The Brief

As Dr. Rishi Patel’s street medicine van bounces over dirt roads and empty fields in rural Kern County, he’s looking for a particular patient he knows is overdue for her shot.

The woman, who has schizophrenia and has been living outside for five years, has several goals for herself: Start thinking more clearly, stop using meth and get an ID so she can visit her son in jail. Patel hopes the shot — a long-acting antipsychotic — will help her meet all of them.

Patel, medical director of Akido Street Medicine, is one of many street doctors throughout California using these injections as an increasingly common tool to help combat the state’s intertwined homelessness and mental health crises. Typically administered into a patient’s shoulder muscle, the medication slowly releases into the bloodstream over time, providing relief from symptoms of psychosis for a month or longer. The shots replace a patient’s oral medication — no more taking a pill every day. For people who are homeless and routinely have their pills stolen, can’t make it to a pharmacy for a refill or simply forget to take them, the shots can mean the difference between staying on their medication, or not.

“They’ve been an absolute game-changer,” Patel said.

Street medicine teams bring the shots directly to their patients wherever they are — whether it’s in a tent along Skid Row in Los Angeles, in a dugout in the middle of a field in the Central Valley, or along the bank of a stream in Shasta County. Doctors can diagnose someone, prescribe the medication, get their consent and give the shot within a matter of days — or sometimes even more quickly — and with minimal paperwork and red tape. They don’t need a psychiatrist’s sign-off.

It’s estimated that California is home to more than 180,000 homeless residents. How to help the sickest of them — people with severe, untreated psychosis who might wander into traffic or otherwise put themselves in danger — has become a hot-button issue, with Gov. Gavin Newsom and state lawmakers creating new and sometimes controversial ways to get people into treatment. In a recent UCSF survey of homeless Californians, 12% reported experiencing hallucinations in the past 30 days, and more than a quarter said they’d ever been hospitalized for a mental health condition.

Doctors say the goal of giving an antipsychotic shot to someone living in an encampment is to get them thinking clearly, so that they can start engaging with social workers, sign up for benefits and get on housing waitlists. While Newsom’s new CARE Court allows judges to order people into mental health treatment, and other recent legislation makes it easier to put people with a serious mental illness into conservatorships, doctors administering street injections take a different approach. The treatment is voluntary, and people can get help where they are, instead of in a locked facility.

An Abilify Maintena shot being prepared by the Akido street medicine team at their main office in Bakersfield on May 28, 2024.

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Larry Valenzuela

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CalMatters/CatchLight Local

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Some success stories are dramatic. Doctors talk about patients who one day are babbling incoherently, and a week after a shot, are having conversations.

“It’s been pretty common that that’s the initiation of, ‘We’re going indoors,’” said Dr. Coley King, director of homeless health care for the Venice Family Clinic in Los Angeles. He said he’s seen dozens of patients get off the street after taking these shots.

As with any medication, the shots can have side effects. And while a patient can stop taking a pill and generally put a stop to a negative reaction, once they’ve been given a shot, they have no choice but to wait a month for the drug to wear off.

Despite some street doctors’ rave reviews, injectable antipsychotics still aren’t reaching everyone who experts say they could help. Street medicine teams report having just a handful of patients on these medications at any one time (King’s team in Los Angeles has about two dozen). Some patients don’t want the shots, balking at the idea of having a drug in their system for an entire month, especially if they have feelings of paranoia related to health care.

And street doctors complain that hospitals still seem to prefer discharging patients from temporary psychiatric holds with a bottle of pills they may or may not take – instead of giving them a long-acting shot.

Losing track of patients

One of the biggest challenges street doctors face in administering these shots is following up with patients.

In Kern County, Patel hasn’t seen the woman he’s looking for since his team gave her first antipsychotic shot almost two months ago. Now she’s past due for another dose.

It’s worrying, Patel said, “because I don’t know how she did on it.”

