Cross-Sectional Study of Homeless High Service Utilizers in Los Angeles County Jails: Race, Marginalization and Opportunities for Diversion.

Objective: To describe the demographic, legal, and clinical characteristics of a cross-section of incarcerated homeless individuals with the highest utilization of Los Angeles (LA) County public services in order to increase opportunities for focused jail diversion. Methods: The "5% list" (N=5,905 in February 2018), LA County's list of homeless individuals with the highest 5% utilization of public services, was cross-matched with the total jail population to obtain a sample of 333 homeless high-utilizing individuals. This sample was compared with the overall jail population (N=17,121) from publicly available aggregate data by Chi-square testing. Results: 84% of the high-utilizing sample were male, 38% Black, 37% Hispanic, 21% White. 67% were prescribed psychiatric medication. Compared with the overall jail population, the sample was significantly older, with a greater proportion of Black and White persons, and a lesser proportion of Hispanic individuals relative to the overall jail population. A significantly greater proportion of high-utilizing individuals faced misdemeanor charges. Conclusion: These data highlight the compounding effects of homelessness, race, and mental illness on carceral and social vulnerability. Findings suggest homeless high utilizers in jail with mental illness are likely to benefit from court-based diversion efforts aimed at housing and treatment.

Differential Incarceration by Race-Ethnicity and Mental Health Service Status in the Los Angeles County Jail System.

OBJECTIVE: This study analyzed race-ethnicity and arrest charge data from the Los Angeles (LA) County jail mental health (JMH) population to examine disparities by race and ethnicity. METHODS: Data from the LA County Sheriff's Department for all persons in the JMH population on February 14, 2019 (N=5,134), and for the overall LA County jail population (N=16,975) were compared with chi-square tests (p≤0.05 for binary measures and Bonferroni correction for multiple comparisons). RESULTS: The JMH sample had a significantly larger proportion of black (41% versus 30%) and white (19% versus 15%) persons and a smaller proportion of Hispanic persons (35% versus 52%), compared with the overall jail population (p<0.001). A significantly smaller proportion of the JMH sample was charged with a felony (80% versus 91%, p<0.001). CONCLUSIONS: Resources should be invested in prioritizing jail diversion of black individuals with mental illness and addressing the incarceration of persons with mental disorders charged with misdemeanors.

Decriminalization in action: lessons from the Los Angeles model.

Los Angeles County's Office of Diversion and Reentry (ODR) has removed over 3800 people from the largest jail system in the country. Across various diversion programs, ODR's fundamental goal is to provide permanent, lifetime care for each diverted person. This article describes ODR's various diversion programs, and elucidates the types of elaborate clinical and court-related interventions that are necessary to remove persons with serious mental disorders from jail custody. As Los Angeles continues to build the necessary community-based continuum of mental health care, ODR's model proves that thoughtfully removing persons with serious mental disorders from jail is possible and necessary for the health of both patients and community.