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RESEARCH WEEKLY: August Research Roundup, California Edition
By Elizabeth Sinclair Hancq
(August 31, 2022) Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about severe mental illness and summarizes recently published research reports or developments.
DATAPOINT OF THE MONTH
$45.9 billion spent by State Mental Health Authorities on mental health care in 2020, $7.2 billion in California alone
According to data published by the Substance Abuse and Mental Health Services Administration, State Mental Health Authorities (SMHA), the entities that receive federal block grant funds to provide public mental health care in each state, spent a total of $45.9 billion dollars in Fiscal Year 2020. This includes $7.2 billion in California alone. To see the SMHA expenditures in your state, click here.
RESEARCH OF THE MONTH
California conservatorship can help get homeless individuals with mental illness off the streets
A Lanterman-Petris-Short (LPS) conservatorship is a legal mechanism in California that mandates long-term intensive mental health treatment for individuals with grave disability who require long-term assistance for making mental health decisions and lasts for one year. Applying for an LPS conservatorship is an extremely long and difficult process requiring multiple steps for the referring facilities.
Almost 40% of involuntary holds in California are attributable to a small number of individuals who have had five or more repeated shorter-term holds, which includes many individuals who experience homelessness. This small number of individuals can utilize a large amount of public resources, cycling in and out of emergency departments, short-term psychiatric hospitalizations and housing supports. LPS conservatorship is a potential way to prevent the revolving door of homelessness and hospitalization that some individuals with severe mental illness experience.
New research conducted by authors from the University of California, Los Angeles and published in Psychiatric Services indicates that an LPS conservatorship can reduce homelessness among individuals with severe mental illness who are gravely disabled. In an analysis of 849 patients admitted to a safety-net psychiatric hospital in downtown Los Angeles, the researchers found that homeless individuals that met the state’s grave disability standard were less likely to be unsheltered upon discharge from the hospital. However, their length of stay in the hospital was much longer than for individuals who were not LPS conserved, in part due to the wait for appropriate placement, according to the authors. But being homeless upon admission increased the length of stay in the hospital, regardless of whether the individual was ultimately conserved, according to the results. The percentage of patients who were homeless when admitted to the hospital increased over the course of the study period, from 2016 to 2018, indicating a growing need for greater supports post-discharge.
Care Courts, which were expected to be authorized with the passage of the CARE Act through the California legislature this week, have the potential to address this service gap as they are less restrictive than LPS conservatorship and is a form of community treatment, outside of the hospital. Importantly, the CARE Act also includes a provision that allows referrals to be initiated by family members and other loved ones, opening up initiation into court mandated treatment to other entities besides police or hospitals.
Choi, K. R., et al. (June 2022). Mental health conservatorship among homeless people with serious mental illness. Psychiatric Services.
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