Expanding the Toolkit: Mental Health Diversion in Los Angeles

By Chidinma Ume and Brett Taylor

Los Angeles is home to the largest jail population in the United States. Even before COVID-19 underlined the negative health impacts of clustering so many vulnerable people together in significant numbers, local government had begun to wrestle with the challenges of jail overcrowding in Los Angeles. Much of this effort has focused on individuals with mental health needs—in 2016, 25 percent of the inmate population in Los Angeles was receiving some kind of mental health treatment. In recent years, this figure has crept up to roughly 33%. Some critics have pointed out that the Los Angeles county jail system has become, de facto, the largest mental health facility in the United States.
 
The effort to reduce the population of people with mental health needs in LA County’s jail was given a major boost in 2018 when state lawmakers passed Assembly Bill 1810, which provides a pathway for individuals with behavioral health conditions to enter treatment before any charges are filed. Upon successful completion, the charges against defendants would be dropped. The message to counties across California was clear: Invest in diversion.
 
In Los Angeles, a group of local decision-makers—including judges, prosecutors, and public defenders— has taken up this challenge. They have come together around a simple idea: linking misdemeanor defendants with mental health needs to supportive services instead of jail. To transform this idea into reality, they turned to the MacArthur Foundation. Through the Foundation’s Safety + Justice Challenge, Los Angeles received a two-year, $1.2 million grant to help support screening and services. 
 
Operating out of the Clara Shortridge Foltz Criminal Justice Center—LA’s highest volume criminal court—the AB 1810 Pilot began in June 2019.  Consistent with the aims of the legislation, the pilot is a pre-plea model—defendants do not have to plead guilty in order to participate in treatment.  The goal is to facilitate program placement before arraignment, taking advantage of a window of opportunity when individuals may be uniquely open to engagement in treatment. 

How It Works

The pilot is designed to serve people whose unmet needs may lead them to encounter the court system frequently. The only exclusions are sex offenses and domestic violence charges. Most of the participants have cycled between mental health facilities and custody environments for years and many are homeless. 
 
A typical case involves someone who has been arrested on a petty theft charge with a history of schizophrenia. A prosecutor from the Los Angeles City Attorney’s Office, which handles all misdemeanors filed in the City of Los Angeles, reviews cases in the morning and makes a determination about which cases they are willing to divert. The public defender then interviews the defendant to assess if the defendant is appropriate and willing to participate in diversion. (The defense attorney will reject cases if defendants’ needs are too severe; the pilot does not take cases where competency may be an issue.)
 
If the defendant agrees to participate, they then receive a clinical assessment from the Department of Mental Health. A staff member from Project 180, a local non-profit, performs the role of service navigator, matching clients with treatment providers in the community. Participants typically receive services for mental health—both residential and outpatient—as well as alcohol and substance abuse. Project 180 provides case management services, including warm hand-offs to treatment providers, transportation, and reminders for court appearances.  
 
There is no minimum amount of time that a person needs to stay in the program to be considered a success. Thus far, the sweet spot seems to be six months of engagement in treatment. Those who make it to this benchmark graduate from the program and have their cases dismissed.  
 
The results thus far are encouraging. After the first eight months, roughly 80 people have entered the program. To date, the majority of participants have either graduated from the program or remain in treatment. Participants who have completed their involvement have remained in stable housing and some have obtained employment. 
 
As the program approaches its one-year anniversary, Los Angeles is looking to grow the pilot, bringing the approach to additional arraignment courts and expanding the caseload to include felonies as well as misdemeanors.  

Lessons

While the AB 1810 pilot is still in its infancy, several lessons have already emerged:
 
Collaboration – The initiative’s greatest strength is that it is the product of a unique joint effort that has managed to overcome the turf issues, policy differences and political concerns that often foil cross-agency partnership efforts. The initiative is led by the LA County Public Defender’s Office, which provides a project coordinator to help manage the initiative. Key criminal justice partners include the Los Angeles City Attorney’s Office, the Department of Mental Health, LA Superior Court, the Los Angeles Sheriff’s Department, the Probation Department, and the Los Angeles County District Attorney’s Office. Assembling and maintaining this collaborative has required a great deal of legwork and shuttle diplomacy. In addition, many of the key partners have made site visits to New York City to observe operating programs created with the help of the Center for Court Innovation. These visits enabled the Los Angeles team to ask their peers in New York about the opportunities—and challenges—presented by inter-agency collaboration 
 
Integration of Services–The AB 1810 pilot seeks to connect individuals with mental health needs to supportive services more often and more quickly than ever before in Los Angeles. This wouldn’t be possible without the active engagement of the County’s health agencies. In particular, the pilot seeks to embed mental health professionals into the courtroom, offering clinical assessments on site. Another crucial partner is Project 180, a community-based non-profit that has agreed to out-station personnel in the courthouse. Project 180 effectively plays a resource coordination role, serving as a bridge between the courtroom players and off-site treatment providers. 
 
Judicial Engagement–Judge Michelle Kim presides over the AB 1810 pilot. She sees clients when they return to court to report on their progress. Case updates happen on a weekly basis, although not all cases are updated each week. In her engagements with participants, Judge Kim takes care to model procedural justice–speaking in plain language and offering participants the opportunity to tell their own stories.  She also regularly offers praise, acknowledging participants when they succeed. Judge Kim also presides over graduation ceremonies, presenting graduates with certificates and offering public remarks. Prior studies suggest that the role of the judge can be a crucial one, helping to motivate success in treatment and enhancing defendant perceptions of the court.
 
External Funding–The MacArthur Foundation’s Safety + Justice Challenge helped galvanize planning efforts in Los Angeles. MacArthur’s contribution went beyond money—the act of putting together a proposal gave focus and energy to the collaboration, helping all of the parties in Los Angeles agree on the basic contours of the new initiative.  
 
Chidinma Ume and Brett Taylor are part of a technical assistance team from the Center for Court Innovation providing consulting services in Los Angeles, helping local stakeholders conceive and implement the mental health diversion pilot. The MacArthur Foundation's Safety and Justice Challenge is funding the consulting services.