Anyone who walks the streets of Los Angeles can tell you this: there are a lot of people suffering from severe mental illness who are not receiving treatment.
More than half of the homeless population faces untreated mental health conditions — including severe depression, post-traumatic stress disorder, and even schizophrenia — that make it impossible to maintain a stable job or permanent residence.
This crisis has been made even worse by the dangerous prevalence of addiction, which affects an estimated 46 percent of Angelenos who are homeless. Real and lasting progress on the statewide homelessness crisis will not materialize unless California addresses its mental health and substance abuse challenges.
This is the perfect time to implement big ideas — and that’s why the Governor announced a new program called CARE, to allow court-ordered treatment for those suffering from mental illness or induced psychosis for drugs.
But we need to learn from past mistakes and solve problems now to achieve real results.
Beginning in the late 1950s and early 1960s, California became a national leader in moving patients from state hospitals to nursing homes and group housing.
Hospital wards were closing as patients left for other destinations. By the 1970s, California completed the transfer of most mentally ill patients from its ranks at state hospitals, making it much more difficult for them to return to the hospital should they relapse and require medical attention.
But the promise of investing in community facilities that offer high-quality, personalized care made only a few strides before disappearing altogether. Board and Care housing, “Pension y Care,” began to close due to an outdated financing model.
Additionally, the promise of a connection to social services, educational opportunities, and jobs never materialized. The loss of this type of housing resulted in an increase in homelessness and fueled the flare of our current crisis. A city report indicates that 5,770 unsheltered people in Los Angeles need this type of housing with medical support.
The Governor’s CARE proposal hopes to provide accountability for people with mental illness. But if we don’t implement solutions to the problems right now, CARE will suffer from the same shortcomings we’ve witnessed in the past.
We cannot push people into court-ordered treatment without having places for them to go, without a sufficient workforce, and without access to medical facilities to weave our safety net and prevent these people from becoming fall between the folds. We must and can do a much better job — and this job requires leadership from start to finish.
We know what needs to be done. Let’s take action starting today.
First, Governor Newsom must apply for a federal exemption from Medicaid under Section 1115 of the Social Security Act. Such a waiver would authorize federal Medicaid reimbursements to psychiatric hospitals and related facilities that are classified as “institutions for mental illness” (IMDs) for the treatment of mental health.
Without an IMD treatment waiver, people requiring help will continue to face a brutal cycle of overwhelmed emergency rooms, an extreme shortage of psychiatric treatment beds, being discharged with no connection to future treatment, homelessness, and imprisonment.
Let’s be clear: not everyone will require a stay of months. Some only need a couple of weeks to stabilize and regain control of their reins.
As a representative in Congress and as a former emergency room nurse, I will do everything in my power to get this waiver authorized.
Second, let’s get the private sector on board too. Right now, there is St. Vincent’s Hospital, near Downtown Los Angeles, with 344 hospital beds in pristine condition — that is, when it’s not being used as a film set. Its owner is willing to rent it. Many others have shown this kind of support, and we must seize this opportunity.
We cannot afford not to use vacant properties that could provide care for those suffering from mental and substance abuse conditions, and potentially provide Board and Care housing, Pension and Care, as well as linkages to social, educational and employment opportunities. .
Additionally, we must immediately conduct a comprehensive audit of closed hospitals that have the existing infrastructure we need, and speed up the channeling of state funds to the reuse of available sites.
Third, the legislation must include a designation for training and hiring at the local level. I am specifically referring to investing in significant incentives that attract medical personnel to combat this challenge. The Department of Mental Health recently reported that there are 1,000 openings. If we are to solve the mental health crisis on our streets, we need to train and retain workers with the knowledge and experience to get this job done.
The time to act is today. We need to help Angelenos who are not in a position to help themselves. The time is right for CARE, and for other bold ideas, but we need to act today to build the ecosystem that delivers positive results.
Let’s hire the staff, sign the leases, and start the hard work of providing our homeless neighbors with what they need to live in community and not die on the streets.
Karen Bass is a congresswoman and candidate for mayor of Los Angeles.
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