News Sexual Health

Kaiser Permanente: Dropping the Ball on Gay Men’s Sexual Health

Kenneth Katz

Kaiser Permanente makes it incredibly challenging for gay men to get the STD tests they need, hurdles that help fuel the spread of STIs in our community – including HIV. This is especially troubling at a time when new antibiotic-resistant strains of gonorrhea have emerged.

Researchers reported this past weekend that they have identified, in Japan, a strain of Neisseria gonorrhoeae – the bacterium that causes gonorrhea – that’s exceptionally resistant to all antibiotics typically used to treat it. The emergence of that resistant strain makes it all the more important that we do our best here in the United States in our fight against gonorrhea.

Unfortunately, one big challenge to our fight against gonorrhea in San Diego stems from how Kaiser Permanente, the large managed care organization that serves a whopping half a million members in San Diego alone, approaches testing of sexually transmitted infections (STIs) for gay men.

Imagine if Kaiser offered simple and potentially lifesaving laboratory tests – think Pap smears, for example, or cholesterol checks – only to patients who specifically asked for them, and who were willing to make a separate visit to a special clinic to get them.

There would be an uproar.

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But tragically, that’s exactly how Kaiser approaches STD testing for gay men in San Diego. Kaiser makes it incredibly challenging for gay men to get the STD tests they need. Those hurdles help fuel the spread of STIs in our community – including HIV, which is more likely to be transmitted or acquired when STIs are present.

There should be an uproar.

I know this firsthand. Until recently I was a Kaiser member. In April I emailed my Kaiser doctor, requesting HIV and STD tests. My sex partners are men, I wrote, and I had no symptoms. But HIV and many STIs can show no symptoms, and rates of HIV and STIs are higher among gay men. For those reasons, public health agencies – including the Centers for Disease Control and Prevention (CDC), the California Department of Public Health, and the County of San Diego – recommend that sexually active gay men get tested for HIV (if their last test was negative) and certain STIs  at least every year.

In my email, I referenced CDC’s guidelines. In addition to an HIV test, I requested a blood test for syphilis and tests for gonorrhea and chlamydia of the urethra (penis), throat, and rectum.[1] Urethral tests can be done on urine; throat and rectal tests can be done on specimens collected from swabbing those areas.

By the way, those guidelines for gay men are not new. CDC has recommended all of the tests I mentioned since 2002. Moreover, since 2006 CDC has recommended using a very sensitive type of test, called a nucleic acid amplification test (or NAAT, pronounced “gnat”), for chlamydia. And since December 2010 CDC has, for the same reason, also recommended NAATs for gonorrhea.[2]

In her response, my doctor said she could order HIV and syphilis tests and a NAAT for urethral gonorrhea and chlamydia. But for gonorrhea of the throat, she could order only a (less accurate) culture test, not a NAAT. That’s because, she said, Kaiser’s lab in San Diego cannot perform NAAT tests on throat specimens. And she could not order any tests at all for rectal gonorrhea or chlamydia. The computer system, she said, does not include “rectum” as a option.

Well, I took what I could get, and I got the tests she offered.

And then I formally complained to Kaiser. “Why is Kaiser Permanente, in 2011, still not able to meet my health needs as a gay man?” I wrote, after explaining what had happened. “And what remedies does Kaiser propose to rectify its inability to do so?”

Kaiser responded in May. NAAT tests of the throat and rectum, Kaiser wrote, are available – if the specimens are sent to a non-Kaiser laboratory, run by a company called Quest. That’s fine with me; I don’t care which laboratory does the test. I do care, however, whether my doctor knows that she can send specimens to that other laboratory. She clearly did not. And her colleagues likely don’t either; that would explain why the nurse who swabbed my throat told me she’d never before seen a doctor’s order for a throat swab for gonorrhea.

Then came the most concerning part of Kaiser’s response:

“You can contact the Kaiser Permanente San Diego Medical Center Infectious Disease Department if you wish to for [sic] these tests to be performed and sent to Quest; specimens will be obtained at any infectious disease clinic.”

