Latest / Brain Stories / Episode 18 - Brain Stories Connections: Judge Jim Bianco: A Model for Solving Homelessness and Mental Health

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Episode 18 - Brain Stories Connections: Judge Jim Bianco: A Model for Solving Homelessness and Mental Health · Brain Stories

• 0:00
  SPEAKER_01: Today on Brain Stories, we're bringing in a judge.
• 0:03
  SPEAKER_01: His name is Jim Bianco, and he works in Los Angeles County.
• 0:07
  SPEAKER_01: But his courtroom is highly irregular.
• 0:11
  SPEAKER_01: First of all, it has more psychiatrists than any court I've ever been in.
• 0:15
  SPEAKER_01: That's because the first qualification for coming in front of Jim is having a serious mental health issue.
• 0:21
  SPEAKER_01: The second is having no housing.
• 0:23
  SPEAKER_01: And the third is being charged with a serious crime.
• 0:26
  SPEAKER_01: That's almost always related to using drugs.
• 0:29
  SPEAKER_01: And the flavor of the month for the last ten years has been methamphetamines.
• 0:34
  SPEAKER_01: So the people who come before Jim have the equivalent of four strikes against them, a mental health issue, no home, a drug addiction, and criminal charges.
• 0:44
  SPEAKER_01: What's more, most of them have already been in this position often.
• 0:49
  SPEAKER_01: The odds of anything good coming out of this look terrible.
• 0:53
  SPEAKER_01: But the results of what starts in Jim's courtroom look astonishing.
• 0:58
  SPEAKER_01: And Jim believes the program to which he sends many of the people who stand before him can and may well already be turning around one of the most frustrating and intractable problems this country faces.
• 1:11
  SPEAKER_01: The program has an advertising budget zero, so despite what appears to be spectacular success, almost no one outside of it has heard of it.
• 1:20
  SPEAKER_01: Prepare to be the first one on your block.
• 1:22
  SPEAKER_01: Here's Jen.
• 1:24
  SPEAKER_01: We're here to talk about one of the most remarkable programs in mental health care in the nation.
• 1:29
  SPEAKER_01: It's LA County's, Los Angeles County's Office of Diversion and Reentry.
• 1:34
  SPEAKER_01: What's being diverted and what is the re-entry piece?
• 1:38
  SPEAKER_00: So the Office of Diversion and Reentry is a county agency that is tasked with helping the most seriously mentally ill, highest risk, highest need population in the county jail to be released from the jail into wraparound housing and services to help that person uh do better and to help that person not re-offend in any way.
• 2:03
  SPEAKER_00: So to try to divert them out of the jail, out of the criminal justice system, and into long-term housing and health.
• 2:11
  SPEAKER_01: Why should people with a mental illness get any kind of like it sounds like it could be something, you know, special?
• 2:16
  SPEAKER_01: Why should they get diversion?
• 2:17
  SPEAKER_01: Why shouldn't they just have to do jail time?
• 2:18
  SPEAKER_00: You know, what we find is people who are in jail with a serious mental illness, who've been living on the streets, tend to have cycled through the system a number of times already.
• 2:29
  SPEAKER_00: So, you know, the idea is let's try something different.
• 2:33
  SPEAKER_00: And what we found over the past 10 or so years is that by providing people with really good care, with housing, with robust medication support, um, people thrive and they tend to change course to be on a path where they're not doing the sorts of things that got them into jail in the first place.
• 2:54
  SPEAKER_00: And, you know, ODR is remarkable in many ways.
• 2:57
  SPEAKER_00: One of the things that that ODR does is provide people with housing for life.
• 3:02
  SPEAKER_00: Uh permanent supportive housing, typically, where they're, you know, they're they're living in an apartment where they've got a team on the first floor that are there to help them uh kind of stay on track.
• 3:13
  SPEAKER_00: And it's uh, you know, over the last 10 years, they've proven that what they're doing is uh remarkably successful.
• 3:20
  SPEAKER_01: That sounds life-changing.
• 3:22
  SPEAKER_01: Housing for life, just right there.
• 3:25
  SPEAKER_00: You know, you sometimes hear people say, oh, well, homeless people don't really want housing.
• 3:30
  SPEAKER_00: That is absolutely a myth.