The last place they saw her was at an encampment known as “The Sump” in the Central Valley farming community of Lamont, where she lived in a plywood shack along a muddy ditch behind a farm. But code enforcement recently cleared everyone out of that area, and Patel’s team doesn’t have a phone number or any other way to contact her.

The Akido street medicine team checks for a patient they are looking for in a homeless encampment in a dirt field in Arvin on May 28, 2024.

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Larry Valenzuela

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CalMatters/CatchLight Local

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The first place they look is another encampment known as “the Shrine,” because it once held a shrine to Santa Muerte, a Mexican saint of death often prayed to by drug dealers. The team drives the van through an empty field of dead, yellow grass. Several people are living in room-sized pits they’ve dug into the dirt and covered with tarps and sheets of metal. Next to the vacant land is a vineyard, with rows of vines dotted with small, green grapes.

She’s not there, so the team hands out sack lunches and bottles of water, then gets back in the van and leaves.

“We’ve seen results,” said Kirk McGowan, a street medicine nurse with Akido. “But we’ve seen more failures than successes. That’s just kind of the nature of the situation.”

Who should prescribe antipsychotic injections?

In most cases, the people prescribing and administering antipsychotic shots in homeless encampments are general practice doctors — not specially trained psychiatrists. That’s because despite the growing prevalence of street medicine, street psychiatrists are still rare, according to a recent USC report.

“You look over your shoulder and there’s not a psychiatrist there helping you out,” King said. “And we want to meet the need. We want to take care of these patients. They’re really, really ill, they’re really disorganized, and suffering and dying on the streets.”

There are no legal restrictions preventing a general practice doctor from administering these injections. But some practitioners think the responsibility should be reserved for psychiatric providers.

“These medications are in there for an extended period of time,” said Keri Weinstock, a psychiatric nurse practitioner who practices street medicine in Shasta County. “They do come with risks. There are specialty things that come along with some of these specialty meds, and it’s a lot to learn when you have to know everything else, too.”

Some street doctors who give these shots seek out additional psychiatric training, while others learn on the job — often with a psychiatrist on speed dial, just in case.

“I don’t think it’s rocket science to diagnose schizophrenia, as long as we’ve done it with some thoughtfulness,” King said.

In-the-field diagnoses aren’t always clear-cut, Patel said. Sometimes, people do such a good job of hiding their symptoms that it’s hard to tell they’re dealing with psychosis. Or, instead of experiencing obvious hallucinations or other symptoms commonly associated with schizophrenia, patients experience “negative symptoms,” such as extreme social withdrawal.

When those types of cases arise, Patel calls a psychologist for a second opinion.

While these drugs are generally considered safe, they do come with a risk of side effects that can include dizziness, sedation, stiffness and decreased mobility. Those symptoms might be no big deal for someone living in a house, but for someone on the street, could be catastrophic, said Dr. Shayan Rab, a street psychiatrist with Los Angeles County’s Homeless Outreach and Mobile Engagement team. It could make someone more vulnerable to being attacked or robbed, or prevent them from accessing food or shelter.

“It’s a very serious kind of action that’s being taken and a lot of time needs to be spent before you say, ‘Hey, this individual is safe for a long-acting injection,’” he said.

To make sure a patient doesn’t have an adverse reaction, doctors typically give them an oral dose of the same medication for a few days before administering the shot.

There’s also a risk that after a street doctor gives someone a shot, that patient could later get sent to the hospital on a temporary psychiatric hold. Doctors there might not know the patient already has a long-acting dose of antipsychotic medication in their body, and might give them another dose.

Before giving someone a shot, Dr. Aislinn Bird wants to be 100% sure their symptoms are actually caused by psychotic disorder, such as schizophrenia, and not complex PTSD, major depressive disorder, methamphetamine use, or something else. Overdiagnosis of psychotic disorders is rampant, especially in the African American community, Bird said.

“You have to be sure you really know the correct diagnosis,” said Bird, who serves as director of Integrated Care at Health Care for the Homeless in Alameda County.

