Nearly a quarter of unhoused adults in LA County report having serious mental illness

The latest homeless count showed a slight dip in the number of unhoused adults in Los Angeles County who said they live with serious mental illness, but experts warn there’s still much to be done to meet the mental health needs of people living on the streets.

They say one approach that has shown promise is providing psychiatrists in the field to treat people where they are. Examples include the county’s Homeless Outreach and Mobile Engagement program, known as HOME, and other programs like the Street Medicine teams at the University of Southern California.

But those on the front lines of the homelessness crisis say there still isn’t enough supportive housing and treatment beds to make a real difference.

“They’re just not able to build them fast enough,” said Brett Feldman director of Street Medicine at USC.

The latest homeless count

The 2024 point-in-time count found that 24% of unhoused people over the age of 18 self-reported that they live with a serious mental illness, according to the Los Angeles Homelessness Services Authority, which conducts the annual count. That amounts to more than 15,600 people who are unhoused and living with a serious mental illness like schizophrenia across L.A. County.

Last year, LAHSA reported 25% of people identified in the point-in-time count said they were experiencing serious mental illness.

Feldman, who regularly treats unhoused patients, said his approach has been to treat people’s physical ailments first, then follow up on psychiatric care when he has earned the patient's trust.

“For example, people are much more likely to tell me about their knee that’s bugging them that makes it that they can’t walk around than the voices that they might be hearing,” Feldman said.

The mental health care system, he said, is “extremely complicated and difficult to navigate,” particularly for people who are the sickest and less likely to find their way to ongoing help, Feldman said.

Feldman said there should be more programs that include street psychiatry as part of their approach to helping people on the streets. He said there are often long wait times for people to see a psychiatrist at a hospital.

Lawmakers and mental health advocates have focused largely in recent years on building more psychiatric beds and residential treatment facilities, but there aren’t enough to meet current needs and they aren’t being built fast enough, Feldman said.

In the meantime, he said, street medicine — and street psychiatry — can go a long way to try to get patients stable so they are more ready to succeed in housing when it becomes available.

In 2022, researchers at USC's Keck School of Medicine identified 25 programs in the state that fit the definition of street medicine. They found that the majority of the programs were in Los Angeles County and the San Francisco Bay Area, and many were part of health centers or sponsored by nonprofit organizations, government entities, academic institutions or health plans.

Long waits for mental health facilities

Through its HOME program, the L.A. County Department of Mental Health interacted with 2,100 unhoused people who live with serious mental illness last fiscal year.

La Tina Jackson, who heads up the HOME teams, said they are focused on people who are “severely and profoundly impaired” because of serious mental illness.

After Jackson and her team of eight psychiatrists and other support staff bring people under their care, it can still take six months to a year or more for people to get placed in a mental health facility or permanent supportive housing, she said.

“We can make the HOME teams bigger and expand them. But if we don’t have placements at the end of the day, that’s not helpful,” Jackson told LAist.

Because of decades-old federal rules, disappearing supportive housing and insufficient government funding, those places to stay are hard to come by.

According to a report from the California Health Care Foundation, “the number of acute psychiatric beds per 100,000 people [in the state] decreased about 30 percent from 1998 through 2017.”

“If you continue to create more on the front end, with the intention of linking to somewhere, but you don’t create any ‘there, there,’ we just end up with the same situation that we’ve had for years,” Jackson said.

Several state-led efforts to bring more unhoused people living with serious mental illness into treatment are underway in L.A. County.

For example, the CARE Court program aims to get more people into treatment by way of a court-ordered treatment program. So far, CARE Court has seen a slow start in L.A. and across the state as the number of petitions filed in the early part of this year has been much lower than expected.

Proposition 1, a statewide ballot measure that voters narrowly approved earlier this year, cleared the way for a nearly $6.4 billion bond to add more beds in psychiatric facilities as well as supportive housing.