• 3:32
  SPEAKER_00: And I think the quite to the contrary, uh, homeless people very much want to have housing.
• 3:39
  SPEAKER_00: And so that's a huge incentive for folks to do the work that's required to succeed in a program like ODR.
• 3:47
  SPEAKER_00: How and when did ODR get started?
• 3:51
  SPEAKER_00: Um it's a great story, really, because I was involved all the way at the beginning, I think just by happenstance, but the person that really uh started the whole process was the DA at the time, Jackie Lacey.
• 4:05
  SPEAKER_00: Jackie was a pretty traditional career prosecutor.
• 4:09
  SPEAKER_00: She had worked in the DA's office uh much of her career, uh, and and saw that the way that people with serious mental illness were being treated in our justice system wasn't quite the way that it should be.
• 4:22
  SPEAKER_01: Uh what does that mean it wasn't quite the way that it should be?
• 4:24
  SPEAKER_01: What was she?
• 4:25
  SPEAKER_00: She felt like there were people that uh were being processed through the criminal justice system in sort of the usual way, if you will, that really deserved to have something different, um, that needed help and didn't necessarily have opportunities to get that help, and that by uh treating them the same way as anyone else in the criminal justice system, we were sort of missing an opportunity to address someone's issues in a way that might help them not recidivate, not be back in the criminal justice system.
• 4:57
  SPEAKER_00: So Jackie got this task force together and it included DAs, it included defense lawyers, it included lots of clinicians, uh, there were some judges.
• 5:06
  SPEAKER_00: So I got involved.
• 5:07
  SPEAKER_00: Uh, you know, I was pretty new to mental health, but it seemed kind of interesting.
• 5:11
  SPEAKER_00: And there were lots and lots of law enforcement.
• 5:13
  SPEAKER_00: And I think uh that was one of the things that I found most interesting is these were police officers and deputy sheriffs, you know, at leadership levels from all over LA County.
• 5:23
  SPEAKER_00: And they were speaking the same tune that everyone else was, which is that something needs to change.
• 5:31
  SPEAKER_00: And they were very much aware of the fact that people with mental illness did not have access to treatment.
• 5:37
  SPEAKER_00: And what they would see is all the officers and and deputies in their departments um would have to deal with this lack of treatment and the fact that people really needed help and and they didn't have a lot of options.
• 5:49
  SPEAKER_00: And so out of that task force came uh a document that was written by the DA's office, but it was the work of the whole task force.
• 5:57
  SPEAKER_00: It was called the Blueprint for Change.
• 5:59
  SPEAKER_00: And it essentially recommended creating an agency that was ODR.
• 6:04
  SPEAKER_00: And the Board of Supervisors uh uh thought it was very compelling, and that's how ODR started.
• 6:13
  SPEAKER_00: What year was that?
• 6:15
  SPEAKER_00: Uh 2014.
• 6:16
  SPEAKER_01: So as of this recording, it's a little more than a decade old at this point.
• 6:20
  SPEAKER_00: Right.
• 6:21
  SPEAKER_00: We just had a 10th anniversary celebration uh right at the beginning of the year.
• 6:26
  SPEAKER_00: Over that time, the latest number is uh they've gotten 16,549 people released from jail into supportive community treatment.
• 6:36
  SPEAKER_00: And that's as of uh the end of last month, August 2026.
• 6:41
  SPEAKER_00: So that's a pretty significant number and I think a huge accomplishment.
• 6:47
  SPEAKER_01: That's a lot of people.
• 6:48
  SPEAKER_01: I'm just thinking of the statistics that I remember, and correct me, correct me if I have this wrong.
• 6:52
  SPEAKER_01: I think there's about 13,500 people in Los Angeles County prisons right right now.
• 6:59
  SPEAKER_01: So if there's 16,000 people who've been through this, that's a lot of people.
• 7:03
  SPEAKER_01: And I think of that of that 13,500, I think there's almost 50% have a serious mental health disorder at this point.
• 7:12
  SPEAKER_00: It's close to that, right.
• 7:13
  SPEAKER_00: It's in the high 40s, which is a pretty incredible number.
• 7:17
  SPEAKER_01: Yeah.
• 7:17
  SPEAKER_01: I'm really interested that law enforcement got behind it.
