A group of Los Angeles County and nonprofit leaders became believers during a 2017 trip to the famous Italian mental health system.
Treatment in the city of Trieste targeted the whole person, not just the disease, and services were available around the clock. Psychiatrists made house calls, families were heavily involved in care, and no one was sitting in a storefront trash can.
Visiting officials were so united in their mission to import models to Los Angeles that they called themselves a “tribe.”
However, the relationship became strained as the purity of the idea collided with real-world challenges. Solidarity turned into finger pointing. It’s been six years since his first visit and four years since the state awarded him $116 million to launch his program in Hollywood, a Trieste-inspired pilot. Not a single dollar has hit the streets. The project has not started yet and is under revision.
Dr. Jonathan Sherin, then director of the Los Angeles County Department of Mental Health, was a founding member of the tribe. Shortly before stepping down as head of the department on July 1, he described the fatigue of attacks over the project and the inflexibility of his former collaborators, whom he described as purists sitting on the sidelines. expressed.
“It’s easy to be in the Peanut Gallery,” Sherin said. “Get in the cauldron.”
The stalled Trieste plan stands as a prime example of the opposition pulling on the nation’s largest mental health agency, with even a $3 billion budget severely constrained by overwhelming caseloads and sheer volume of testing. , augmented visions frequently run into the daily reality of being tested. Officials.
These pressures will influence the county’s decisions about who should replace Sherin. is in favor of finally getting the post permanently. Anyone who does, however, will face many of the same dilemmas that Sherin faced.
When county officials appointed 57-year-old Sherin to the position in 2016, he was hailed as a visionary.
As a student, Sherin planned to become a neurosurgeon. However, during his senior year of medical school at the University of Chicago, he enrolled in electives at the Institute of Psychiatry and became obsessed with caring for people with schizophrenia and other mental disorders.
Following his newfound passion for psychiatry, he began a residency at UCLA in 1998. Training there intertwined with the VA’s medical center in West LA.
While there, Sherin noticed that veterans often ended up back in hospitals or landed on the streets or in prisons, even though the team went to great lengths to help them. .
As Sherin became vocal about the need to do a better job, his responsibilities grew, and he eventually became the head of psychiatry and mental health at the West LA campus.
A few years later, Sherin held a similar post at the Miami VA and served as Vice Chair of the University of Miami Psychiatry Department. He then returned to Los Angeles to serve as chief medical officer for the nonprofit Volunteers of America before returning to West LA VA as a campus master. I was.
County officials hope Sherin’s background and passion will breathe new life into a system crippled by a legacy of neglect, and make up for his relative inexperience pushing huge bureaucratic levers. There was
Sherin sought to reinvent the system and implement holistic care defined by connection and humanity. This is the approach we witnessed in Trieste. Assuming this position, he quickly shifted his department’s focus to treating the most vulnerable patients, especially those suffering in prisons and homeless camps.
Sherin and others say his transformation plan was hampered by the intransigence of the bureaucracy he was tasked with leading.
“He wanted to make changes much sooner than the bureaucracy wanted him to,” said Heidi, who worked with Sherin before stepping down as executive director of the Los Angeles Homeless Services Authority in late May.・Marston said, “It’s not that I’ve been trying hard.”
In addition to Sherin and Marston, the county’s Director of Children and Family Services will also be stepping down at the end of 2021. Critics question whether the Los Angeles County Oversight Board’s “care first, jail last” agenda can be implemented. aims to divert many of the 5,700 mentally ill inmates in county jails to community programs.
However, Sherin’s critics see his desire for rapid transformation as an obstacle.
Mental health advocate Kelly Morrison, who organized the trip to Trieste, questioned whether Sherin had enough managerial experience for his high-powered post.
“The CEO of the LA Phil isn’t Gustavo Dudamel. He’s the artistic director,” she said figuratively. “The CEO runs the business.”
County Superintendent Kathryn Berger said Sherin is in a position to make a difference.
“As the director of the division, you are the leader,” Berger said. “You have the ability to really dismantle that bureaucracy, and you see department heads doing it.”
Still, he “definitely took the department to new heights,” she said.
Berger rejected the idea that the board would stifle progress.
Complicating Sherin’s tenure is one that also points to the political pressures county department heads sometimes have to deal with, involving a public corruption case against former supervisor Mark Ridley Thomas. doing.
