OutPatient Conservatorship (OPC) Study: Addressing Mental Health Disability in Unsheltered Homelessness

Addressing Mental Health Disability in Unsheltered Homelessness: Outpatient 2 Conservatorship in Los Angeles

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Highlights:

• Los Angeles County’s outpatient conservatorship (OPC) pilot program used a population health approach, multi-system care coordination, and prioritization of least restrictive environments to address mental health disability among individuals experiencing homelessness.

• At 12 months, 81% of clients were no longer experiencing unsheltered homelessness, and 65% accessed an LPS conservatorship.

• Compared to usual care, the OPC intervention demonstrates untapped opportunities to minimize time spent in highly-restrictive settings for individuals experiencing grave disability.

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Abstract Objective:

This paper describes a pilot program for gravely disabled individuals experiencing unsheltered homelessness in Los Angeles County (LAC) that illustrates a promising public health framework to address mental health-related disability in homeless populations. Homeless outreach teams implementing the outpatient conservatorship (OPC) pilot adopted a population health approach, multi-system care coordination, and prioritization of least restrictive environments. The pilot allowed initiation of LPS conservatorship outside of a hospital, with the goal of serving highly vulnerable individuals in least restrictive settings.

Methods: Using observational program evaluation data, we describe its impact on a small sample of participants served in the first year. Results: At 12 months, 81% of OPC clients were no longer experiencing unsheltered homelessness; 65% accessed an LPS conservatorship. While most OPC clients utilized a psychiatric hospital, 54% left locked settings earlier than would have been possible without the pilot. One-third of clients referred for LPS conservatorship used unlocked licensed residential facilities in the first year. Negative events, such as remaining in unsheltered homelessness, were more common among clients not referred for LPS conservatorship.

Conclusions: Timely receipt of street-based services and coordination of care before, during, 3 and after referral for LPS conservatorship reduced use of restrictive settings. The OPC program’s components comprise a promising triadic framework for addressing mental health related disability among unsheltered individuals that warrants further investigation.

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