• 7:20
  SPEAKER_01: And you talked about it a little bit, but can you just say a little bit more about why?
• 7:23
  SPEAKER_01: What why was it in their interest?
• 7:26
  SPEAKER_00: They're the ones that are on the street and they're, you know, dealing with people that are unhoused and have untreated mental illness.
• 7:34
  SPEAKER_00: And, you know, frankly, these are people that cause all sorts of uh the need for police response.
• 7:41
  SPEAKER_00: And, you know, when police show up, what do they do?
• 7:45
  SPEAKER_00: Right?
• 7:45
  SPEAKER_00: Their options were if the person committed a crime, take them to jail.
• 7:49
  SPEAKER_00: Or if they needed mental health treatment, take them on a 51-50 hold to a psych hospital.
• 7:55
  SPEAKER_00: But, you know, neither of those are solutions which really address the problem.
• 7:59
  SPEAKER_01: Why wouldn't a psych hospital address the problem?
• 8:02
  SPEAKER_00: Well, you you know, the criteria for holding someone in a psych hospital is such that people might get treated for a short time and then released.
• 8:12
  SPEAKER_01: And once another revolving door, it's just not jail, but it's just another revolving door.
• 8:17
  SPEAKER_00: Absolutely.
• 8:18
  SPEAKER_00: And and I and I can tell you that anyone living on the streets, even if they have access to a psychiatrist and can somehow fill prescriptions and you know get their medication, there's no way for them to stay on medication.
• 8:29
  SPEAKER_00: Their stuff gets stolen.
• 8:31
  SPEAKER_00: They're just I've never seen in in all the years I've been working in in uh the mental health world, I've never seen a person that's unhoused successfully stay on medication long term.
• 8:42
  SPEAKER_01: Yeah, that's so hard under the best of circumstances.
• 8:45
  SPEAKER_01: That's a great point.
• 8:47
  SPEAKER_01: So I know legally you can't talk about any specific individuals or cases, but tell me what you know uh the average person who walks into your court is like, let's let's call her Jane Doe.
• 9:00
  SPEAKER_01: Um paint me a portrait of Jane.
• 9:02
  SPEAKER_00: I mean, I'll answer that question, but let me just say, you know, what I saw very quickly when I started working with people with mental illness is there is no one size fits all.
• 9:10
  SPEAKER_00: So everyone's got different needs.
• 9:12
  SPEAKER_00: They have different sort of, you know, aptitudes.
• 9:15
  SPEAKER_00: Some people with mental illness, you you say, uh, something's not quite right.
• 9:18
  SPEAKER_00: Some people with mental illness, you know, you would never have any idea they were taking medication or had mental health needs.
• 9:24
  SPEAKER_00: But I I think, you know, to paint a picture of sort of the atypical person, let's say this is a person who has been untreated, has schizophrenia, has been living on the streets, let's say, for four or five years.
• 9:39
  SPEAKER_00: Uh, it can sometimes be a whole lot longer.
• 9:41
  SPEAKER_00: But without treatment, let's say Jane hears voices.
• 9:45
  SPEAKER_00: She's kind of paranoid.
• 9:47
  SPEAKER_00: She's been living on the streets, which is really dangerous.
• 9:50
  SPEAKER_00: Homeless people get preyed upon quite a lot.
• 9:53
  SPEAKER_00: Uh, the most dangerous time, as you can imagine, is at night.
• 9:56
  SPEAKER_00: And so somewhere in the in the time Jane was living on the streets, you know, someone offered her some methamphetamine and she tried that.
• 10:04
  SPEAKER_00: And that actually, you know, first of all, took away some of the misery of being on the streets.
• 10:09
  SPEAKER_00: It also kept her up all night so that she was able to kind of look out for herself at a time when she otherwise might be sleeping and really vulnerable.
• 10:17
  SPEAKER_00: And once she started using meth, it was extremely difficult to stop using.
• 10:22
  SPEAKER_00: So, you know, the meth just made her mental health symptoms that much worse, right?
• 10:27
  SPEAKER_00: The voices, the paranoia, that was all kind of exacerbated by using meth.
• 10:33
  SPEAKER_00: So she was hearing voices and, you know, thought a person was following her on the sidewalk, a complete stranger, thought that person was out to get her and turned around and hauled off and whacked her and hurt the person.
