Most people who complete a prison sentence are free to walk out the gates with $200 and a new shot at life.
But there are inmates deemed so dangerous they can be kept in custody long after their sentence is up — even indefinitely.
In a rare proceeding this week, a Monterey County jury decided that one such man must wait another year to try for freedom.
Inmates such as Ecclesiastes Presley are known as mentally disordered offenders, and they exemplify the challenges that arise when counties turn to prisons to deal with the severely mentally ill.
Presley, 31, sentenced for assault, is an "MDO" from Monterey County who asked to be released from a state hospital this year. His psychiatrist testified in court on Thursday that he is still too much of a danger, and Monday a jury agreed, committing him to one more year at Metropolitan State Hospital near Los Angeles.
Chief Assistant District Attorney Terry Spitz said Monterey County follows about 10 to 11 people designated as MDOs by the state corrections department. But few of the cases ever result in a jury trial like Presley's.
"They are very rare," Spitz said. "This was probably the first one in years."
Often, he said, state officials and the local court reach an informal consensus about treatment plans for the patient.
Trials such as Presley's are civil, not criminal proceedings, said prosecutor Deborah Gullett, though they "originate out of criminal convictions.
To qualify for the designation, a prisoner has to have a severe mental disorder that contributed to their crime and won't go into remission without treatment. The prisoner must present a "substantial danger of physical harm to others."
Presley, like all MDOs, was initially given the designation by the state's parole board. According to testimony at his hearing last week, he has been "in the system" since 1996, but didn't receive mental health treatment until 2002.
Dr. Jeouhsing Lai said Presley suffers from paranoid schizophrenia that is now in "partial remission." He has limited intellectual functions, Lai said, and a second-grade reading level.
"Some psychotic symptoms are still there," Lai said, and Presley has at times heard "ungodly voices."
According to testimony, Presley has a long history of assaults on family members, police and correctional officers. In prison and jails, he has refused to eat, claiming officers were poisoning his food.
Presley is aware of his illness, Lai said, and a few years ago voluntarily agreed to continue treatment in a state hospital.
Last year he asked for a trial before a Monterey County judge — without a jury — and was re-committed.
This year, he went for a jury trial and was again found unfit for release.
Officials say that when an MDO is found fit for release, he is referred to a supervised treatment program that can be revoked if doctors later decide there is a danger.
In contrast to inmates designated sexually violent predators, state corrections and mental health officials don't try to keep MDOs like Presley locked away for life.
"The goal is to get him to a conditional release program," Lai said.
Lai said Presley has done much better in the past year, but has a history of refusing to take medications.
Because California counties have long depended on state prisons to provide mental health treatment for criminal offenders, concerns were raised when state prisoner realignment went into effect in 2011.
The California Mental Health Directors Association expressed some of those concerns in a draft memo distributed before the law went into effect in October 2011, saying counties "do not have the leverage to safely and effectively treat" MDOs.
Spitz said prosecutors worry because under realignment, non-violent, non-serious and non-sexual crimes can result in jail terms but not prison.
"Realignment did not account for (the MDO) system," Spitz said.
Now Spitz and San Luis Obispo County prosecutor Lee Cunningham have written proposed legislation to allow courts more discretion.
Under the proposal, a judge who thinks an offender might qualify as an MDO can send the defendant to prison even if the offense is a "triple non." If the state prison staff determines the prisoner doesn't qualify as an MDO, the prisoner can be sent back to the county.
Spitz acknowledged it's a complicated way to ensure state mental health care for offenders, but said counties need to have that option.
"If a judge has concerns that the defendant is a mentally disordered offender ... for a handful of cases, it reverses realignment," he said.
With minimal mental health services in county jails, some feel a prison referral to a state hospital may be the only practical option.
Jeff Budd, retired Monterey County jail chief, has repeatedly said the jail isn't set up to treat inmates with severe mental illness.
As if to drive home the point, Judge Mark Hood on Tuesday asked for yet another mental health evaluation of inmate Christopher Sorenson, who apparently tried to commit suicide by leaping from a Monterey County Jail tier last month.
Sorenson is accused of killing his mother in December 2011, shortly after two civil trial juries failed to find him suitable for involuntary commitment to a state mental hospital.
Presley also has a troubling history in the jail.
Lai testified that when Presley awaited hearings in Monterey County, he deteriorated quickly.
In March, he went off his medication because jail staff members are not allowed to forcefully medicate inmates.
"He lost 14 pounds in two weeks" after stopping medication and refusing to eat, Lai said.
County jails often don't stock the right drugs to treat the severely mentally ill, Lai said, "or the jail may even run out. ... This is a problem."
With such deficiencies in counties around the state, prisons and state hospitals have more and more become the option of choice for the mentally ill, often long after their sentences have been served.
"They're not being punished," prosecutor Gullett said of MDOs like Presley. "It's really a matter of whether they are deemed a substantial danger to others in the community. We deal with treatment."
Julia Reynolds can be reached at 648-1187 or email@example.com.