But Dr. Susan Partovi, who practices street medicine on Skid Row in Los Angeles, said that’s an “antiquated way of thinking.” When someone is experiencing psychosis, it’s an emergency that needs to be treated as soon as possible, no matter the cause, she said. Her preference is to treat the symptoms first, and then see if the patient wants to work on other issues, such as substance use.

Antipsychotic injectables, such as Abilify and Invega, tend to be most prevalent in street medicine practices. But street doctors also administer long-acting injectable HIV medication, as well as medication for addiction such as Vivitrol — an injectable, long-acting medication that can help reduce cravings for opioids and alcohol, and protect against overdose.

Silencing the voices in his head

Ricardo Fonseca Jr., who goes by “Ricky,” has been homeless for two years, living in a tent behind a Dollar Tree, then in a park in rural Kern County. The 31-year-old said he was working as a welder until he had a sudden mental breakdown and started hearing voices.

The voices said horrible things to him. Sometimes they yelled, and he yelled back, scaring those around him. He used methamphetamine to cope.

“It was getting to the point where I just felt like killing myself,” Fonseca said.

Two months ago, Fonseca started taking a monthly shot of the antipsychotic drug Abilify. Since then, “everything’s changed,” he said.

Now, Fonseca is staying at a friend’s house and considering going to school. He says he’s stopped using meth.

“I can finally hear the birds and the crickets,” he said. “I couldn’t hear them before.”

That ocean breeze is just not cutting it in schools in Torrance and Long Beach as Southern California reels from a heat wave.

Parents have taken to social media, created petitions and are proposing a bond measure in order to address the sweltering classrooms as temperatures hit triple digits in some areas.

Only 25% of Torrance Unified classrooms have air conditioning, according to a district spokesperson. And while 90% of Long Beach Unified schools have air conditioning, the schools without air conditioning have to bear this heat spell until the end of 2027 when new air conditioning will be in all classrooms.

What are schools doing to beat the heat?

In Long Beach, the district says there are portable fans in classrooms without AC and the district has installed heat-blocking window covers.

"The things that we do immediately and have been doing for several years, hydration stations,” Keith Butler, the deputy superintendent at TUSD, told the school board early this week. “So our nutrition services freezes blocks of ice, puts them into containers with water, and students are — and staff are able to rotate through and at least get ice water.”

There is also a classroom rotation system so everyone gets a turn in cooling zones, he said.

Can schools close on extreme heat days?

Eric Mitchell, a spokesperson for LBUSD, told LAist, “The District will not close schools because of extreme weather unless the City of Long Beach Public Health Department or a state-authorized emergency response agency directs it.”

Baillie echoed his words adding that a state-declared emergency allows schools to close temporarily without needing to make up teaching time. School funding is dependent on attendance and instructional time.

If a local emergency is declared, school districts, she said, must consult with labor unions to adjust the school schedule to either extend the school year or move to a student-free professional development day.

“Our district is actively discussing creating union-approved ‘weather days’ that would provide a mechanism to adjust the schedule,” Baillie said. “Thresholds would be part of that discussion and might focus on when national weather alerts elevate a heat advisory to an extreme heat event, as they did this week.”

So how can Torrance get ACs in the classroom?

School districts like Torrance pay for facility upgrades like new ACs through district issued bond measures. A school district takes a loan and the people in that city pay back that loan through an increase in their property taxes. That is because there is no specific state allocation of funding for major upgrades or construction. Most of the money schools get from the state is spent on instruction and other student services. There have been some occasional grant programs, like CalShape, but no ongoing source of funding.

This week, a petition to get TUSD to place a bond measure on the ballot to fund ACs has already garnered over 1500 signatures.

But, Baillie said, “Third-party polling completed earlier this year showed a willingness to vote for additional future bonds; however, when specifically asked about the costs of specific bonds to fund the $520 million needed to upgrade the electrical systems and install AC at all 34 campuses, polling showed there would not be enough support (bonds require 55% +1 of voters in an election) to pass a bond for AC.”