• 10:47
  SPEAKER_00: You know, the person suffered, let's say, a broken nose for no reason at all.
• 10:52
  SPEAKER_00: So Jane got arrested.
• 10:54
  SPEAKER_00: She's charged with a felony.
• 10:55
  SPEAKER_00: She's now been in jail for, I don't know, let's say three months.
• 11:00
  SPEAKER_00: And so ODR became aware of Jane because they keep track of the folks in the jail.
• 11:05
  SPEAKER_00: They're tasked with helping not just all mental health, mentally ill people in the jail, they're tasked with helping the most uh sick people in the jail.
• 11:15
  SPEAKER_00: And so the jail kind of gives people a sort of an acuity score based on their mental health needs.
• 11:22
  SPEAKER_00: So Jane would have been among the sort of most psychiatrically sick people in the jail.
• 11:28
  SPEAKER_00: They identify Jane, they look at her records to see how she's been doing in jail, whether she's been taking medication, how she's responding to that medication.
• 11:37
  SPEAKER_00: They'll look at the police reports so they'll get a sense of what the case is about.
• 11:41
  SPEAKER_00: And what they'll see about Jane, if she's a typical person coming through my court, um, is that Jane has cycled through the system many times before.
• 11:49
  SPEAKER_00: So Jane, you know, has had other criminal arrests.
• 11:52
  SPEAKER_00: She's been arrested for felonies and misdemeanors, she's been on probation, she's been to prison.
• 11:58
  SPEAKER_00: And what they'll also see is that Jane has been amenable to treatment and that when she's on medication, she does really well.
• 12:06
  SPEAKER_00: So they'll recommend Jane, the case will eventually be transferred to my court for consideration.
• 12:11
  SPEAKER_00: And then we'll see Jane on a day when we have a whole team in court from ODR and and uh uh we're I'll ultimately make a decision about whether to release Jane to the ODR program.
• 12:24
  SPEAKER_01: And that's that's where you come in, is that you're the one who's actually you're the one who's actually overseeing that process.
• 12:30
  SPEAKER_01: You're the judge in in the courtroom who's saying Jane will go into the ODR or she will remain in jail and essentially incarcerated and getting whatever she gets there, but probably being released and probably returning.
• 12:44
  SPEAKER_00: Right.
• 12:44
  SPEAKER_00: So if Jane stays on the sort of non-ODR track, you know, her lawyer will try to connect her with some other program.
• 12:52
  SPEAKER_00: If uh her lawyer's not uh successful in doing that, uh and she's convicted, then she'll, you know, receive some sentence.
• 13:01
  SPEAKER_00: She's you know getting credit for the time that she's spending in jail, uh, but she might have you know some additional time that's imposed either in jail or prison, depending on the case, depending on you know how the judge sees it.
• 13:14
  SPEAKER_01: It really strikes me as you're describing it that that when when Jane walks into your courtroom, this is when her life can go in two different directions.
• 13:24
  SPEAKER_00: Yes.
• 13:24
  SPEAKER_00: This is an opportunity for her to really change course in her life.
• 13:28
  SPEAKER_00: And you know, the amazing thing about ODR is probably about 50% of the people that I give a chance in ODR do great right out of the gate.
• 13:38
  SPEAKER_00: No issues.
• 13:39
  SPEAKER_00: You know, they work with their team, they do the the hard work that the program requires, uh, and they really do change the course of their lives and get to their own housing and uh and and I think are out of the criminal justice system at that point on a long-term basis.
• 13:56
  SPEAKER_01: That's really remarkable.
• 13:57
  SPEAKER_01: And as long as we're here, the so 50% sort of work out really easily.
• 14:02
  SPEAKER_01: What happens to the other 50%?
• 14:04
  SPEAKER_00: Though those are folks that, you know, may struggle.
• 14:07
  SPEAKER_00: So they're coming to court, they're, you know, not doing well, they're you know, struggling with substance use, maybe not following the rules at housing, um, sometimes not taking their medication.
• 14:18
  SPEAKER_00: So we're gonna really try to intervene and help that person get on track.
• 14:23
  SPEAKER_00: I think the most common thing that happens when people don't succeed in ODR is they just leave.
