AILSA CHANG, HOST:
Too often, people living with mental illness have run-ins with the law. They end up in jail and eventually on the street. Los Angeles County has the nation's worst homelessness crisis. Nearly 60,000 people live without shelter here. The county also has one of the nation's largest jail systems, including one of the biggest mental health jails.
This morning, we heard about overcrowding and rough conditions there, and now NPR's Eric Westervelt takes us inside a small but promising program in LA. It's trying to break that cycle of jail and homelessness for people with serious mental health disorders.
ERIC WESTERVELT, BYLINE: On a recent morning, LA Superior Court Judge Karla Kerlin is thankful for the day's relatively light load - just three dozen files sitting on her desk. On some days, the stack obstructs her courtroom view.
KARLA KERLIN: And who has the file DAs on Barclay (ph)?
WESTERVELT: Judge Kerlin oversees the city of LA's Diversion and Reentry housing court. It's a relatively new effort by the county to try to get more people with a mental illness who are homeless diverted from jails and off the streets. It funnels them into treatment and supportive housing. Kerlin takes up the case of Angie Barclay, a 57-year-old with a long arrest history, according to court records, including for thefts, narcotics possessions and prostitution. And there's her latest charge.
KERLIN: Assault with a deadly weapon - in this case, a knife. This is a felony, also a serious felony, which means it is a strike.
WESTERVELT: Barclay sits stoically in the defendant's chair in a blue jail jumpsuit. In any other courtroom, she would likely continue to cycle between jail and the streets. But today Judge Kerlin wants to try to end that pattern. She starts by calling the courtroom psychiatrist to the bench for a sidebar talk.
UNIDENTIFIED PERSON: So her diagnosis is bipolar 1 disorder. She is doing well, actually. I saw her a few weeks ago - a little bit flat, blunted. But she's a really sweet woman.
WESTERVELT: She's taking her medications. She's improving, the psychiatrist tells Kerlin. The judge decides to give Barclay a chance at the housing and treatment program despite objections from the prosecutor.
KERLIN: All right, Miss Barclay. Let me confirm that this is what you'd like to do because it's a lot more extensive than just being on regular probation. First, you would be conditionally released, which means you don't just walk out of jail. Someone comes and picks you up. They take you to your housing. You get housing. It's not locked down, but I want you there every night.
WESTERVELT: And you have to keep taking all your meds and attend all your counseling sessions, the judge adds. Barclay agrees to the terms with a quiet yes.
KERLIN: Any questions? All right. Good luck to you. I hope it works out, OK? Welcome to the program.
WESTERVELT: This is the more humane alternative to the warehousing of people with a mental illness in the city's Twin Towers Jail, an overcrowded, long-troubled facility where critics say too few people actually get well. But this diversion program is risky. Some in it have committed serious crimes. Judge Kerlin.
KERLIN: There's a lot of weapons involved. There's a lot of - you know, like, someone's walking down the street. They're mentally ill. They're not medicated. They come up on someone and whack them with a metal pole or something. That's a very common fact pattern. So it's very dangerous, but I have to assess whether it's safer to treat the person and keep close tabs on them and have them in a program where they're cared for and get housing versus just sending them to prison. At some point, they'll be released and be back out on the streets unmedicated. So which is safer?
WESTERVELT: So far, since LA launched the Office of Diversion and Reentry four years ago, it's helped transition nearly 4,500 people from jail and off the streets into community services, including housing.
(SOUNDBITE OF DOOR CREAKING)
WESTERVELT: At a large house in a peaceful Central LA neighborhood, some of the 22 men who live here are watching TV or just hanging out. Nearly 80% of the people in this diversion program are living with at least one serious mental health disorder. About 40% have both mental health and substance use disorders. Here, treatment looks a lot different from what they got at the Twin Towers. There's no locked gate, no guards at the door - only a binder for signing in and out.
RYAN IZELL: Everybody's connected to a case manager and a therapist once they come in.
WESTERVELT: The program's housing director, Ryan Izell, says the concept is simple. Humans need community, a home and, when ill, quality care.
IZELL: So there are clinicians, psychiatry onsite as well as nursing staff to make sure that we can provide support with people with taking medication as well as additional staff that are available to just kind of provide day-to-day support and make sure that the house is operating well.
WESTERVELT: Unlike the Twin Towers Jail, this house has calm, quiet and privacy. Twenty-one-year-old Halel Feldman, who goes by Finn, is reading in his room. He's been in the program about a year. Like all men in this house, Finn was judged incompetent to stand trial. His felony charges include assault and vandalism.
FINN FELDMAN: I saw a lot of different visual hallucinations that really affected my day-to-day life.
WESTERVELT: Finn is getting, in the words of the court, restored to mental competency here instead of in a jail or a state hospital. If he successfully completes this two-year diversion program, his case will be completely dismissed. If not, his criminal case will be reinstated. At age 16, Finn says he was diagnosed with schizophrenia.
FELDMAN: My head wouldn't stop shaking. My head doesn't shake anymore - thank God - because of the medication they have me on. I don't go through the suicidal thoughts that I used to. I don't go through voices as much. Like, I'm in a very good headspace - better than jail.
WESTERVELT: So far, the program shows promise, and it's saving money. The county says jail costs almost five times more than inpatient housing. The biggest challenge is scaling it up to meet the massive need. Psychiatrist Kristen Ochoa is the Office of Diversion and Reentry's medical director.
KRISTEN OCHOA: I mean, I think that the average person must see that something needs to change. It's so apparent that the numbers are growing.
WESTERVELT: The number of people with a mental illness in jail is growing for reasons that include California's homeless, housing and substance abuse crises. And then there's state prison downsizing that was ordered by the court and voters. That sent thousands of people into already overcrowded county jails, including LA's. Psychiatrist Kristen Ochoa.
OCHOA: In terms of the jail mental health population of Los Angeles County, we did a study, and we think that more than half of them would be eligible for interventions that would release them from jail and put them into care and housing if those services existed.
WESTERVELT: That's nearly 60% of those behind bars who could go to this diversion court. The county estimates they'd have to add thousands of beds the first year to begin to try to meet that need. And diversion doesn't work for everyone.
OCHOA: I had a guy who ran down the street the day of drop-off, which was, like, quite a visual.
WESTERVELT: Judge Karla Kerlin notes that this program so far has a far lower recidivism rate than county jail, but she does see some of the same faces circling back through, and she sees some of them wipe out.
KERLIN: You know, I'm very disappointed when someone I know picks up a case or have had a couple of deaths, and it's heartbreaking. And there have been people I've had to terminate from the program, and that's heartbreaking as well. But the successes are fantastic, and it just makes you see that this can be done and is worthwhile and people's lives better.
WESTERVELT: But expanding these diversion programs will take more than money and political will. Advocates here say it will also take more compassion for people living with a mental illness cycling through homelessness and jail.
Eric Westervelt, NPR News, Los Angeles.
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