LOS ANGELES – The Los Angeles County Board of Supervisors voted Tuesday to launch a pilot program that aims to get homeless people gravely disabled by mental illness into treatment, even involuntarily, if necessary to save their lives.
Supervisors Kathryn Barger and Mark Ridley-Thomas co-authored a motion to have Homeless Outreach and Mobile Engagement (HOME) teams provide critical treatment interventions for people experiencing homelessness and struggling with mental illness. [View the motion here.]
HOME teams include mental health psychiatrists, mental health counselors, psychiatric nurses, psychiatric social workers, substance abuse counselors, medical caseworkers and peers, who make mental health evaluations on the street and offer voluntary crisis intervention services along with access to resources like housing.
If necessary, the team can also place individuals who are in imminent danger or considered gravely disabled on a 72-hour hold for involuntary evaluation and treatment.
Under the pilot program, the teams will be able to seek a court-ordered conservatorship for someone who is not in imminent danger but is gravely disabled and refusing voluntary mental health services.
“This is another important tool in our ongoing effort to serve those suffering with mental health issues who fall into chronic homelessness,” Barger said. “We remain dedicated to address the needs of these vulnerable individuals and must work together to find new solutions that improve and enhance the treatment options we provide for people experiencing homelessness.”
Barger has fought to change California’s legal definition of gravely disabled in order to prevent people unable to care for themselves from dying on the street. That has proven difficult, and opponents of changes say individuals have the civil right to refuse medication or other treatment.
“Gravely disabled” means that someone cannot provide for their own basic needs, including food, clothing and shelter, due to a mental disorder. The standard can be difficult to meet in practice and different municipalities treat the standard differently.
The Department of Mental Health developed the pilot program to help people suffering with severe mental illness who cycle repeatedly through county jails and hospitals and in and out of homelessness. Dr. Jonathan Sherin, who heads the department, underscored the need for more dramatic interventions.
“Our department’s countywide, multidisciplinary HOME teams interact on a daily basis with individuals whose lives have been shattered by serious mental illness,” Sherin said. “These clients are unable to make good decisions about their care. It is unjust and inhumane to allow our clients to be exposed to the streets or jails when help is available. This pilot program would provide our HOME teams additional engagement tools, including ‘outpatient conservatorship’ to ensure a client receives treatment, without having to rely on hospitalization.”
Under a conservatorship, a court can appoint someone to care for an individual who cannot care for themselves and the court can mandate treatment. If DMH recommends a conservatorship, the department will also provide appropriate housing or a mental health bed and a dedicated treatment team for the person.
Nearly 1,000 homeless people died on the streets last year, a count that is likely to increase this year with the spread of COVID-19. Looking back at deaths in 2017, the Department of Mental Health found that a significant number of deaths were due to preventable or treatable medical conditions.
Ridley-Thomas said the need for the pilot program was urgent.
“Even before the pandemic, three of our homeless neighbors were dying on the streets every day. It is all the more urgent that we intervene humanely to prevent people from passively decaying on the streets as a result of severe and untreated mental illness,” Ridley-Thomas said.
“[The] motion will allow the county’s Department of Mental Health to immediately deploy their Homeless Outreach Mobile Engagement teams to pilot street-based treatment and clinical oversight to help our most vulnerable residents get on the path to recovery.”