Mental health-related disability and homelessness in Los Angeles
What is it about?
The authors describe a pilot program for gravely disabled individuals experiencing unsheltered homelessness in Los Angeles County that illustrates a promising public health framework to address mental health–related disability in homeless populations. Homeless outreach teams implementing the outpatient conservatorship (OPC) pilot adopted a population health approach, multisystem care coordination, and prioritization of the least restrictive environments. The pilot allowed initiation of the Lanterman-Petris-Short Act (LPS) conservatorship outside of a hospital, with the goal of serving highly vulnerable individuals in the least restrictive settings. Methods: Between August 2020 and July 2021, the OPC pilot program served 43 clients, corresponding to 2% of those served by the outreach teams during that period. Using observational program evaluation data, the authors describe the impact of the program on this sample of participants. Results: At 12 months, 81% of OPC clients were no longer experiencing unsheltered homelessness; 65% accessed an LPS conservatorship. Although most OPC clients utilized a psychiatric hospital, 54% left locked settings earlier than would have been possible without the pilot. One-third of clients referred for LPS conservatorship used unlocked licensed residential facilities in the first year. Negative events, such as remaining in unsheltered homelessness, were more common among clients not referred for LPS conservatorship. Conclusions: Timely receipt of street-based services and coordination of care before, during, and after referral for LPS conservatorship reduced use of restrictive settings. The OPC program’s components constitute a promising triadic framework for addressing mental health–related disability among unsheltered individuals that warrants further investigation.
Why is it important?
• Los Angeles County’s outpatient conservatorship (OPC) pilot program used a population health approach, multisystem care coordination, and prioritization of the least restrictive environments to address mental health disability among individuals experiencing homelessness. • At 12 months, 81% of clients were no longer experiencing unsheltered homelessness, and 65% accessed a LPS conservatorship. • Compared with usual care, the findings on the OPC intervention suggest untapped opportunities to minimize time spent in highly restrictive settings for individuals experiencing grave disability.