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No one has a “right” to die on our sidewalks

By Kerry Morrison

July 16, 2014

You see that guy every day.  He sits with a mountain of stuff at the bus bench.  Even on a hot day, he seems to be wearing all that he owns.  He’s been there for years.

People who know I’ve inserted myself into the homeless issue will ask, “Why can’t people like him be helped?”

I couldn’t begin to answer that question until recently.  In Hollywood, we’ve committed ourselves to changing these individuals’ stories.  Last year we identified our “Top 14” in Hollywood: 14 severely vulnerable people who remain homeless despite our best intentions.

So why can’t they be helped?  First, we’ve learned that these people have no voice in our systems.  As a result, no one is held accountable for their health and safety.  They become invisible by any meaningful societal measure.

Second, many of them are either not enrolled or not engaged with our county Department of Mental Health (DMH).  For some individuals, DMH or their contractors have determined that they are unwilling to engage or are “non-compliant,” and essentially dis-enroll them from care.  Third, even if the police or a county clinician has detained them for a “5150 hold” (danger to self or others), the system almost always releases them back to the streets, sometimes within hours.

It sounds like a maze with no exit.  Nevertheless, Hollywood 4WRD, a small but determined coalition of people in Hollywood, decided to enter the maze.  We wanted to knock some holes in the wall.  We wanted to save some people before they died on our streets.

Our first big move was a by-name homeless registry conducted over three nights in 2010.  The registry removed the anonymity of those left sleeping on our streets.  We knew their names, had their photos and knew a little about their history and situation.  This represented a sea-change in Hollywood. (The photo above is “Janice”, who used to live on Whitley.  For months, we only knew her as “Jane Doe.”  She was on the Top 14 list, and is now successfully housed in a local board & care home.)

In March 2013, we reconvened to check our progress in housing these individuals.  We documented that 190 people listed in the registry had been housed with help from public and private partners.  A nagging question remained: Despite this progress, why do our ‘anchor homeless’ neighbors, the ones we see day in, day out, remain on the street?

We selected 14 people who fit this description and committed ourselves to changing their stories.  All but one of the 14 suffered from mental illness.

In the 15 months since we selected our Top 14, we’ve been able to help three individuals find permanent shelter: One is under the care of the Public Guardian in an assisted living facility, one lives in a board and care home, and one has an apartment.

The rest?  Two people have died on the streets of Hollywood.  The most recent, “Trudy,” spent several weeks hooked up to a ventilator in a local hospital after our BID Patrol found her unconscious in a Hollywood alley.  Three are missing.  Six remain homeless, despite our best intentions.

It should not be this hard.

Through our work, we identified three roadblocks to helping the long-term homeless.

First, Health Insurance Portability and Affordability Act (HIPAA) constraints should be loosened to allow family members or concerned community members to have a greater say in the plan to care for a person living on the street.  HIPAA is well-intentioned, but to apply this “protection” to a mentally ill person slowly dying on the sidewalk is ludicrous.  When a DMH representative cannot discuss a homeless person’s care with engaged neighbors because of HIPAA constraints, this protection has turned into a penalty.

Second, psychiatrists who make the decision to hold a person for 72 hours should make that decision at the place where the person is living.  They must come to the street to see the “informed decisions” this person has made about their sidewalk domicile, often surrounded by feces, urine, rotting food and insects.  Currently, a psychiatrist makes a decision about whether to hold a person during a 15-minute slice of that person’s life, after that person has been fed, showered and clothed.

Finally, the county must create more psychiatric beds for individuals who need treatment.  The only options for the mentally ill in our communities are to be detained in our jails and prisons, or sent back to the street.  A hospital will release a person brought in under a 5150 (72 hour hold) because there’s no place to put them.  A 5250 hold, which would allow 14 days of observation and care, is almost impossible to secure.  A 5270 for a 30-day hold?  You have a better chance of winning the lottery.

In Hollywood, we’re tracking all the twists and turns of systems that leaves the most vulnerable among us on our streets.  Let’s see where we are with the Top 14 a year from now.

Kerry Morrison is executive director of the Hollywood Property Owners Alliance.  She serves as a Mayoral appointee to the Los Angeles Homeless Services Authority (LAHSA) and blogs at www.onlyinhollywood.org.

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