In other words: Yes, I can get the tests I need. Presumably other gay Kaiser members can, too. But only if we know to ask specifically for them, and if we make separate visits to a special Kaiser clinic. How many of us will jump through those hoops? Practically speaking, most of us won’t. That means STIs will go undiagnosed and untreated, leading to further spread of STIs, including HIV, in our community.

That’s a travesty.

Kaiser needs to change its approach to STD testing for gay men in San Diego. It should do the following:

  • Offer gay members all of the recommended types of STD tests, at all recommended anatomic sites, during routine primary care visits. It’s not that difficult. Clinics in Kaiser’s Northern California region have been doing it for years already. So have the County of San Diego’s STD clinics.
  • Ensure that Kaiser clinicians take complete sexual histories, know which STD tests to order and how to order them, and are trained to obtain swab specimens.
  • Educate gay Kaiser members about the importance of routine STD and HIV testing. The part of Kaiser’s website that focuses on STD testing, for example, recommends routine syphilis testing for men who have sex with men, but it doesn’t mention routine chlamydia or gonorrhea testing. Kaiser should change its website to reflect current public health recommendations.

At the same time, we as a community need to make sure our doctors, including those at Kaiser, meet our health needs, by doing the following:

  • Knowing which tests we need, and how often we need them. That information can be found in this explanation of HIV and STD testing for gay men and in this handy guide, which can be taken when seeing a doctor.
  • Complaining to our doctors, health insurance plans, and employer benefit programs if we don’t get what we need. To complain to Kaiser, call 1-800-464-4000 or use Kaiser’s website.

Kaiser has already demonstrated that it can take some aspects of LGBT health seriously, with many of its medical centers (including its San Diego facility) scoring well on the Human Rights Campaign’s recent evaluation of hospital policies regarding LGBT patients and staff.

It’s not enough. For the sake of our health and the health of our community, Kaiser needs to change its approach to STD testing for gay men in San Diego. And so, for that matter, do other doctors and managed care organizations in San Diego and elsewhere that don’t meet national, state, and local standards.

As public health challenges posed by resistant gonorrhea, other STIs, and HIV continue and intensify,  let the uproar in San Diego begin.

[1] Strictly speaking, CDC and the California Department of Public Health do not recommend pharyngeal tests for chlamydia – only for gonorrhea. However, NAATs commonly test simultaneously for chlamydia as well as gonorrhea. In practice, both tests are often performed by laboratories using NAATs to test pharyngeal specimens.

[2] Although NAAT tests have not been FDA-approved for testing specimens from the throat or rectum, many laboratories – including those at the County of San Diego and at Kaiser Permanente Northern California – have performed simple verification tests that, once completed, enable use of NAATs for testing  throat and rectal specimens.

Commentary Violence

This is Not The Story I Wanted—But It’s My Story of Rape

Dani Kelley

Writer Dani Kelley thought she had shed the patriarchal and self-denying lessons of her conservative religious childhood. But those teachings blocked her from initially admitting that an encounter with a man she met online was not a "date" that proved her sexual liberation, but an extended sexual assault.

Content note: This article contains graphic descriptions of sexual violence.

The night I first truly realized something was wrong was supposed to be a good night.

A visiting friend and I were in pajamas, eating breakfast food at 10 p.m., wrapped in blankets while swapping stories of recent struggles and laughs.

There I was, animatedly telling her about my recently acquired (and discarded) “fuck buddy,” when suddenly the story caught in my throat.

When I finally managed to choke out the words, they weren’t what I expected to say. “He—he held me down—until, until I couldn’t—breathe.”

Hearing myself say it out loud was a gut-punch. I was sobbing, gasping for breath, arms wrapped as if to hold myself together, spiraling into a terrifying realization.

This isn’t the story I wanted.

Unlearning My Training

I grew up in the Plymouth Brethren movement, a small fundamentalist Christian denomination that justifies strict gender roles through a literal approach to the Bible. So, according to 1 Corinthians 11:7, men are considered “the image and glory of God,” while women are merely “the glory of man.” As a result, women are expected to wear head coverings during any church service, among other restrictions that can be best summed up by the apostle Paul in 1 Timothy 2:11-12: Women are never allowed to have authority over men.

