LA officials call for overhaul of system that cares for severely mentally ill

Los Angeles County officials are trying to tackle a problem they say is hampering the region's ability to serve its most severely mentally ill people: the agency tasked with serving as their guardian is chronically understaffed and has trouble retaining employees. 

The L.A. County Board of Supervisors Tuesday voted to pursue an overhaul of the Office of the Public Guardian by looking for ways to bring down caseloads, improve the quality of services, and ensure those who qualify for public guardianship are getting adequate care.

The move comes as the county embarks on a massive effort to address homelessness and cut the number of people ending up in jail because of untreated mental illness. 

"This is an issue that needs to be addressed," said Supervisor Kathryn Barger. "When you look at the number of homeless mentally ill on the street, we need to get to the root cause."

That, she said, means not only treating people when they're placed on emergency mental health holds, but also making sure they receive ongoing mental health care. 

"This is one vehicle to do that," she said.

The type of conservatorship at issue is reserved for those who are "gravely disabled" due to mental illness and cannot, in the eyes of a court, care for themselves. When such individuals have no willing family members to serve as their guardian, the county's Office of the Public Guardian steps in to manage their affairs, including their mental health treatment. 

At the moment, the office serves as a conservator for 2,700 people. Due to staffing issues, deputies in the office each have 70-110 cases, according to the office of Supervisor Sheila Kuehl, who authored the overhaul motion.

"The caseloads are very, very high," said Dr. Jonathan Sherin, director of mental health for L.A. County.

Part of the issue is that despite the complexity of the position, the job is considered entry-level, with relatively low pay. Staffers often move on to higher level positions in other county departments quickly, sometimes only lasting in the job for a few months. 

While staffing is a major issue, Kuehl said challenges exist at every stage of the conservator process, from making sure that the correct people are referred to and approved for conservatorships, to whether they're exiting the program too quickly. 

Under the motion, which received unanimous support, mental health officials, advocacy groups, and court officials will look at how the county can reform the conservatorship process, start to track and measure outcomes from the program, and address staffing issues. 

Much of conservatorship is governed by state law, but the county still has significant leeway in how the program works, Kuehl said. 

"It's been a pretty hidden issue," Kuehl said. "Hopefully this will shine a brighter light."