Reviewed by Emily Henderson, B.Sc.
At a time when public and private agencies and the legal system are
grappling with how to best assist people who live at the intersection of
homelessness and mental illness during a global pandemic, UCLA
researchers have found mental health conservatorships for people with
disabling, severe mental illness who are also homeless can result in
lengthy psychiatric hospitalizations.
"Our study found that mental health conservatorships resulted in very
lengthy inpatient stays for those who were homeless when conserved,
sometimes as long as months or even a year," said Dr. Kristen Choi, UCLA
Fielding School of Public Health assistant professor of health policy
and management. "We observed a 'bottleneck' effect in this study. There
are very few long-term housing options for people who are disabled by
mental illness and in need of supportive housing in Los Angeles. When
these individuals are stabilized and ready for a lower level of
community-based care, there is no place for them to go."
Choi, a psychiatric nurse who is also an assistant professor with the
UCLA School of Nursing, led the current study, "Mental Health
Conservatorship Among Homeless People With Serious Mental Illness."
Mental health conservatorships, known as a Lanterman-Petris-Short Act
(LPS) Conservatorship in California, are highly restrictive and thus
reserved only for individuals with severe, ongoing disability from
mental illness who cannot accept voluntary treatment. There is a strict
legal process for initiating such conservatorships that involves review
and monitoring by the courts.
"It is important to note that the majority of people experiencing
homelessness do not have mental illness," said Dr. Enrico Castillo, a
psychiatrist with the UCLA Center for Social Medicine and Humanities.
"Homelessness is not the same thing as mental illness and as such, the
solution to homelessness is housing, not psychiatric treatment."
The most recent measurement, the 2020 Greater Los Angeles Homeless
Count, found 66,436 people in Los Angeles County experiencing
homelessness; the 2021 survey was suspended because of the COVID-19
pandemic. At the same time, across the United States, the best available
estimate of homelessness is some 580,466 people, according to the U.S.
Department of Housing and Urban Development. Twenty-one percent of
individuals who are homeless have serious mental illness, compared with 5
percent in the general U.S. population. Mental illness among people who
are homeless is associated with higher risk for mortality, disability,
substance use disorders, and suicide.
Publication of the study is pending in an upcoming edition of the peer-reviewed journal Psychiatric Services,
published by the American Psychiatric Association. It is currently
available on-line. The researchers from the UCLA Fielding School and the
UCLA Center for Social Medicine and Humanities examined a sample of 795
adults, 18 years of age or older, who were hospitalized on an
involuntary psychiatric hold in Los Angeles between 2016 and 2018. They
examined discharge and mental health conservatorship outcomes for
patients who were homeless. The researchers found that inpatient stays
were almost four weeks longer for individuals who were homeless when
admitted compared to those who were housed.
For the minority of people experiencing homelessness who also
have severe and disabling mental illness, such as those in our study,
supportive housing options that combine treatment with housing are
greatly needed in Los Angeles."
Dr Marissa Seamans, Study Co-Author and Assistant Professor of Epidemiology, UCLA Fielding School of Public Health
The study was conducted in partnership with Gateways Hospital and
Mental Health Center, a safety net mental health system in Echo Park
that aims provides mental health care to all people regardless of their
ability to pay. In response to their growing homeless patient population
and the results of this study, Gateways Hospital has formed a new
partnership with the Homeless Outreach and Mobile Engagement (HOME) Team
pilot program to link street-based psychiatric treatment with
inpatient, outpatient, and residential treatment in the Gateways system.
"This partnership will enable us to better meet the needs of homeless
individuals who are living in the streets due to their mental health
related impairments," said Dr. Shayan Rab, a street psychiatrist with
the HOME Team. "Street-based mental health services can be a first step
in addressing long-term treatment needs. At the same time, more
residential treatment options in Los Angeles is ultimately the solution
we need most."
Source:
Journal reference:
Choi, K. R., et al. (2021) Mental Health Conservatorship Among Homeless People With Serious Mental Illness. Psychiatric Services. doi.org/10.1176/appi.ps.202100254.
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