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Once You've Seen Trieste, You Cannot Pretend it Doesn't Exist

Tag: Community

Here is the humbling reality.

I had the privilege to attend an international conference on mental health last week in Trieste, Italy. There were 36 countries represented; panels, speakers and site visits stretched out over four days. Not surprisingly, there were no speakers invited from the U.S. to share best practices. We have none.

I was in Trieste with 12 leaders from Los Angeles county who traveled thousands of miles to witness this stunning cultural paradigm shift up close. Thanks to my Stanton Fellowship from the Durfee Foundation, I had to privilege to visit Trieste in June and blogged about that earth-shattering experience. About a month after arriving home, when I received word about this conference, I reached out to leaders in LA asking if they would be willing to make this pilgrimage. You can read about the Trieste Model, but you have to actually see it in action to appreciate the humanity associated therewith.

Our Los Angeles delegation included representatives from the Department of Mental Health, Los Angeles Police Department, LA County Jail, Los Angeles County Sheriff’s Department, LA County District Attorney, LA City Council, Los Angeles Homeless Services Authority, Community Partners, the Superior Court, and a Skid Row service provider. Because of the diversity of these perspectives (which was healthy), I felt like we were the proverbial blindfolded people touching an elephant trying to describe what we saw. What was remarkable was that by the end of the week, we were able to converge our impressions into one unified image of what needs to change in Los Angeles. Will that be easy? No. But what we witnessed and experienced together will be impossible to ignore.

It is hard to capture in one blog all that we need to do different in LA (and in America, for that matter). But let me use one illustration that will provide some insight.

While I was at the conference, I woke up one morning to a text sent by a frustrated Hollywood cafe owner. There was a short video file attached. In this clip, a disoriented man is walking into her cafe. He is barefoot and has a white bedspread draped over his shoulders. The business owner says, “I need to ask you to go. You have to go.” He turns around and heads to the door. He stops for a moment at the door, and then he walks out. This simple video documents five things about what is wrong in Los Angeles. Watching it 6,000 miles away in Trieste reminded me why we were all there. We are frustrated too.

  1. This barefoot man, naked except for a pair of shorts and a blanket, is clearly uncared for; left to fend for himself.
  2. He is likely hungry; he is wandering the streets of Hollywood.
  3. The shop owner shoos him away. She clearly wants him to leave. She is fatigued of this behavior, because this happens quite frequently — he is not the only one.
  4. Her fatigue is understandable. She has no one to call. There is no phone number that will lead her to a place where he could be helped. She sends me a text instead, and I am 6,000 miles away.
  5. If he comes back again, her only recourse will be to call the police.

Prior to spending this intense week in Trieste, all of our conversations about “fixing this” travesty in Los Angeles revolved around trying to “streamline” things, create special outreach teams, build partnerships between law enforcement and DMH, employ a “housing first” model to get that guy into housing. Though helpful, they are stop-gaps.

So imagine this man walking into a trattoria in Trieste (and you must suspend some disbelief here because people are not left to deteriorate to this level). But, consider this: the shop-owner would have the freedom to let her heart lead and exercise patience because this doesn’t happen hardly ever. Instead of trying to “protect the business” she would probably have him sit down and get him something to drink, or maybe something to eat.

Then she would know to call the community mental health center — not the police. There would be someone who would come within a reasonable time to “scoop up” the person (that is a word we heard in Italy) and take them back to the center. (If he was not willing to go, that is the subject for another blog,)

At the center, this person would be offered an emergency place to sleep while the team jumped into action. I am not sure I accurately understand everything that would happen within the context of “jumping into action.” But I do know that these essential elements of engagement would kick in:

— hospitality
— relationship building
— attempt to contact the family

Now, I will stop here, because we have a lot of work to do to capture the essence of this model (it cannot be completely replicated in the U.S.). But here is what I know. In Trieste, we were reduced to thinking about this wearing our human-being hat. Risk-management is not a department that exists in the Trieste mental health system. Never was there a discussion about:

— what are the “rules” of engagement?
— what is the liability associated with acting in this way?
— is there a HIPAA violation if we try to find the family?
— how will this be paid for?

I hope this plants the seed in fertile soil for the paradigm shift the LA Trieste team experienced this week. I am still trying to find the words to describe this. Please private message me if you are moved and would like to stay connected to this journey.

Kerry Morrison is the founder and project director of Heart Forward LA. She is the former executive director of the Hollywood Property Owners Alliance and served as a Mayoral appointee to the Los Angeles Homeless Services Authority (LAHSA).