A History of Mental Health in LA

May 3, 2021

One thing I’m very excited about in @MayorofLA’s budget: A multidisciplinary street medicine team dedicated to CD4.

LA doesn’t directly provide health care -- it’s the purview of the County. And mental health care in particular is a major gap in our current system.  Over the past half century, disinvestment in mental health care has exacerbated our homelessness crisis.

Psychiatric drugs allowed people to leave inpatient hospitals, but deinstitutionalization wasn’t matched with enough investment in community-based careState legislatures began disinvesting in state-run psychiatric hospitals in the late 60s, shifting the cost burden onto federal programs like Medicaid. 

But under Reagan, federal spending on mental health care declined significantly, leaving many with nowhere to turn. Absent adequate funding, the only place many people suffering from mental illness could receive consistent treatment, cruelly, became jails and prisons.

Outside our criminal justice system, resources became scarce and serious conditions were left untreated.  CA began addressing this gross inadequacy in 2004 by imposing a 1% tax on personal income over $1 million for mental health programs. County Measures H and J are helping as well.But several structural issues remain, especially when it comes to people experiencing homelesseness.

One problem with our current health system is that our city’s unhoused pop. tends to not get its fair share of resources. While 70% percent of LA County’s unhoused residents live in the City of LA, funds are often allocated according to our overall pop., which is closer to 40%.

Another issue is that care for MediCal patients receives matching federal funds -- but many homeless people are not enrolled in the program. As a result, health care for unhoused people is disincentivized, and often limited to funds remaining *after* serving MediCal clients. 


Our office is making up for these structural inequities through a direct contract for more County services. Our multidisciplinary team (MDT) will be composed of five specialists representing physical health, mental health, substance use, case management, and peer support. I’m really excited about the impact this will make in our district, but we also need more sweeping structural change.

One state bill, AB369, could really help by extending a presumption of MediCal coverage to all people experiencing homelesseness in CA. We already extend presumptive MediCal eligibility to pregnant women. It’s a no brainer to do the same with people experiencing homelessness.

The bill would also enable medical care to come directly to unhoused people by adding street medicine as a Medi-Cal benefit.

Street medicine has been shown to lead to 2/3 decreases in costly hospital admissions. It also dramatically improves housing placement. In LA, such teams have successfully transitioned 42% of their patients into permanent housing.

I fully endorse Mike Bonin's and Kevin De Leon's recent resolution in support of AB369, and hope you’ll advocate alongside me for its passage.