• 14:28
  SPEAKER_00: So they walk away from the program and they'll end up getting arrested.
• 14:32
  SPEAKER_00: They'll be back in custody, and then they'll be back in court for me to decide whether to give them a second chance in the program.
• 14:39
  SPEAKER_00: And often second chances are granted, depending on the circumstances.
• 14:43
  SPEAKER_00: And so I would say out of the remaining 50%, probably something like 20 or 25% eventually do change course, do get on track and succeed, get their cases dismissed, and end up in their own uh permanent housing.
• 14:59
  SPEAKER_00: Um, so I would say overall, you know, 50% do great right out of the gate.
• 15:04
  SPEAKER_00: Another 20 or 25%, you know, struggle but get it right uh eventually.
• 15:09
  SPEAKER_00: And then, you know, there's a group that uh just never seems to to turn the corner, usually ends up going back to criminal court after uh lots and lots of efforts to try to help them correct course.
• 15:22
  SPEAKER_01: Yeah.
• 15:22
  SPEAKER_01: I mean that's uh that's that's a a loss, of course.
• 15:27
  SPEAKER_01: And 70 to 75 percent is a is a huge, it strikes me as a huge number, an incredible success rate, especially as I said, the most difficult community to work with is people who live with serious mental disorder and have a substance use issue.
• 15:40
  SPEAKER_01: And all the numbers I've heard in that are so much lower than uh in terms of success rates with that that particular community.
• 15:48
  SPEAKER_01: So I I'm struck by something else too.
• 15:50
  SPEAKER_01: So you when someone comes into when Jane appears in your courtroom for the first time, you're starting a process that is involving intensive treatment, a lot of support, a lot of clinical support, and eventually um and and housing and eventually their own housing.
• 16:07
  SPEAKER_01: Um, but you're seeing them a lot.
• 16:10
  SPEAKER_01: I mean, I think like most judges, they're they're they're famous for saying, like, I never want to see you in this courtroom again.
• 16:15
  SPEAKER_01: You're sort of just the opposite, right?
• 16:18
  SPEAKER_00: Yeah, I really like uh having people come to court for check-ins.
• 16:22
  SPEAKER_00: It's interesting because a lot of these folks have not had good experiences in court.
• 16:27
  SPEAKER_00: You know, I'm trying to change that because I think that positive reinforcement makes a much bigger difference to people.
• 16:34
  SPEAKER_00: I think a lot of these folks have never had positive influences in their lives.
• 16:38
  SPEAKER_00: You know, they've dropped out of school, their parents, you know, were around or not, or and and and are maybe long gone.
• 16:44
  SPEAKER_00: To hear that they're doing a good job from you know a guy sitting in a up on a bench with a robe on, uh, I think sometimes is meaningful and can really, you know, be one of the many, many influences that help them stay on track and and really uh change their lives.
• 17:02
  SPEAKER_00: And you know, one of the things that I think I find amazing is the folks that struggle and to see how they struggle, uh, and and you know, there are times when I really wonder, are we at the end of the road?
• 17:15
  SPEAKER_00: You know, do I is it time for me to give up on this person?
• 17:19
  SPEAKER_00: And to see that sometimes when I think, oh, all is lost and this person's not going to turn the corner, sure enough they do.
• 17:26
  SPEAKER_00: And when that happens, it's it's amazing.
• 17:29
  SPEAKER_00: And I and I think it's a tribute to all of the folks that are working with that person day to day when they're in the ODR program, you know, really supporting that person, really continuing to believe in that person and their ability to change course.
• 17:43
  SPEAKER_00: Um, I think sometimes uh it seems like the person may be the last one to see their own potential when all of us can see, you know, we we still think this person can turn the corner.
• 17:54
  SPEAKER_01: Yeah, that's so that's so interesting.
• 17:57
  SPEAKER_01: And and it sounds so true.
• 17:59
  SPEAKER_01: And just to plug brain stories for a moment, we actually did a story about Michael Stewart, who was homeless and had a very long addiction with crack and for years.
• 18:10
  SPEAKER_01: And it wasn't until he was 59 years old that he actually got into a mental health diversion program and his life completely changed.
• 18:17
  SPEAKER_01: And I don't want to spoil how the episode ends.
