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Bromley E, Rahmanian Koushkaki S, Davis LG, Moon S, Resnick J, McCoy M, Bennett K, Rab S, Draxler CD, Jackson LT, Lovelace A, Sherin J. Addressing Mental Health Disability in Unsheltered Homelessness: Outpatient Conservatorship in Los Angeles. Psychiatr Serv 2024:appips20230235. [PMID: 38268464 DOI: 10.1176/appi.ps.20230235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The authors sought to describe a pilot program for gravely disabled individuals experiencing unsheltered homelessness in Los Angeles County that illustrates a promising public health framework to address mental health-related disability in homeless populations. METHODS 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 clients, corresponding to 2% of those served by the outreach teams during that period. Using observational program evaluation data, the authors examined the impact of the program on this sample of participants. RESULTS At 12 months, 81% of OPC clients were no longer experiencing unsheltered homelessness; 65% accessed an LPS conservatorship. Although most OPC clients utilized a psychiatric hospital, 54% left locked settings earlier than would have been possible without the program. One-third of clients referred for LPS conservatorship used unlocked licensed residential facilities in the first year. Negative events, such as remaining in unsheltered homelessness, were more common among clients not referred for LPS conservatorship. CONCLUSIONS Timely receipt of street-based services and coordination of care before, during, and after referral for LPS conservatorship reduced use of restrictive settings. The OPC program's components constitute a promising triadic framework for addressing mental health disability among unsheltered individuals that warrants further investigation.
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Affiliation(s)
- Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Sara Rahmanian Koushkaki
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Lisa G Davis
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Stephanie Moon
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Jaclyn Resnick
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Matthew McCoy
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Karla Bennett
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Shayan Rab
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Connie D Draxler
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - La Tina Jackson
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Aubree Lovelace
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Jonathan Sherin
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
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