If you’ve spent any number of years in conservative Christianity like I did, you’re likely familiar with the fundamentalist tendency to demonize that which is morally neutral or positive (like premarital sex or civil rights) while sugar-coating negative experiences. The sugar-coating can be twofold: Biblical principles are often used to shame or gaslight abuse victims (like those being shunned or controlled or beaten by their husbands) while platitudes are often employed to help members cope with “the sufferings of this present time,” assuring them that these tragedies are “not worthy to be compared with the glory that is to be revealed to us.”

In many ways, it’s easy to unlearn the demonization of humanity as you gain actual real-world experience refuting such flimsy claims. But the shame? That can be more difficult to shake.

The heart of those teachings isn’t only present in this admittedly small sect of Christianity. Rather, right-wing Western Christianity as a whole has a consent problem. It explicitly teaches its adherents they don’t belong to themselves at all. They belong to God (and if they’re not men, they belong to their fathers or husbands as well). This instilled lack of agency effectively erases bodily autonomy while preventing the development of healthy emotional and physical boundaries.

On top of that, the biblical literalism frequently required by conservative Christianity in the United States promotes a terrifying interpretation of Scripture, such as Jeremiah 17:9. The King James Version gives the verse a stern voice, telling us that “the heart is deceitful above all things and desperately wicked.” If we believe this, we must accept that we’re untrustworthy witnesses to our own lives. Yet somehow, we’re expected to rely on the authority of those the Bible deems worthy. People like all Christians, older people, and men.

Though I’ve abandoned Christianity and embraced feminist secular humanism, the culture in which I grew up and my short time at conservative Bob Jones University still affect how I view myself and act in social situations. The lessons of my formative years created a perfect storm of terrible indoctrination: gender roles that promoted repressed individuality for women while encouraging toxic masculinity, explicit teaching that led to constant second-guessing my ability to accurately understand my own life, and a biblical impetus to “rejoice in my suffering.”

Decades of training taught me I’m not allowed to set boundaries.

But Some Habits Die Hard

Here’s the thing. At almost 30, I’d never dated anyone other than my ex-husband. So I thought it was about time to change that.

When I found this man’s online profile, I was pleasantly surprised. It was full of the kind of geekery I’m into, even down to the specific affinity for eclectic music. I wrote to him, making sure my message and tone were casual. He responded instantly, full of charisma and charm. Within hours, we’d made plans to meet.

He was just as friendly and attentive in person. After wandering around town, window-shopping, and getting to know one another, he suggested we go to his favorite bar. As he drank (while I sipped water), he kept paying me compliments, slowly breaking the touch barrier. And honestly, I was enthralled—no one had paid attention to me like this in years.

When he suggested moving out to the car where we could be a little more intimate, I agreed. The rush of feeling desired was intoxicating. He seemed so focused on consent—asking permission before doing anything. Plus, he was quite straightforward about what he wanted, which I found exciting.

So…I brought him home.

This new and exciting “arrangement” lasted one week, during which we had very satisfying, attachment-free sex several times and after which we parted ways as friends.

That’s the story I told people. That’s the story I thought I believed. I’d been freed from the rigid expectations and restraints of my youth’s purity culture.

Now. You’re about to hear me say many things I know to be wrong. Many feminists or victim advocates almost certainly know the rationalizations and reactions I’m about to describe are both normal responses to abuse and a result of ingrained lies about sex in our culture. Not to mention evidence of the influence that right-wing conservatism can have on shaping self-actualization.

As I was telling people the story above, I left out important details. Were my omissions deliberate? An instinctive self-preservation mechanism? A carryover from draconian ideals about promiscuity?

When I broke down crying with my friend, I finally realized I’d kept quiet because I couldn’t bear to hear myself say what happened.

I’m a feminist, damn it. I left all the puritanical understandings of gender roles behind when I exited Christianity! I even write about social justice and victim advocacy. I ought to recognize rape culture!

Right?

If only being a socially aware feminist was enough to erase decades of socialization as a woman within rape culture—or provide inoculation against sexual violence.

