Health Lead Story Local News News West Edition

D.A. says she’ll expand efforts to fight mental illness

LOS ANGELES — District Attorney Jackie Lacey has announced an expansion of her office’s efforts to help people living with mental illness in the criminal justice system.

The Mental Health Division brings together deputy district attorneys whose cases involve defendants who have been declared incompetent to stand trial or are seeking alternative sentences due to their mental illness.

The new division — the first of its kind in a prosecutor’s office in California and, possibly, the nation — was established Jan. 23.

“Our goal is to protect the public and to assist people in getting the mental health and other services they need to be productive members of our community,” Lacey said. “We also want to make sure that jails and prisons are reserved for the most serious and violent offenders.”

The new division builds on Lacey’s efforts to establish a more effective criminal justice system for people living with mental illness. The division staff will seek ways to expand treatment and other community-based services for people whose untreated mental illness historically has resulted in longer periods of incarceration and mental deterioration.

The Mental Health Division will serve as a resource to deputy district attorneys faced with questions about potential diversion cases and motions made under Senate Bill 1810, the new pre-trial mental health diversion law. It also will provide training to attorneys and first responders, advocate for more community-based mental health resources and pursue legislation to enact meaningful criminal justice reform in California.

An important internal policy component of the mental health continuum is Lacey’s directive that allows deputy district attorneys to consider a defendant’s mental health when deciding if they should participate in a diversion program.

“With this policy, I am encouraging my lawyers to make courageous decisions and do the right thing,” District Attorney Lacey said. “We must make informed decisions to ensure public safety and help another human being in crisis.”

Since her election in 2012, Lacey has worked diligently to address the needs of those with mental illness. She formed what would become the county’s Mental Health Advisory Board with mental health and criminal justice professionals in 2013.

The advisory board created its Blueprint for Change, a 2015 report that mapped out a path to address issues within the mental health and justice systems.

In response to its recommendations, Lacey has provided free mental health awareness training to more than 1,400 first responders from smaller police agencies. The training shows first responders how to safely de-escalate encounters with people in a mental health crisis, improving the safety of the officers and the public.

In 2016, Lacey appointed the nation’s first mental health liaison for a local prosecutorial agency. The liaison worked in collaboration with a variety of stakeholders to address ways to safely help people in a mental health crisis stay out of the criminal justice system.

In an unrelated action, the county Board of Supervisors voted unanimously Jan. 22 to expand the availability of in-patient mental health care in the face of a worsening, decades-long shortage.

Supervisor Kathryn Barger, who authored the motion, said the wait time for a bed in one of California’s five state psychiatric hospitals is a year or more, leaving severely ill patients without the care they need. She cited mental health experts who estimate that 50 public mental health beds are needed per 100,000 residents and said Los Angeles County has less than half that number.

“If we do not address the homeless mentally ill, in eight years, people are going to feel like we did nothing,” Barger told her colleagues.

Mental health advocates painted a picture of hospitals deluged with patients in crisis they cannot adequately serve, including children and teens who need specialized care. Some said emergency rooms have seen an increase in violent patients that facilities aren’t set up to manage. All that demand also means that patients with other medical issues end up with longer emergency room waits. And in an effort to free up beds, mentally ill individuals are released without the resources they need to stay well, according to Dr. Jonathan Sherin, who heads the county’s Department of Mental Health.

“The need to right size our hospital network is paramount,” Sherin told the board. “We have nowhere near the number of sub-acute [or] step-down types of beds” needed for patients to transition out of acute care.

Facilities have been starved of funding at both the federal and state level. The federal government has long excluded Medicaid reimbursement for residential mental health treatment for non-elderly patients but recently announced that it would offer funding for innovative programs.

California, which moved to de-institutionalize mental health care in the late 1970s over concerns about abusive treatment, would need to support the county’s request for dollars under a Medicaid waiver.

The board directed the Department of Mental Health to develop a plan to generate more beds, including identifying potential sites and available funding and assessing the patient population, including in county jails.

Peter Eliasberg of the American Civil Liberties Union of Southern California said only patients in need of the highest level of care should be in a locked-down psychiatric ward, stressing the need for community-based care. He also urged the board to release jail inmates found incompetent to stand trial to be treated in the community.

“I am sick and tired of the sad reality that the number one provider of mental health services is the jail, where it is done poorly,” Eliasberg said.

In addition to expanding resources, Sherin said his department would be instituting performance-based accountability for existing care providers.

“There’s very little incentive for the hospital system to provide the level of care that we would like to see” under current contracts, Sherin said. 

Staff and Wire Reports