A Paradigm Shift in Justice Reform: Alternatives to Incarceration

By Mark Ridley-Thomas

As a close observer of LA County’s criminal justice system for over four decades, I know one thing is clear: “You cannot get well in a cell.”

Over a year ago, I joined Supervisor Kuehl in establishing a working group of our brightest thinkers to help us envision what a system that focused on alternatives to incarceration could and should look like.

This week, the landmark “Care First, Jails Last” report submitted by the Alternatives to Incarceration (ATI) Work Group to the Board of Supervisors created a road map for reforming our criminal justice system. The importance of this paradigm shift cannot be overstated. What underlies this work is a moral obligation to provide critical care to those in need and to make our communities safe.

As we proceed in implementing meaningful and long-lasting alternatives to incarceration, I’m proud that we aren’t starting from scratch. At the Martin Luther King Medical Campus in Willowbrook we have multiple examples of models that can be replicated countywide.

On any given day, more than 3,300 people struggling with mental health disorders in our jails are legally suitable and clinically eligible for diversion to community-based treatment programs, according to a study by the non-profit RAND Corp.

This reality is what drove the design of the Behavioral Health Center which is set to open at the MLK Campus later this year; and when it does, it will be the most striking demonstration of Los Angeles County’s growing focus on treating – instead of jailing – people with serious clinical needs caught up in the criminal justice system. It will offer a range of subacute, acute and crisis residential beds to house those being diverted from jails, as well as wrap around services ranging from psychiatric in-patient treatment to outpatient services, job training and peer mentorship programs to help those who would have otherwise landed in a jail cell. The ground floor will offer multi-system triage with urgent care services for those with medical, mental health and substance use issues.

The Behavioral Health Center is perhaps the most striking example – but not the sole example on the MLK medical campus of ways to scale a “Care First, Jail Last” philosophy.

Over the past 12 years later, we have built a campus in South Los Angeles filled with the infrastructure and programs that are designed to address both acute and chronic health and mental health crises, how and when individuals need it most.

Here are some other examples:

• The Psychiatric Urgent Care Center, when it opened in 2014, was the first of seven such facilities that are now available countywide to help people in the throes of a serious mental health crisis. This center is accessible for drop-offs by law enforcement and medical practitioners as well as walk-ins 24/7 by any member of the community. It has become a safe haven for police officers who used to have no other choice but to take the individual experiencing an acute psychotic episode to jail. Now they have another option.
• We also repurposed an existing dormitory into a 100-bed Recuperative Care Center on the MLK Campus which allows homeless medically fragile individuals who are ready to be discharged from the hospital a place to rehabilitate before they are connected to affordable housing with supportive services.
• We opened the Community Healing and Trauma Prevention Center through the Department of Public Health, the first center in the County charged with preventing violence at its roots.
• And there is more coming. Next year, we plan to open the County’s first Family Justice Center to provide wrap-around services to victims and families of domestic violence.

The resources on the MLK Medical Campus reflect some of the diverse tools that exist to stop the cycle of jails to hospitals to the streets, but it doesn’t stop there.

We need to scale up diversion strategies like the sobering center, the only one of its kind in the County, which we piloted in Skid Row, dedicated to people struggling with substance abuse disorders.

Moreover, as the Board approved last year, we must scale the County’s Office of Diversion and Reentry (ODR), which has so far diverted 4,600 people from jail into long-term care and supportive housing, with very low rates of reoffending. The cost: $70 per person per day, compared to the $600 for incarceration.  Through ODR, we have seen the ways that diversion, coupled with effective treatment, can be a homelessness prevention strategy. Almost all ODR diversion program participants remain in housing after six months. This is significant, as incarceration too often exacerbates and worsens health, employment and housing outcomes.

Of the ATI report’s 114 recommendations, about two-thirds call for scaling up or improving programs already existing in Los Angeles County. Besides being humane, these solutions have been proven to save taxpayer money without compromising public safety.

We have a template for what works. Now is the time to expand, deepen and refine.

Governor Gavin Newsom has shown his interest in doing so. Having seen the success of our local diversion and reentry programs, he has proposed $25 million in this year’s budget, and $365 million over six years, to replicate its work across the state.

It is long past time for us to stop people from cycling in and out of jail with no support, only to end up languishing on the street, homeless.

And as we do this work, we must continue to be mindful of the opportunities to confront systemic racism and promote racial and economic justice. We must not forget that black people make up less than a tenth of the County’s population but constitute about a third of its homeless population and about a third of its jail population as well. This is why my appointee to the LAHSA Commission led the process to produce a ground-breaking report on Black People Experiencing Homelessness. I now applaud the ATI report’s thoughtful approach and commitment to racial equity. Each recommendation – whether on policies, programs, training or contracts – is centered on identifying, monitoring and achieving racial justice. This must become a model for our County, and country.

With the ATI report, we have a cohesive vision of a system of care that promotes health and safety – for everyone. The task at hand is to implement the key strategies laid out in the ATI report with thoughtfulness and urgency.

It is time that we stop turning away from people who are suffering and instead implement data informed support systems that help patients to heal. The County’s medical campuses – dispersed in all geographic corners – are prime locations to begin to scale up this work. In fact, Governor Newsom’s Council of Regional Homeless Advisors, which I co-chaired with Mayor Steinberg of Sacramento, released a Comprehensive Crisis Response Strategy in January, which highlighted this very recommendation – that the State encourage localities to capitalize on assets within medical campuses to scale up the response to the twin crises of homelessness and mental health.

I am confident we have the political will, the brain power, the partnerships, and the resources to make a “Care First, Jail Last” system not just a vision but a reality. Let’s use this report to work harder and smarter, so that all Angelenos can achieve a life of dignity and worth, rather than have their potential stunted because of long-standing failed policies.