• 18:19
  SPEAKER_01: I'm gonna tell the listeners and viewers to go see it, go listen to it.
• 18:23
  SPEAKER_01: Um, but it's it's uh that never give up on the people thing is uh was really true in his story, and it sounds like you see it a lot.
• 18:31
  SPEAKER_01: You wrote a piece for the Los Angeles Times about um about what you called, you called yourself a mental health court judge.
• 18:39
  SPEAKER_01: How did you become a mental health court judge?
• 18:43
  SPEAKER_00: You know, it was never something I planned on or wanted.
• 18:47
  SPEAKER_00: Um I was a judge in downtown Los Angeles, the same courthouse I'm in right now, and I had been on the bench for eight years just doing criminal assignments, and that's that was my practice when I was an attorney.
• 19:00
  SPEAKER_00: And I thought I would stay a criminal judge for the rest of my career.
• 19:04
  SPEAKER_00: And one day, three supervising judges walked into my office at the same time, which is very unusual.
• 19:11
  SPEAKER_00: I was thinking I must have done something horribly wrong and tried to rack my brain thinking of, you know, what what is this visit about?
• 19:18
  SPEAKER_00: And they sat down and said, we want you to go to the mental health court.
• 19:23
  SPEAKER_00: Uh and, you know, at the time, that was a terrible assignment.
• 19:27
  SPEAKER_00: You know, it was in an awful courthouse.
• 19:30
  SPEAKER_00: Uh, no one really liked being in that assignment.
• 19:33
  SPEAKER_00: Uh uh to say it lacked prestige is really an understatement.
• 19:37
  SPEAKER_00: Uh and it just wasn't an area that I was really interested in.
• 19:43
  SPEAKER_00: Um, so I was really crestfallen, but you never say no.
• 19:48
  SPEAKER_00: And the committee.
• 19:49
  SPEAKER_01: Especially when you got three judges walking in your leg ganged up on.
• 19:53
  SPEAKER_00: Right, right.
• 19:55
  SPEAKER_00: And uh and so they they were looking for a two-year commitment, and and so I went to mental health uh and it it didn't take long before I decided this was really a great place to be.
• 20:09
  SPEAKER_00: Uh, I thought the work that was being done there was absolutely amazing.
• 20:13
  SPEAKER_00: I found the people that were coming into court to be, you know, very in need of help.
• 20:20
  SPEAKER_00: That was really compelling to me.
• 20:22
  SPEAKER_00: Like this was a place where everyone, the doctors, the lawyers, the judges were really about trying to help people.
• 20:30
  SPEAKER_00: And so it was really unexpected, but it was probably the best career turn ever in in my life.
• 20:37
  SPEAKER_01: That's really remarkable.
• 20:39
  SPEAKER_01: So let me just back up one second to say, so you'll actually see individuals, they they're there for two years.
• 20:46
  SPEAKER_00: Yes.
• 20:47
  SPEAKER_00: The court I'm in now, it's a two-year period.
• 20:50
  SPEAKER_00: So whether I know them uh from the past or not, uh they're gonna be in this court for about two years.
• 20:55
  SPEAKER_00: And so I'll I'll usually see them, you know, if they're struggling, I'll see them every couple weeks.
• 20:59
  SPEAKER_00: If they're doing great, uh, you know, then it may be every few months that that their uh case comes up for a check-in.
• 21:06
  SPEAKER_01: Ever have anybody come back after they've gone through and just report back in, hey, this is how I'm doing, Judge Jim, or whatever.
• 21:13
  SPEAKER_00: Yeah, uh, yeah, absolutely.
• 21:15
  SPEAKER_00: And, you know, one of the things that we started doing is holding graduation ceremonies.
• 21:20
  SPEAKER_00: Uh, and I was always kind of against it because it was just a way for people who are putting in on the program to feel good about themselves.
• 21:28
  SPEAKER_00: And, you know, politicians come and give speeches, and I just didn't see that it was worth anyone's time.
• 21:34
  SPEAKER_00: Um, but we we had a graduation and really made it about the graduates.
• 21:39
  SPEAKER_00: And we had graduates be the speakers.
• 21:42
  SPEAKER_00: We didn't let any uh you know politicians speak at all, although there's you know, some of them attended because they wanted to see what's going on.