That first night, once we got to my car, he stopped checking in with me. I dismissed the red flag as soon as I noticed it, telling myself he’d stop if I showed discomfort. Then he smacked my ass—hard. I pulled away, staring at him in shocked revulsion. “Sorry,” he replied, smirking.

He suggested that we go back to my house, saying we’d have more privacy than at his place. I was uneasy, unconvinced. But he began passionately kissing, groping, petting, and pleading. Against my better judgment, I relented.

Yet, in the seclusion of my home, there was no more asking. There was only telling.

Before I knew it, I’d been thrown on my back as he pulled off my clothes. I froze. The only coherent thought I could manage was a weak stammer, asking if he had a condom. He seemed agitated. “Are you on birth control?” That’s not the point! I thought, mechanically answering “yes.”

With a triumphant grin and no further discussion, he forced himself into me. Pleasure fought with growing panic as something within me screamed for things to slow down, to just stop. The sensation was familiar: identical to how I felt when raped as a child.

I frantically pushed him off and rolled away, hyperventilating. I muttered repeatedly, “I need a minute. Just give me a minute. I need a minute.”

“We’re not finished yet!” he snapped angrily. As he reached for me again, I screeched hysterically, “I’M NOT OK! I NEED A MINUTE!”

Suddenly, he was kind and caring. Instead of being alarmed, I was strangely grateful. So once I calmed down, I fucked him. More than once.

It was—I told myself—consensual. After all, he comforted me during a flashback. Didn’t I owe him that much?

Yet, if I didn’t do what he wanted, he’d forcefully smack my ass. If I didn’t seem happy enough, he’d insistently tell me to smile as he hit me again, harder. He seemed to relish the strained smile I would force on command.

I kept telling myself I was okay. Happy, even. Look at how liberated I was!

All week, I was either at his beck and call or fighting suicidal urges. Never having liked alcohol before, I started drinking heavily. I did all I could to minimize or ignore the abuse. Even with his last visit—as I fought to breathe while he forcefully held my head down during oral sex, effectively choking me—I initially told myself desperately that surely he wouldn’t do any of this on purpose.

The Stories We Tell and The Stories That Just Are

Reflecting on that week, I’m engulfed in shame. I’m a proud feminist. I know what coercion looks like. I know what rape looks like. I know it’s rarely a scary man wearing a ski mask in a back alley. I’ve heard all the victim-blaming rape apologia you have: that women make up rape when they regret consenting to sex, or going on a date means sex is in the cards, or bringing someone home means you’re game for anything.

Reality is, all of us have been socialized within a patriarchal system that clouds our experiences and ability to classify them. We’re told to tend and befriend the men who threaten us. De-escalation at any cost is the go-to response of almost any woman I’ve ever talked to about unwanted male attention. Whatever will satiate the beast and keep us safe.

On top of that, my conservative background whispered accusations of being a Jezebel, failing to safeguard my purity, and getting exactly what I deserve for forsaking the faith.

It’s all lies, of course. Our culture lies when it says that there are blurred lines when it comes to consent. It violates our personhood when it requires us to change the narrative of the violence enacted against us for their own comfort. Right-wing Christianity lies when it says we don’t belong to ourselves and must submit to the authority of a religion or a gender.

Nobody’s assaulted because they weren’t nice enough or because they “failed” to de-escalate. There’s nothing we can do to provoke such violence. Rape is never deserved. The responsibility for sexual assault lies entirely with those who attack us.

So why was the story I told during and after that ordeal so radically and fundamentally different from what actually happened? And why the hell did I think any of what happened was OK?

Rape myths are so ingrained in our cultural understanding of relationships that it was easier for me to believe nothing bad had happened than to accept the truth. I thought if I could only tell the story I wanted it to be, then maybe that’s what really happened. I thought if I was willing—if I kept having him over, if I did what he ordered, if I told my friends how wonderful it was—it would mean everything was fine. It would mean I wasn’t suffering from post-traumatic stress or anxiety about defying the conservative tenets of my former political and religious system.

Sometimes, we tell ourselves the stories we want to hear until we’re able to bear the stories of what actually happened.

