Commentaries from the Edge: Mental Health on the Frontlines
Episode #9: The HOME Team
In Los Angeles, California, there exists a “City within a City” where its citizens live and die on the streets. The numbers are staggering. At the last approximate count, over 75,000 people are struggling to survive unhoused, and thousands are dying each year. In response to this humanitarian crisis, LACDMH launched a pioneering and innovative initiative known as street psychiatry — a program often referred to as a “radical solution.” This approach provides critical medical and therapeutic care directly on the streets, creating a kind of outdoor emergency room.
On this episode, we hear from Aubree Lovelace, Chief Administrator of the HOME (Homeless, Outreach, Mobile, Engagement) Team. The HOME Team comprises psychiatrists, social workers, nurses, and peers who dedicate their efforts to saving lives as part of their daily work. In upcoming episodes, several HOME Team members will share their experiences confronting the most critical situations among those living on the streets. They work with individuals experiencing severe mental illness who are unable to meet their most basic needs.
Referrals to the HOME Team often come from other homeless outreach providers, law enforcement officers, family members, and community members. The program’s successes — such as helping individuals accept medications to stabilize their mental health — have led to its growth. Stabilization often marks the first step toward housing, reconnection with family, and reintegration into society.
The work of the HOME Team not only provides immediate relief but also reduces costly hospitalizations, clinic visits, and incarcerations. Expanding this dedicated team of mental health professionals is vital to addressing the crisis on the streets of Los Angeles.
Episode #10: HOME and Shayan Rab
Dr. Shayan Rab ventures where few psychiatrists have gone: into the streets where Los Angeles’ unhoused population fights to survive. He describes his work as “majestic,” a word that reflects the beauty and dignity he finds in saving lives and transforming systems to address this urgent humanitarian crisis. Dr. Rab began his journey in 2018, walking the streets and treating individuals on the brink of losing their capacity to survive due to severe mental illness.
At the program’s inception, Dr. Rab was the sole psychiatrist on the HOME Team, working alongside a multidisciplinary staff comprised of a nurse, social worker, medical caseworker, and peer. Today, thanks to the program’s remarkable success, the team has expanded to include 17 psychiatrists and over 200 staff members who cover Los Angeles County’s vast geographic area. As the HOME Medical Director, Dr. Rab not only performs his daily duties but also serves as a passionate advocate, demonstrating how communities can unite to solve what seems like an insurmountable problem.
In this episode, Dr. Rab shares his insights and approach to building trust with the unhoused population. His work embodies the LACDMH motto: “Hope, Recovery, and Wellbeing.” Through his dedication, he has pioneered a model of street psychiatry that serves as a beacon for Los Angeles, the nation, and the world.
Episode #11: HOME with Dr. Yelena Koldobskaya and Isidro Alvarez
We continue our series on Street Psychiatry, exploring the Los Angeles County Department of Mental Health (LACDMH)’s HOME Team program. In this episode, we hear from Yelena Koldobskaya, M.D., Ph.D., Medical Director for the southern region of Los Angeles, and Isidro Alvarez, Medical Caseworker. Together, they are key to the program’s success, treating individuals as if in an open-air hospital to save lives.
They share their experience working with people who are homeless and in critical condition but refuse treatment. Dr. Koldobskaya and Isidro discuss their process of monitoring these individuals over time and attempting to establish a care partnership. When necessary, they initiate a Conservatorship, where a family member or guardian, if available, is given control over the person’s decisions to prevent them from dying on the streets. This extreme measure requires a court decision.
Dr. Koldobskaya and Isidro offer a firsthand account of their work, including the story of a woman living on a bus bench. When Dr. K’s medical expertise and Isidro’s experience with Conservatorship intersect, the result is a successful intervention — an example of the HOME Team’s impactful work. As many cultures say, “When you save one life, it’s as if you’ve saved an entire world.”
Episode #12: HOME with Elizabeth Cope
A few years ago, the Los Angeles County Department of Mental Health (LACDMH) launched an innovative program to provide services in uncharted territory: the Street Psychiatry-HOME (Homeless Outreach Mobile Engagement) Team. This program was groundbreaking because it introduced new techniques for helping people with severe mental illness living on the streets. A psychiatrist provided care directly in the community, and the team — comprising nurses, social workers, and peers — worked together to save lives.
This episode, the final installment in a four-part series, highlights the successes of the program, featuring Elizabeth Cope, Administrator and Co-Manager of the team, which includes 220 staff members across Los Angeles. Cope’s dedication mirrors that of other leaders who, like her, bring enthusiasm and positive outcomes to the homeless community.
The program’s model requires vision, funding, and willpower to address the growing crisis of homelessness in Los Angeles, where people are living in dire conditions under freeway overpasses, in tents, and in other vulnerable situations. LACDMH is committed to this approach, guided by the department’s motto: “Hope, Recovery, and Wellbeing.”
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