• 21:48
  SPEAKER_00: So these are people who have graduated already in their court case, but now are coming back for a sort of more formal ceremony, and that is absolutely amazing to see uh you know people continue.
• 22:00
  SPEAKER_00: continuing to thrive uh and and and do well and you know of course they feel really good about their accomplishments and for for good reason you know there's one guy not long ago that um he he came to graduation and then came to court uh sometime after that and and is headed back to college and I have promised him I will come to his college graduation so I'm I'm very much looking forward to that well I want to talk for a second about the economics of of this program so it sounds like there's you know it's a lot of work two years housing clinician psychiatrist um a lot of support it sounds like it could be expensive how does that compare to actually you just having somebody do their time in in prison I I think there's really no comparison as expensive as ODR is you know in terms of providing housing and and all the other services they provide if you look at what it takes to pay for someone in this category to be in the jail you're talking somewhere in the$700,$800 a day category because they're in their own cell, they're uh you know getting medication and they need other support.
• 23:15
  SPEAKER_00: So it's just the jail time alone is extremely expensive.
• 23:19
  SPEAKER_00: But then if you look at it in terms of long-term outcomes, right, if someone's cycling through the system, you're talking about all these police costs and arrest course costs and additional jail costs.
• 23:31
  SPEAKER_00: And along the way maybe they'll go to a psych emergency room for care.
• 23:35
  SPEAKER_00: Those are all extremely expensive visits and those are all paid for by the county right we're all paying for those expenses and so by comparison ODR is a much more cost efficient way and a much more humane way to help people.
• 23:52
  SPEAKER_01: So why isn't this being seized by every single county town village all over the country or world and and being put into place?
• 23:59
  SPEAKER_01: I mean it just seems like this is a huge step forward.
• 24:02
  SPEAKER_00: I think setting up a program like this is a a huge lift.
• 24:06
  SPEAKER_00: I think it really helped us in Los Angeles County that the leader of this effort was the district attorney I I you know I just don't know of that happening in other places.
• 24:16
  SPEAKER_00: I think there are other uh counties and states that are trying to replicate ODR you know I had a number of judges from I think seven or eight different states around the country come and visit and and look at what ODR was doing uh you know and they were all really blown away.
• 24:34
  SPEAKER_00: I just think starting a program like this is not easy.
• 24:37
  SPEAKER_00: It takes a lot of coordination and you know the willingness to fund a program initially even though over time it will save a ton of money.
• 24:46
  SPEAKER_00: The housing piece is huge.
• 24:49
  SPEAKER_00: And you know ODR pretty early on figured out a way to address that both uh what we call interim housing which is where someone goes initially in the program and permanent housing you know the apartments where they they get support um and they've been really remarkably effective at building housing uh so they've got lots and lots of housing sites all over the county and I think other counties are starting to see that they need to do what ODR did um but again it's it's all a ton of heavy lifting yeah yeah the housing piece alone is huge it's um obviously something that's a gigantic national problem so clearly this program is better for the individuals they're doing much much better than they would if they were on the streets and um but what about public safety?
• 25:42
  SPEAKER_01: Is this actually better for public safety or worse?
• 25:46
  SPEAKER_00: I think it's much better for public safety because you're considering a population that you know is untreated, unhoused they tend to sort of reoffend over and over because of their circumstances and when they're in ODR and they're diverted out of the criminal justice system and and they you know change course in their lives so that they're not re-offending that's a whole lot better for public safety than the alternative because if they don't get ODR, most of these folks are not going to spend you know years and years and years in jail or prison.
• 26:23
  SPEAKER_00: They're going to spend you know maybe a year, maybe two years.
• 26:26
  SPEAKER_00: But you know eventually they're gonna be released from jail or prison.
• 26:31
  SPEAKER_00: Their connection to housing and services at that point is pretty much non-existent.
• 26:37
  SPEAKER_00: And so you're putting them back in the same circumstance uh that they were in when they originally offended.
• 26:44
  SPEAKER_00: And so chances are they're gonna reoffend and potentially hurt someone.
• 26:49
  SPEAKER_00: And so I I think ODR is a public safety program because it it really reduces the likelihood that someone is is going to engage in that same sort of conduct that uh landed them in jail in the first place.