We all have a right to say who has what kind of access to our bodies. A man’s masculinity gives him no authority over anyone’s sexual agency. A lack of a “no” doesn’t mean a “yes.” Coercion isn’t consent. Sexual acts performed without consent are assault. We have a right to tell our stories—our real stories.

So, while this isn’t the story I wanted, it’s the story that is.

I was raped.

Analysis Human Rights

Erika Rocha’s Suicide Brings Attention to the Dire Need for Mental Health Care in Prison

Victoria Law

Erika Rocha's was the first suicide of the year at Corona's California Institution for Women (CIW), which is currently at 130 percent capacity. CIW's suicide rate, however, is more than eight times the national rate for women behind bars.

On April 14, 2016, one day before her parole hearing, Erika Rocha committed suicide. The 35-year-old had spent 21 years behind bars. But what should have been a day of hope for Rocha, her family, and her friends instead became a day of mourning.

Rocha’s was the first suicide of the year to rock Corona’s California Institution for Women (CIW), which is currently at 130 percent capacity. CIW’s suicide rate, however, is more than eight times the national rate for women behind bars. The prison had four suicides and 16 attempts in 2014. In 2015, it had two suicides and 35 attempts. And in the first two months of 2016, CIW had four additional suicide attempts.

These numbers, advocates say, display the consequences of the lack of mental health resources for women in prison, some of whom have been behind bars for decades.

The need for comprehensive mental health care has long plagued California prisons. In 1990, advocates filed Coleman vs. Wilson, a class-action civil rights lawsuit alleging unconstitutional medical care by the California Department of Corrections and Rehabilitation (CDCR). In 1995, a U.S. District Court ruled in Coleman that mental health-care access in the state prisons violated the Eighth Amendment prohibition against cruel and unusual punishment; the following year, it appointed a special master to review California’s prisons and to monitor mental health care. That special master is still monitoring CDCR’s mental health care.

In 2013, Lindsay Hayes, a suicide prevention expert, audited all of the state’s prisons for their suicide prevention plans. In 2015, he re-audited 18 of those prisons. In the report he released in January 2016, he noted that, while some prisons had made progress on the issue, “CIW continued to be a problematic institution that exhibited numerous poor practices in the area of suicide prevention.” These poor practices, Hayes wrote, included low completion of suicide risk evaluations, inadequate treatment planning, low compliance rates for annual suicide prevention training, and multiple suicides during the calendar year.

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“This Seemed To Be the Only Way”

No one will ever know what pushed Rocha over the edge. But others at CIW say that those who need mental health treatment there, both before and after their suicides, face a lack of preventive treatment, including counseling, and almost no follow-up.

Amber, who asked to be referred to by a pseudonym, noted that the prison lacks available mental health programming. She had already spent 14 years at another prison when she was transferred to CIW. There, she found that nearly every self-help and support group had a long waiting list.

In addition, mental health treatment was sparse. “I would only see mental health [staff] every 90 days, and that was only about five minutes,” she recalled in an interview with Rewire. “As time went on and I became more and more frustrated by the lack of anything to take my mind off my emptiness, I got more lonely and hopeless.” She stopped talking to her friends, stopped eating, lost interest in her appearance, and began losing weight. No one noticed these red flags. She told mental health staff that she wanted to stop taking medication. No one, she said, questioned her decision.

In July 2014, Amber and her friend Mindy (also a pseudonym) decided to end their lives together. Once they made their decision, Amber remembered feeling a sense of relief: “I was happy. I knew my misery and pain were ending. … This seemed to be the only way.” The two slit their throats, losing consciousness. But someone found them, alerted staff and they were transported to the hospital. How they were treated next, they said, didn’t make them feel any more hopeful about life.

After being released from the hospital, both women were placed in a mental health crisis bed, commonly referred to as “suicide watch” among people in prison. Amber described suicide watch as a place “where they strip you naked and put a hard gown on you, basically a life jacket. They give you a blanket made of the same material and have a bright light on with a nurse watching and recording [on paper] your every move. … You are not allowed anything for the first week. Then you can ‘earn’ a book. And maybe a muumuu gown if you are calm and cooperative. You aren’t even allowed a roll of toilet paper. When you need to use the toilet [in your cell], they hand you a tiny bit and watch you use it.”

