Where do we go from here? Some people look at the Michael Watkins case and see the "criminalizing of homelessness." Others see a habitual sex offender. His own grandmother sees a failed system that can't seem to find an answer.
"They're overloaded with people like him. They don't know what to do," said Dixie Holt, Watkins' grandmother of El Sobrante.
Look at this in dollars and cents: Watkins has cost Alameda County taxpayers hundreds of thousands of dollars. Look at it through the lens of the people exposed to his shocking behavior. You can look at it as a human tragedy — a man in his 30s whose life began in chaos and clearly hasn't gotten any better.
Watkins' paper trail includes arrests, convictions, stay-away orders, jail time, probation, and more. And nobody can say where it ends.
Few would argue that we want a world where open public masturbation is considered okay. Many would say someone like Watkins needs a different approach.
"When we are looking at behavior that has been classified as a crime, like this, I think that it would be more appropriate for society to treat that as a mental health problem, said Alameda County Deputy Public Defender Jeff Chorney.
In fact, Alameda County District Attorney Nancy O'Malley does see a sex offender who needs help.
"When he's convicted, he should be ordered to be evaluated and, through that evaluation, it'll give us a better sense of what kind of treatment he should be ordered to participate in," said O'Malley.
That's up to the courts, but as O'Malley pointed out, "To my knowledge, he has not been evaluated by a sex offender treatment provider."
Mental illness clearly is a component in many criminal cases. San Francisco's been running a Behavioral Health Court for nearly 20 years, trying to divert defendants into treatment.
The idea is to treat the underlying mental illness so people can move forward. The Behavioral Health Court claims 75% of those who complete the program avoid arrest over the next two years.
But another number stands out: the program only graduates a couple of dozen people a year.
Plenty's been said and written about the new state law that lets cities like San Francisco become legal guardians of people with mental health and substance-abuse issues. It's controversial. And it's also clearly not the answer for people like Michael Watkins.
"People who are sleeping in their own excrement, people who are running out in the middle of the street, screaming at cars," said State Senator Scott Wiener, who authored the legislation allowing a limited trial of the conservatorship approach.
Across America, the argument is being made that arresting and locking people up is the wrong way to go.
San Francisco's newly-elected District Attorney Chesa Boudin comes from that camp as a former public defender who promises change.
"Jails and prisons cannot be utilized as a solution to all of our problems," Boudin told KCBS Radio following his election. "We must think differently. We will think differently."
But how does philosophy translate into action when it comes to a specific man and his behavior? It's not as if the system is unaware of Michael Watkins.
The woman whose attorneys keep prosecuting him wonders if a roof over his head might help.
"If a person is unhoused and they have issues, legal issues as well, would it change if we could get them housed and get them stabilized?," wondered O'Malley.
Nobody would disagree with this statement: Michael Watkins needs a lot of help. It's pretty clear he's not getting it from the systems that by now, know him well.