By Dane O’Leary
Los Angeles County is the most highly-populated county in the U.S. at over 10 million people. In fact, it holds nearly double the population of Cook County, Illinois, which is the second-most populous county in the nation and contains the city of Chicago.1 Naturally, when you have such a high concentration of people in a relatively small space, immense pressure is put on even the most basic of resources, including mental health services. Although meeting the mental health needs of millions of individuals is inherently difficult, LA County has garnered criticisms for being ill-equipped and having no strategy in place to alleviate untreated mental illness in the Los Angeles area.
Historically, a city’s homeless population has been a strong indicator when it comes to determining the level to which that city can meet its demand for mental health support. While there are a number of reasons why a person might become homeless, studies have shown that substance abuse and mental illness are two of the driving forces behind homelessness.2 Sure enough, LA County has long had a problem with homelessness. For 2016, the year-over-year increase in the number of homeless individuals living in LA County was a dismaying 23 percent with some areas — Santa Clarita, San Gabriel, San Fernando, Cresenta — showing an increase of more than 30 percent.3 Again, a number of factors can cause homelessness, but most experts attribute the county’s insufficient mental health support as a main factor in the homelessness increase.4
But it’s not just the homeless individuals who need better mental health support. Another common criticism many have had of the Los Angeles County Department of Mental Health is the difficulty that people have when it comes to gaining access to the resources they need. From a practical standpoint, the offices were small, disorganized, and inefficient. Meanwhile, more and more of the individuals needing mental health treatment would inadvertently find themselves arrested and in nearby jails or correctional facilities, which became de factomental institutions; there have even been reports that LA County’s jails have become overrun with individuals needing social services and mental health support.5
The past few years have been particularly turbulent for the mental health department, particularly as a few different individuals have donned the role of director of mental health services for Los Angeles County. Director Marvin Southard — who’d been the director for 17 years — retired in late 2015, followed by the Department of Mental Health being consolidated with two other departments: the Department of Health Services and the Department of Public Health.6 Then in November 2016, Dr. Jonathan Sherin took on the title of director of mental health services, formally replacing Southard.7 Since then, Sherin has been extremely vocal about his plans for revitalizing the largest mental health department in the U.S. and the role it plays among Los Angeles communities.
Pioneering a Peer-Focused Approach
Residents who lived in the immediate vicinity of the mental health department will recall that the building, which was in pretty rough shape, had previously been surrounded by a tall chain-link fence. One of the first changes that Sherin made was to give the building a facelift, tearing down the fence and giving the building a fresh coat of paint. In a sense, these visual changes are representative of Sherin’s more philosophical changes. According to recent statements, Sherin intends to make the Los Angeles County Department of Mental Health more inviting to both those in need as well as individuals who have benefited from mental health services and could be a resource to others.
There will also be a focus on being available and accessible to people whose life situations are the most challenging. Of course, there are high rates of untreated mental illness among individuals who are homeless, but those who have been released from prison or jail and foster children are examples of other groups that are in dire need of social services and mental health support. Under Sherin’s leadership, representatives of the Department of Health believe that these populations will benefit from the increased focus.
Hoping to encourage collaboration between the mental health department and the surrounding communities, Sherin will offer training and certification as part of a peer-to-peer resource that will be a prominent offering at the mental health department. In fact, incorporating peers into the health department’s new strategy is one of the most important pieces of the puzzle, Sherin has said. “Whether [the individual has] been in the military or the streets, or in jails, those shared experiences create affinity.” Similarly, there are plans to instate what Sherin is calling ‘intentional communities’, which are essentially satellite installations of peer representatives who would be stationed throughout LA County (i.e., at the Veterans’ Affairs campus in West Los Angeles) to further expand access to resources.
There are currently more than 250,000 people receiving services through the LA County Mental Health Department. With more than 10 million county residents, one of the greatest difficulties that Sherin faces is having the staff to meet such huge demand. Fortunately, Sherin’s proposed budget for the next fiscal year includes roughly $2.5 billion to hire and train some additional staff members and workers.
Obviously, these changes can’t happen overnight. However, while revitalizing and expanding the mental health department is certainly a work in progress, those who are close to the project are unabashedly optimistic about the future.