County officials looking at options for LA homeless who refuse help

Los Angeles officials are looking into options for getting homeless with severe mental illnesses off the county's streets.

On Tuesday, the L.A. County Board of Supervisors instructed the Department of Mental Health to research what legal options officials have at their disposal to compel people into treatment if it's believed they're so gravely disabled, they can't make decisions for themselves.

The move comes as city and county agencies in L.A., backed by new taxpayer dollars, are making major investments in tackling the region's growing homeless problem. As they do so, there are questions the supervisors want answered about whether a small percentage of homeless will refuse all attempts to get them into stable housing.

"Approximately 30 percent of those living on the streets suffer from some sort of mental illness – that's not to say all have to be hospitalized" said Supervisor Kathryn Barger, who authored the request. "My intent is to really examine where we need to make changes and even, if we need to."

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There are a smattering of laws that provide for family members, law enforcement, and others to essentially force treatment, though not necessarily medications, on reluctant patients. California law allows for 72-hour and 14-day hospitalizations in extreme circumstances, and courts can order longer-term commitments. Part of the Department of Mental Health's report is expected to look at how often and easily such holds are used.

At the request of Supervisors Sheila Kuehl and Hilda Solis, the report is also expected to look at what steps, like better outreach, might be used instead of forced hospitalizations. 

Both supervisors said they were concerned about infringing upon people's autonomy and civil liberties by compelling them into treatment.

"I'm not saying absolutely we can't ever do it," Kuehl said. "Where's the bright line, if there is one, or how do we find a line."

There's also a question of where people who are institutionalized end up—the county has more demand for mental health beds than it has supply, said doctor Jonathan Sherin, director of the L.A. County Department of Mental Health. 

Building more institutional options, he said, might not be the only way to go. But, he said, those are "sometimes punitive environments and punitive environments are not designed for individuals to flourish to the best of their ability."

Sherin said the county may examine something more akin to living communities with onsite services. 

"A place where people would want to be," Sherin said. "Create something that's inviting and appealing to bring them to services as opposed to being more paternalistic."

Todd Lipka, CEO of the homeless service provider Step Up said people may be resisting services simply because they're overwhelmed by the process of getting help.

"They cannot navigate the mental health system, the housing application system, that's why they've been out on the street the longest," Lipka said. 

He estimated only about 2 or 3 percent of the chronically homeless with mental illness can't be reached using existing outreach tools. 

Agencies in the City of L.A. are concerned about the same issues. 

The Los Angeles Police Department, which has officers dedicated to outreach and policing of the homeless community, estimates nearly half of homeless individuals offered services by these officers refuse them.

At a special meeting of the L.A. Police Commission Tuesday devoted to homelessness, officers described interacting with people who were suffering from health problems, living in tents filled with feces, who would refuse their help. 

"If someone has severe mental illness or is severely in a drug state, they're probably going to say 'no' more than anybody else will," said L.A. Police Commissioner Steve Soboroff, at a special meeting of the L.A. Police Commission Tuesday devoted to homelessness."What can we do better to help the people say 'yes.'"

But Peter Lynn, who heads the L.A. Homeless Services Authority, warned the widespread idea that many people don't want help is overstated. Many, he said, have been offered help before, but didn't receive the appropriate shelter and permanent housing they were promised.

"I think the key is to enrich the service proposition that we have and really offer something that's authentic," Lynn told the commission. 

Lynn said with new dollars coming in as early as July from voter-approved bonds and a raise in the sales tax, the city and county should be able to entice most people to buy into the system simply by offering them quality services.