Los Angeles County supervisors talked for years about how it might make more sense to provide lower-cost healthcare at outpatient clinics instead of sending ambulatory patients to costlier beds at county hospitals. They talked — but did nothing until the mid-1990s, when soaring hospital costs pushed the county close to bankruptcy. The Clinton administration bailed L.A. out, in the process requiring more clinics and fewer hospital admissions. The result was better and more appropriate patient care, smarter spending and, not inconsequentially, fiscal solvency.
So if it took near-bankruptcy for the county to finally wise up on healthcare, what is it going to take to get the supervisors to finally move mentally ill offenders from costly and dangerous jail beds to more appropriate, more effective and less expensive community-based treatment?
The question has to be asked yet again, as on Tuesday the supervisors are set to discuss options for housing accused and convicted mental patients. The proposals include tearing down the dungeon that is Men's Central Jail and replacing it with a more "campus-like" facility. But though it could be more humane, it would still incarcerate just as many mentally ill inmates as Men's Central. In other words, despite years of talk about how it would be better for the patients, public safety and the county's bottom line to divert more mentally ill people from jail altogether, the supervisors appear to have no intention of actually doing any diversion. It's as if they got the 1990s healthcare bailout but kept using the federal money to expand inpatient hospitals. The added irony in this case is that the county would actually get more federal money for treating more patients outside of jail.
Is anyone surprised? Even with the Justice Department breathing down their necks over poor treatment of ill inmates, the supervisors asked for mental health treatment plans not from experts in recidivism or treatment but from a jail construction firm. The proposals naturally revolve around constructing jails.
Let's be clear: Men's Central does indeed need to be put out of its misery and replaced with a facility that includes treatment space for mentally ill offenders who are too dangerous to be diverted to community treatment. But any competent study must discuss protocols for distinguishing between those who could and those who could not be successfully and safely treated in community clinics. It would then project how many costly jail beds for the mentally ill will still be needed, and how much savings can instead be reaped by using a wiser non-jail diversion program. And it would be based on diversion programs already underway — if only the county would actually begin some. Other jurisdictions do it, and they save money and stop sick people from cycling in and out of jail. When will L.A. wise up?