Mindy spent 11 days in suicide watch; Amber was there for two weeks. Both were then placed in the prison’s specialty care unit, where they were able to have human interactions and access to group programming, which Amber described as 14 hours a week of coloring, watching movies, singing karaoke, and walking.

However, suicide watch is frequently full. In those cases, people are placed in an “overflow unit” in the prison’s Security Housing Unit (SHU), an isolation unit where people are locked in their cells for 23 to 24 hours each day. This kind of isolation can cause myriad mental health issues, including anxiety, panic, depression, agoraphobia, paranoia, aggression, and even neurological damage.

Krista Stone-Manista is an attorney with San Francisco-based Rosen Bien Galvan & Grunfeld, which co-litigated the Coleman case. She is also part of the team now monitoring compliance. She notes that, when a person reports feeling suicidal, she is supposed to be moved to a mental health crisis bed. But, because there aren’t enough mental health crisis beds, California prisons utilize what’s known as “alternative housing,” which might include isolation until a bed opens up. “What we’re seeing is that people are repudiating their suicidal ideation to get out of alternative housing,” she told Rewire. That means that they don’t receive counseling or any other type of mental health treatment.

But even when they are placed on suicide watch, the special master, in his 2015 review of CIW, found that “patients were discharged from the mental health crisis bed as soon as they reported they were no longer suicidal, with little effort to determine the underlying causes of their initial reports of suicidality.”

People incarcerated at CIW report that its environment has not improved in the two years since Amber and Mindy attempted to take their lives. In March 2015, Stephanie Feliz hung herself. Mindy, who was in the mental health unit at the time, said that Feliz walked in and requested services for a mental health crisis. Despite having a history of suicide attempts and self-mutilation, Mindy said staff told her that she had already been seen the day before. According to Mindy, Felix returned to her cell, where she was found dead two hours later. This treatment is not unusual, Mindy noted, writing to Rewire in a letter that she too has requested mental health services only to encounter delays and, at times, outright dismissal.

But no matter what changes the institution makes, Stone-Manista pointed out, “There’s only so much CIW can do for someone who is chronically suicidal. They’re not a hospital.”

CDCR did not respond to queries about the numbers of suicides and suicide attempts at CIW or about its suicide prevention practices.

Rocha’s Years in Prison

When Rocha was 14 years old, she and several older teens were arrested for an accidental shooting. Rocha was charged as an adult and, without a parent or guardian present, questioned by police and, according to advocates, pressured to plead guilty by the prosecutor. She did and was sentenced to 19 years to life. Rocha was initially sent to a juvenile prison, where she spent two years. At age 16, she was transferred to the adult Valley State Prison in Chowchilla. There, prison officials placed her in solitary, ostensibly for her own protection due to her age. She stayed in isolation for one year.

Windy Click is now program coordinator for the advocacy group California Coalition for Women Prisoners (CCWP). She was imprisoned at Valley State when Rocha arrived and met the girl shortly after she had turned 19. Rocha was looking for something positive to do and asked how to get to the prison library. While Click, then in her 30s, and Rocha never became close friends, each time Rocha was released from solitary, she sought the older woman out.

“She was a funny girl,” Click recalled in an interview with Rewire. “She liked to joke and be light-hearted.” One of the topics that Rocha frequently joked about was growing old in prison. “She’d say she would be an old lady in prison.”

Other times, however, the girl had a hard time coping with prison. “She would be very shaky, trembling almost,” Click recalled. “‘I can’t do this no more,’ she’d tell me.” During those times, Click said, Rocha would tell prison staff that she was afraid for her life and request to be placed in administrative segregation, a form of isolation commonly known as ad-seg, where she would be locked in a cell for 23 to 24 hours each day. Prison staff obliged and Rocha would be placed in isolation. When she returned to general population, Click remembered that the girl would seem better but “after a day or so, she’d be back to that shakiness.”