Federal prosecutors have confirmed that Sherin is not under investigation in the case. Also, he has not been accused of any wrongdoing. But prosecutors say he took actions that were key elements of the case, alleging that Ridley Thomas and Marilyn Flynn, the former dean of social work at the University of Southern California, were involved in a illicit conspiracy. increase.
Prosecutors believe that starting in 2017, not long after Sherin began her tenure as department head, Ridley Thomas pressured Sherin into committing public affairs, including a lucrative contract with USC for a mental health division telemedicine clinic. accused of pressured him to commit violent acts.
In return, Flynn gave Ridley-Thomas’ son Sebastian many benefits, including a full tuition scholarship, employment as a professor, and routing campaign funds through USC to Ridley-Thomas’ son’s non-profit organization. says the prosecutor.
Ridley-Thomas has been accused of continuing to rely on Sherin well into 2018. In July of that year, county supervisors unanimously approved the telemedicine contract. Sherin said he could be a witness in the Ridley-Thomas criminal trial scheduled for March.
While dealing with the pressure of suspicion, Sherin was trying to change the direction of the department’s staff. He drove people accustomed to office jobs into his filthy homeless camp, trying to connect with clients with severe mental illness.
He pioneered guardianship hearings on the street through video conferencing. He promoted therapeutic vans and created a well-received public education campaign called “Why We Rise.”
Jim Zenner, a former homeless veteran who was mentored by Sherin and now works for the county’s Department of Mental Health, said there was an outflow of staff who resisted Sherin’s efforts.
Senior officials, including members of the supervisory board, held back, Marston said.
“He said he needed a psychiatrist to hit the streets. The position was funded by the state, but he still couldn’t make it,” Marston said. He had an org chart that took months, if not years, to approve.”
However, Sherin earned a strong loyalty from some of the employees who accepted his approach. Zenner said that with his resignation he “definitely felt he lost the champion”.
Some of the same conflicts played out in the long-running debate about the Trieste model.
In 2019, the California Mental Health Services Act Oversight Board, which oversees $2 billion annually in state funding, committed $116 million to a five-year pilot program aimed at bringing Trieste principles and practices to Los Angeles. was awarded.
But its most ardent supporters have distanced themselves from it, as Sherin helped shape the project to the parameters allowed by state and county structures.
From the outset, some experienced service providers wondered if this model would work in Los Angeles as well. Trieste, a city of 200,000 on Italy’s northeastern Adriatic coast, is free of raging methamphetamine epidemics and housing crises.
“It just doesn’t make sense to think that you can suddenly bring in a culture of radical hospitality and solve that problem,” Sherin said. “It’s not based in reality, and we knew it was coming in.
Morrison, on the other hand, believes that “these principles can certainly be adapted to local conditions.”
Dave Pilon, who wrote the Trieste grant application, said the proposal hinged on working outside Medicaid, which is notorious for drowning its staff in paperwork. Working with Medicaid funds typically spends 25% to 35% of his time among his members of staff on recordkeeping and documentation, he said.
But the pandemic has brought with it a cascade of economic uncertainty. In April 2021, Sherin asked the Oversight Board to make Medicaid funding available to the project. County officials at the time were under the impression that COVID-19 would significantly reduce available funding, he said.
The exact opposite happened — state revenue soared. In retrospect, the funding change “probably wasn’t necessary,” Sherin said, adding, “I’m not happy about it.” or delayed this project” is completely irrelevant.
When Morrison learned that the proposal had changed, she asked Sherin to correct the pilot’s name. Now called Hollywood 2.0.
In November, the oversight board voted to proceed with the pilot, including allowing county mental health departments to hire staff.
Whoever takes over the department will face many of the same problems as Sherin.
It is widely agreed that decades of underinvestment, neglect and misguided regulation have created a fragmented and woefully inadequate mental health system. Berger, the county supervisor, said 15 years ago, no one in Sacramento touched the mental health law.
One silver lining of the pandemic is that it has put mental health in the spotlight.
Marston, the former head of the Homeless Authority, said the county needs to give anyone they choose the breathing room to succeed.
“They need to give those people the authority they need to get the job done,” she said.
Times Staff Writer Matt Hamilton contributed to this report.