And so the bond measure was not placed on the upcoming ballot.

Butler, the deputy superintendent, explained during this week’s school board meeting that parents cannot simply donate an AC unit.

“ One [reason] is it's not super effective to have a typical window unit from a home that would be trying to cool a 960 sq. ft. classroom with 27 students and a teacher, maybe an instructional aide,” he said. “But the bigger issue is the ones that are large enough to really do that, the room has to have a large electrical load, and our electrical system within our buildings where most of them were built in the 1960s, it's just not meant to handle what it does.”

LAist reporter Mariana Dale contributed to this article. 

The Orange County District Attorney’s Office is hosting a buyback event Sunday where people can exchange their e-bikes and e-motorcycles for up to $1,000 in gift cards. The goal is to reduce the number of illegal bikes on the road, and give parents an incentive to get dangerous vehicles out of kids’ hands.

“These vehicles are not child’s play, and the consequences are incredibly dangerous and increasingly deadly,” DA Todd Spitzer said in a news release announcing the event.

Communities in Orange County have been grappling with a surge in e-bikes and e-motos on the road, including among young kids, and an accompanying increase in serious crashes.

“Our area has pretty much the highest concentration of e-bike injuries and e-bike accidents in the country,” said Dr. Tetsuya Takeuchi, the trauma medical director at Providence Mission Hospital in Mission Viejo.

Takeuchi said  just over 70% of the children treated at the hospital for e-bike injuries had some level of head injury, “from a simple concussion to devastating brain damage, brain bleed and skull fracture."

A lot of those injuries are among teenagers not wearing helmets, he said. Plus, many e-bikes on the market are too heavy and fast for children to control, Takeuchi said.

Besides safety concerns, tensions have flared with other drivers, pedestrians, and neighbors in areas with heavy concentrations of e-bikes.

Newport-Mesa Unified School District became one of the first districts in the country this year to restrict e-bikes to high school campuses only. District leaders say the policy is working to disincentivize young students from riding e-bikes to school. But at one middle school, students with e-bikes have opted to ride them anyway, parking in the surrounding neighborhood and raising the ire of homeowners.

The DA’s approach

The DA’s office has started to target parents who allow their children to ride e-bikes and e-motorcycles that have been illegally modified for high speeds, sometimes with deadly consequences. In April, the district attorney filed child endangerment charges against a mother from Aliso Viejo after her 14-year-old son struck and killed an 81-year-old man while doing wheelies in the street in Lake Forest. The boy was riding an e-motorcycle souped up to reach 60 mph.

Details of the buyback program

The e-bike and e-motorcycle buyback program is part of the DA’s plan to address safety concerns with e-bikes. Local police departments, hospitals and the California Office of Traffic Safety will also be onsite with information booths.

People can bring in functioning or non-functioning e-bikes, e-motorcycles, e-scooters and pocket bikes and exchange them for gift cards worth up to $1,000 — while supplies last.

The event takes place from 10 a.m. to 1 p.m., Sunday, Sept. 13, at Angel Stadium in Anaheim.

An appeals court issued a ruling Friday that strikes down a federal government effort to block a lower court’s order requiring the construction of 2,550 new housing units on the Veterans Affairs campus in West Los Angeles.

The long-running case, brought forward by disabled veterans struggling with homelessness in the L.A. area, has centered on the use of the sprawling 400-acre VA campus.

U.S. District Judge David O. Carter had previously scrutinized leases for the private Brentwood School’s athletic facilities, a parking lot company, an oil drilling enterprise and UCLA’s baseball stadium.

Ruling that the campus was meant to aid veterans, Carter ordered the VA to not renew the leases and quickly build 750 units of temporary housing and 1,800 units of permanent housing.

But Carter’s September 2024 order has been on hold ever since the defendants asked the 9th Circuit Court of Appeals to review his decision.

