Until February, for 22 years, I managed a business improvement district around the Hollywood Walk of Fame — a top destination for global tourists that bears witness to our country’s abandonment of people struggling with severe and untreated mental illness.
Daily, I’d see the faces of shocked foreign tourists walking past ragged people huddled in doorways or sitting half-naked on a bus bench yelling at the traffic.
They’d come to visit one of the wealthiest countries on the planet, only to be assaulted by the heartbreaking sight of human misery playing out on one of the world’s most famous streets.
These people were homeless not because of rising housing costs or losing a job, but on account of untreated mental illness, in some cases exacerbated by substance abuse.
The American mental-health system is broken beyond repair. To tweak or fix around the edges is as futile as filling potholes on a highway to nowhere.
It is a system that values institutional preservation and risk management ahead of meeting the human needs of those it is supposed to serve. It marginalizes families and friends who are in a position to help. It thrives on regulations, and shackles the discretion of workers who, given the opportunity, would lead with the common-sense instincts guided by their hearts.
In this system, fear rules the day — fear of violating privacy laws, fear of violating someone’s civil right to sit in their own feces on the sidewalk, fear of providing desperately needed services that might be ineligible for Medicaid reimbursement.
We are afraid of the very people we are expected to serve.
Three years ago, I received a two-year study fellowship to research a better path forward for caring for people with severe mental illness.
For the first year, I searched in the US, and though I found bright spots — places, programs and heroic people who try to “MacGyver” human-centered programs into our system — the system ultimately wins.
Then I went overseas, to a remarkable city where fear is replaced with radical hospitality. A place where the best human instincts of staff are liberated to connect with the users of their mental-health system as fellow human beings.
The World Health Organization has recognized the system in Trieste, Italy, as a global best practice of mental-health care. It’s built upon managing the aspirations of the whole person, tapping into family support, facilitating social inclusion and believing in the human right to a purposeful life.
After closing their 1,200-bed asylum in 1980, the citizens of Trieste created a community-based system of care to integrate people back into their neighborhoods. Their culture of mutual respect and protection of human dignity is breathtaking. This is the system promised after deinstitutionalization in America, but never actualized.
In Trieste, police are not the first responders to a mental health crisis; psychiatrists come to the scene and situations are diffused with less trauma to all involved. Involuntary hospitalization is rare.
The city, with a population of 240,000, has only six psychiatric hospital beds, and they are in an unlocked ward where attending staff wear plain clothes. The community mental-health center collaborates with its users to create life plans that lay out goals for work and social activities.
Individuals whose severe mental illness precludes independent living may reside in congregate housing with 24-7 care. Unlike the institutional feel of our adult residential facilities, these places are home-like. Residents are encouraged to participate in neighborhood clubs, and there are house chores and pets.
Last month I returned from an international conference in Trieste, joined by representatives from 44 countries. Speakers shared their experiences pursuing the Italian-inspired model on several continents. Trieste is a pilgrimage destination, because it serves as a reminder of what is possible for our fellow human beings.
Los Angeles County is now collaborating with the Trieste system. We’re seeing what we can learn, seeking to try something bold and new.
On a visit last fall, colleagues from Trieste toured Los Angeles’ ground zero for human suffering, Skid Row. The extent to which we’ve allowed people to deteriorate on our streets far exceeds anything you will see in Trieste, where there is virtually no homelessness.
One psychiatrist told me, “You may think you closed the asylum in America, but we just walked through an open air asylum.”
It’s time to stop filling potholes. Let’s pave the new road forward.
Kerry Morrison is now leading the community-engagement effort to push for a mental-health-reform pilot program in Hollywood.