• 27:04
  SPEAKER_01: So ODR is a way that we actually um disconnect or disrupt the revolving door people going in, doing their time and coming out no better than they were receiving no help to to to change their lives and resuming what they're doing including criminal activity.
• 27:20
  SPEAKER_00: Right.
• 27:22
  SPEAKER_01: What's your hope for for ODR in the future?
• 27:26
  SPEAKER_00: I mean I think it it should grow until it's really meeting the need.
• 27:32
  SPEAKER_00: So for instance right now um you know people in the jail are rated in terms of their psychiatric acuity from P0 to P4 and ODR focuses on the P3s and P4s.
• 27:47
  SPEAKER_00: There are plenty of people at the P2 level that would do really well in ODR and could really use that help.
• 27:54
  SPEAKER_00: Give me a sense of what P2 means in terms of a human being P2 means that this is someone let's say with a serious mental illness like schizophrenia who is taking uh psychotropic medication in the jail um but they're they're sort of doing well enough taking that medication every day uh they're doing well enough that they don't need to be in a cell by themselves they could be in what's called a dorm setting so those are folks with serious need they may be homeless uh or uh and they may have substance use needs but they're able to do well enough in the jail that they are no longer part of the target population for ODR.
• 28:36
  SPEAKER_00: ODR would very much like to be able to help those folks if they had enough funding to be able to do that.
• 28:41
  SPEAKER_01: Yeah.
• 28:43
  SPEAKER_01: If there was one thing that you wanted viewers and listeners to take away about ODR, what is that?
• 28:50
  SPEAKER_00: I think that ODR is an incredible example of what's possible.
• 28:54
  SPEAKER_00: What we're seeing on our streets is the result of closing uh institutions in the 60s and 70s.
• 29:01
  SPEAKER_00: And those institutions were horrible.
• 29:03
  SPEAKER_00: This was really the right move.
• 29:05
  SPEAKER_00: We were planning to build out a community mental health system uh to be able to meet the needs of the folks that were uh being released from those institutions but we never did that and you know now 40 or 50 years later we're seeing the consequences of that and so I think ODR is a great start in terms of digging ourselves out of that hole but there's just so much need for expansion of the sort of work that ODR does.
• 29:31
  SPEAKER_00: And it's not just in Los Angeles it's all over California it's all over the country.
• 29:37
  SPEAKER_01: This is the sort of uh work that really needs to be done to meet the needs of of people uh that are otherwise going to be living on the streets and yeah that's that's really extraordinary that that that ODR is finally addressing the great deinstitutionalization that started I think with the Kennedy administration back in the 60s took maybe a great leap forward during the Reagan administration and while we're wounding up with this huge homeless population with a lot of serious mental health disorders.
• 30:08
  SPEAKER_01: Finally we're actually getting around to we're having a program addressing it and helping some people is that is that really what's happening right now?
• 30:15
  SPEAKER_00: Absolutely.
• 30:16
  SPEAKER_00: And you know what's happened is the longer someone goes without treatment when they need it, the longer someone lives on the streets, their needs continue to grow and the the ability to treat them becomes more and more challenging.
• 30:31
  SPEAKER_00: And so you know ODR does an amazing job of providing a whole wraparound set of services.
• 30:37
  SPEAKER_00: So it's helping the person with their mental health needs, it's helping them with their substance use needs, it's giving them housing, but it's also addressing all of the physical health issues that people have you know we all need to see the doctor, right?
• 30:51
  SPEAKER_00: But most people who are living on the streets don't see a doctor regularly and you know right and may have developed all sorts of other physical ailments.
• 31:00
  SPEAKER_00: The quicker we can help people get back on track the the the less work it is I certainly think ODR is a is an example of how to do that work.
• 31:12
  SPEAKER_00: For listeners or viewers who would like to find out more about ODR or and maybe how to how to you know begin advocating for one where they live um where would you send them I'd say look at the ODR website there's some good information online some videos about the program if you just Google uh Office of Diversion and reentry you'll you'll get right to it.
• 31:34
  SPEAKER_01: Thank you so much for taking the time to talk today Jim and thank you for coming on Brain Stories Connections.
• 31:40
  SPEAKER_00: This was incredibly illuminating it's absolutely my pleasure thanks for having me