Special clinics help keep mentally ill out of jail and ERs

A growing chain of specialized Los Angeles County clinics is keeping people experiencing mental health crises from ending up in jail or an emergency room, according to statistics compiled by the county and an agency that runs two of the clinics.

One of the clinics, Exodus Eastside Urgent Care Center, sits across the street from the L.A. County/USC Medical Center. Patients are referred from other hospitals, rehab programs, social service agencies, and law enforcement. Roughly one in five is homeless, and most are poor.

The clinic is open 24 hours a day, 365 days a year. Patients come with a range of mental health needs. Some need a refill of their psychiatric medications. Others have been placed on involuntary psychiatric holds, and can remain at the clinic up to 23 hours.

"The emergency rooms aren't really a great place for treating people who are in psychiatric crisis," says Marvin Southard, director of the L.A. County Department of Mental Health, noting that ERs are chaotic, overcrowded with medical patients and expensive.

There are currently four mental health urgent care clinics, which together serve about 23,000 patients a year. A  fifth is scheduled to open on Thursday on the campus of the Martin Luther King, Jr. Community Hospital. 

The clinics are more than emergency rooms for the mentally ill. They're better understood as service hubs, stabilizing people in the short-term, and connecting them to outpatient mental health care and longer term alcohol and drug treatment, Southard says.

Establishing those links between patients and services is challenging but critical, says Kathy Shoemaker, vice president of clinical services for Exodus Recovery Inc., the nonprofit agency that runs Eastside Urgent Care Center for the county.

"Every individual that comes to see us will leave here with a very definitive plan as to how to continue with mental health services," Shoemaker says.

That "warm hand-off," as the center's team calls it, allows patients to continue to recover – instead of ending up back on the streets, in the ER, or possibly in jail.

County data from the past several years show the urgent care clinics succeeding in some key areas, at least in the short term: Almost all of their patients stayed out of jail and psychiatric ERs in the month following a visit.

Eastside Urgent Care Center also features a primary care clinic. The goal is to locate treatment for people with chronic mental and physical health issues under one roof, says Patzi Dvoiatchka, who manages the integrated clinic.

"The idea is to make it easy for people to come in and get the services they need in one place, as opposed to having to go to multiple different offices, multiple different doctors, especially focusing on the people who really need it," she says.

Dvoiatchka says this approach is working: Before they connected with the clinic, about two-thirds of the clinic’s patients were frequent flyers in the emergency room, according to Exodus Recovery's statistics. The data show that 52 percent of first-time patients had visited the emergency room up to three times in the previous six months; two years later, that number had fallen to 29 percent.

In addition, Exodus Recovery says that 14 percent of its first-time clients had visited an ER from four to 10 times in the previous six months; after two years, it says that number was zero.

Exodus Recovery runs another mental health urgent care clinic in Culver City; the other two clinics are at Olive View Medical Center and in Long Beach. 

Just like Eastside Urgent Care Center, the clinic opening Thursday on the MLK Community Hospital campus will be open 24 hours. It will also accept people on involuntary holds and include a primary care clinic. 

Meanwhile, the county is moving ahead with plans to open three more mental health urgent care centers next year, with funding from the Investment in Mental Health Wellness Act, a state law.