The conference room in Trieste fell silent. Attendees couldn’t believe their eyes. On the big screen were photos of Hollywood residents living in the street, huddled under blankets and covered with grime. Their mental and addiction problems were evident. The photos depicted the status of the homeless in Hollywood and greater Los Angeles where one quarter have mental illnesses, and thousands are endlessly shuffled from streets to jails to hospitals and back to the street again. An average of 3 die every day. About 5,000 mentally ill people are locked up in jails at any given time. In the richest country on the planet, this was the underbelly of the capital of film and imagination.
The Los Angeles Times recently told the story of a woman named Kerry Morrison who had seen enough. She quit her job to devote full-time, unpaid, to her cause. She joined boards, reached out to mental health professionals, researched mental health policy and what went wrong in the United States, and checked out programs in other U.S. cities and in Europe. It was her trip to Trieste in NE Italy that turned her despair into hope. In Trieste she found a mental health model in which every patient was looked after and no one was left to pitch a tent and fend for himself.
When mental institutions were closed in Italy and the United States about 40 years ago, Trieste innovated while the U.S. abdicated on the promise of community clinics. Under the leadership of a psychiatrist named Franco Basaglia, Trieste built a coordinated network of treatment centers, embraced patients as full-fledged members of the community, invited family members to participate in recovery, built relationships with employers who hired patients, and didn’t let bureaucracy or billing entanglements sabotage good outcomes.
When someone has a psychotic episode in Trieste and there’s a call for help, usually a mental health team responds, not the police, and the team often has already built a relationship with the client. The doors of community mental health facilities in Trieste are not locked; if patients choose to leave, staff members keep in contact with them to be sure they remain connected to help. Involuntary commitments are rare; when people have easy access to regular care and begin to know and trust health care providers, they are easier to treat. They are less likely to resist therapy and medication, and their conditions are less likely to deteriorate.
Ms. Morrison brought a delegation of mental health and government representatives to observe the system in Trieste. In five days, there they didn’t see a single homeless person in Trieste, a city that also does not have a significant drug epidemic. It will be extremely challenging to bring Trieste’s model to Los Angeles where so many with serious mental illness also have debilitating addictions…and live in tents (if they’re lucky) on the street. Funding and staff shortages are major obstacles. “We have 40 times the population of Trieste and 50 times the challenges,” Morrison stated.
But she is undaunted. The Los Angeles delegation will start with a pilot project. It will involve at least a year of planning—identifying urgent care and community health centers, recruiting businesses to participate, convincing residents that improvements will become a community asset, hiring clinicians and outreach teams, and finding enough housing to give the pilot a fighting chance.
Brava, Barbara. Come va? Felice Thanksgiving.
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