Click recalled one conversation in which she told Rocha, “This place isn’t the last place you’ll ever be.” But, she remembered, the younger woman couldn’t see the light at the end of the tunnel.

It didn’t help that Rocha spent more than a decade without seeing her family, who lived nearly 300 miles in the Los Angeles area. Lacking a car, they could not make the trek to Central Valley. It was not until Rocha was moved to CIW, 15 minutes from their home, that they could visit. By then, Rocha’s father had died; her stepmother Linda Reza brought her three daughters as soon as Rocha was allowed to receive visits.

“She was still the same little kid that left us,” Reza remembered of that first visit in an interview with Rewire.

That was how Geraldine, Rocha’s half-sister, saw it as well: “She’s nine years older than me. But it was like I was the big sister.”

Rocha got along best with her teenage sister Freida, who was born after her incarceration and whom she met for the first time in the CIW visiting room. When the family visited, Reza remembered that Rocha and Freida would head to the visiting room’s play area and play on the swings. Reza recalled that, when Rocha received news of her upcoming hearing, she and Freida made plans to share a room at Reza’s house, clipping magazine pictures and envisioning how to decorate the room.

Colby Lenz, a volunteer legal advocate with CCWP, saw a different, more vulnerable side, one that Rocha did her best to keep from her family. “She was the most fragile and traumatized person I had ever met in prison,” Lenz recalled about their first meeting less than two years ago. It was only partway through the legal visit that Rocha began to open up. “She went back to [age] 14 or 15 and talked about her early years—how much time she had done in solitary, how they treated her.”

Under California’s SB 260, which passed in 2013 and went into effect in January 2014, Rocha became eligible for a youth parole hearing for youth sentenced as adults to long prison sentences. As part of the hearing process, she was given a psychiatric evaluation. But, said Lenz, no one explained to her why she was undergoing a psychiatric evaluation. The process brought her back to the police interrogations she had gone through at age 14 without a parent or guardian present. Frightened and retraumatized, Rocha not only waived her hearing, but also attempted to take her own life.

In 2015, Rocha learned she was scheduled for another youth parole hearing on April 15, 2016. In the weeks before, Reza recalled that Rocha was excited. The last time she called, Reza wasn’t able to answer her phone. The message Rocha left was hopeful. “Tell my sisters I know they’re going to kick my ass when I get home,” she said. “But that’s okay, I’ll take it.”

“In a Hopeless Place, Most Don’t Make It”

Since Rocha’s death, CCWP has reported that at least 22 people in CIW have been placed on suicide watch for attempting suicide or stating that they felt suicidal.

Mariposa, who asked to go by her stage name, is one of those 22 placed on suicide watch. She is the co-author of the one-woman play Mariposa and the Saint about her own time in solitary. She was also Rocha’s cellmate and fiancée. After Rocha was found hanging in their shared cell, Mariposa was immediately placed in suicide watch, where she was not allowed regular visits, phone calls, or mail. She was, however, allowed a legal visit with CCWP, but, advocates told Rewire, kept in a treatment cage the entire time.

Those inside the prison report that the lack of programs and activities contributes to the feeling of hopelessness. “People have way too much time to think and be in their heads,” wrote another woman at CIW to Rewire one month before Rocha’s death. “A lot of us are only hanging on by hope alone. In a hopeless place, most don’t make it.”

Krista Stone-Manista noted that CDCR is working on new policies and procedures to move people who need more care or longer-term care to inpatient care rather than keeping them inside the prisons, which are often inadequately staffed with mental health professionals. She also pointed to CDCR’s reduction of the use of solitary confinement, noting that studies have shown the damage to mental health and that suicides and suicide attempts often occur in segregation. In addition, she says, CDCR is working on how to respond to reports of suicidal thoughts before they become attempts or actual suicides.

All of these efforts are too late for Rocha. “When I get out, I want you to take me to the park,” Reza remembered her stepdaughter telling her and her sisters during one visit. “I want to play on the swings and the slide and run in the grass.”

Reza plans to honor that wish. “After her cremation, we’re going to have a reception in the park,” she said. “We’re going to put her on the swings.”