Case returns to lower court

On Friday, more than two-thirds of the court’s 29 judges ruled against the VA’s petition for a rehearing.

“It's a historic day for veterans,” said Mark Rosenbaum, an attorney with Public Counsel representing the plaintiffs.

“The government has been fighting their veterans, who went to fight on behalf of the nation,” he added. “They've been fighting them like they are the enemy. They went to the district court to fight. They lost.”

Rosenbaum said he’s pleased to see the case return to Carter’s courtroom after a long appeals process. Carter, himself a Marine Corps veteran who served in the Vietnam War, took an active role in pushing the VA to address a homelessness crisis that has thousands of former service members experiencing homelessness on any given night in L.A. County.

Could the VA pursue further appeals? 

Carter has also ordered the VA to stop using veterans' disability payment benefits as a reason to make them ineligible for supportive housing programs due to income restrictions.

But Rob Reynolds, an Iraq War veteran who advocates for L.A.’s veteran community, said the federal government’s attempts to win an appeal could continue.

“The government can still appeal this to the U.S. Supreme Court,” Reynolds said.

When veterans involved in the case first heard today’s news on the 9th Circuit ruling, he said they immediately asked about the potential for further appeals.

“All of us are really hoping that the government stops this fight, and that we can get housing built for our veterans and end this madness once and for all,” Reynolds said.

A spokesperson for the VA declined to comment on the ruling, saying the department does not discuss pending litigation.

Jenny Yang, a comedian from L.A., has been traveling across the country turning immigrant grocery stores into comedy hubs. Now she’s back in L.A. getting ready to start a mini-residency in Highland Park, tape her first one-hour special and share moments from the tour.

Yang kicked off her Good Egg Immigrant Grocery Store Standup Comedy Tour in June in L.A., then took it to 15 cities across the country. She told LAist the decision came as a way to cope with the grief from her dad’s death, 10 failed in vitro fertilization treatments between 2020 and 2025 and seeing the news of Immigration and Customs Enforcement raids spread across the country.

She said the idea to tour grocery stores was a way to reclaim those spaces, after immigration enforcement left many afraid to go out and do simple tasks like buying groceries.

“If we cannot laugh in front of a wall of instant ramen around our bok choy," Yang said, "then what is the American dream for?"

Her routine wove in stories about her fertility struggles and the challenges of having to be a “good egg” growing up as the child of immigrant parents from Taiwan. Her hope for the tour was to connect with people, to make jokes and help people feel lighter after.

The tour proceeds went to local nonprofits serving immigrant communities, and Yang said those organizations helped recruit the grocery stores. She said some stores said no at first — they felt overwhelmed by ICE activity in their city, had lost staff or worried about drawing attention.

“That's part of the story of the tour is it's one thing to want to imagine this beautiful world where you can tell jokes inside of immigrant grocery stores," Yang said. "It's another thing to know what those obstacles are, and I think that's still very telling for where we are as a country.”

One moment stood out to Yang: performing at Shuang Hur Supermarket in Minneapolis. It’s near the memorial for Alex Pretti, the nurse that a U.S. Border Patrol agent shot and killed in January as federal agents carried out immigration enforcement in the city.

“I was able to talk to Henry, the owner who’s a Chinese American uncle. [He] was so proud of being able to help his regular patrons, who for the most part even though it was an Asian centered grocery store, were majority Latino,” Yang said. “I was able to bear witness to their resilience as a community, what they did to take care of each other.”

Now she’s back in L.A. and is doing a mini-residency at the Outside In Theater at 5317 York Blvd. in Highland Park. Her first show is 6 p.m., Saturday, Sept. 12, followed by shows on Sept. 19 and 26 at the same time. Tickets are pay-what-you-can, and you can find them at Outside In's website.

In February 2027, Yang will be taping her first one-hour special at Rancho Meat Market #1 in Lincoln Heights. She describes it as a love letter to Los Angeles that’s endured so much, from the ICE raids to the January fires.

You can follow Jenny Yang’s work here.