A Los Angeles County, California pilot outpatient conservatorship program for homeless residents with serious mental illness (SMI) helped 81% of the 43 pilot participants remain sheltered, according to a recent program analysis. Led by the county and including a partnership of more than 40 different organizations and agencies, the pilot offered wraparound housing, health care, and social services for the participants who had severe illnesses such as schizophrenia, delusional disorders, addiction disorders, and other medical illnesses. Many of the participants had been homeless for more than five years.
The pilot took place between August 2020 and July 2021. The 81% housing retention rate for the pilot participants was significantly higher than the county’s anticipated 12-month housing rate for people served the county’s homeless outreach services. In the year before the pilot program began, about 20% of all people served by Los Angeles County’s homeless outreach had obtained housing placement within 12 months.
About 65% of the pilot participants were placed under a conservatorship, with 88% requiring treatment at an acute psychiatric hospital due to the severity of mental illness. A total of 54% of these participants were able to leave these locked settings and transfer to licensed residential facilities earlier than would have been possible prior to the pilot program. For residents under a conservatorship through the pilot program, the average number of inpatient days was 97, about 60 days less than other residents placed under involuntary psychiatric holds in Los Angeles County in recent years.
These findings were reported in “Addressing Mental Health Disability in Unsheltered Homelessness: Outpatient Conservatorship in Los Angeles” by Elizabeth Bromley, M.D., Ph.D.; Sara Rahmanian Koushkaki, Dr.P.H., M.S.H.A.; Lisa G. Davis, Ph.D., L.C.S.W.; and colleagues. Homeless outreach teams implementing the outpatient conservatorship (OPC) pilot program adopted a population health approach, multisystem care coordination, and prioritization of the least restrictive environments. The program allowed initiation of a Lanterman-Petris-Short (LPS) conservatorship outside of a hospital, with the goal of serving highly vulnerable individuals in the least restrictive settings. Between August 2020 and July 2021, the OPC pilot program served 43 people, corresponding to 2% of those served by the outreach teams during that period. The goal was to describe the OPC pilot outcomes in terms of a public health framework to address mental health–related disability in homeless populations.
For more information, contact: Elizabeth Bromley, M.D., Ph.D., Psychiatrist, Ronald Reagan University of California, Los Angeles Medical Center, 757 Westwood Plaza, Los Angeles, California 90095; Email: ebromley@mednet.ucla.edu; Website: https://www.uclahealth.org/providers/elizabeth-bromley