comes to helping people in crisis, Roup says sending cops to respond is sometimes the worst option.
“But I know when I think, growing up, when I think law enforcement growing up I think someone has been bad. But here is someone in a mental health crisis and they need help. If I had a heart attack, law enforcement would not be called,” Roup says.
It is a complaint some in law enforcement have started to make. That officers are being asked to take on too many different tasks, from busting bad guys to diagnosing health conditions on the fly.
But it’s not that say that counties in the valley aren’t trying to reach vulnerable people.
In Kern, for example, the county spends about $1 million on the Mental Health Department. But total spending is nearly $160 million a year, when factoring in state and federal dollars that pass through the department.
That’s to serve a county of less than 1 million people.
Still, for communities in the Central Valley, access is hard.
People like Roger Centeno say those resources are not enough and that even now nothing has been made available to help him and his mother deal with their grief.
He wonders how much it would cost to provide more health care services that could help save more lives.
“Why do they give them so much red tape? And if someone feels like they need to be conserved for a few months, why wouldn’t they go with that? Instead of trying to get killed like my brother,” Centeno says.
Health care professionals are asking themselves that same question.
If we are already spending a handsome sum of money, how else can we better deploy our resources? And what about the impact to children? How do we prevent them from growing up to be the next Freddy Centeno?
We will examine these questions and more as our series continues.
This article was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.
