Tashaunda was living on the sidewalk at the corner of Western Avenue and Washington Boulevard, sheltered by a tent — before it was stolen. The corner is a typical nondescript Los Angeles intersection, bursting with traffic and surrounded by a check-cashing business, a doughnut shop, a nail salon and a 7-Eleven. Tashaunda had no intention of leaving.
The voices, you have to understand, demanded she stay. They were loud, incessant. They encouraged her to bark and make shooting gestures at passersby, and they convinced her she was a government spy. Tashaunda’s delusions compelled her to verbally assault or even hurl food at anyone who approached her to offer assistance.
Over in MacArthur Park, near where she lives, Gloria Leiva was speaking via Zoom to parents of students at a school. As a promotora — a Spanish-speaking lay health promoter in her community — Leiva spends a lot of her time coaxing her neighbors to open up about mental health issues that typically remain hidden from view in the Latinx community. She had just turned to the topic of sexual abuse when she detected a sudden change in the expression of one of the mothers listening on the Zoom. After the presentation, Leiva messaged her. Would she like to talk?
“I’m OK,” the woman said.
But Leiva knew she wasn’t.
Born in Florida, Diego was just 9 months old when his family was deported back to Honduras in 2008. When he was 7, his parents, desperately hoping to give their son a better life, sent him to Atlanta to live with an uncle. But the next two years proved traumatic. The uncle frequently locked Diego in his room and made him skip meals. He sometimes left him outside in the cold. Diego eventually was sent back to Honduras.
Last year, Diego’s mother told her aunt, Maria, a U.S. resident, of the bullying her son — then 13 — was experiencing following his return to their country. Seeking to help the boy, Maria and her husband agreed to let Diego live with them in Azusa, 20 miles east of downtown L.A., and attend high school there. Maria knew it was the right thing to do, but she worried about Diego’s adjustment to more upheaval. “The abuse has made him a nervous person,” she says, speaking in Spanish through a translator. “When he speaks, his lips quiver, his hands shake and he starts to stutter.”
A woman with a mental illness on the street, refusing help. An anonymous mother on Zoom, needing to talk, to be heard, but unable to do it. A young abuse survivor, bouncing from place to place.
Three very different cases, but all requiring precise attention to address a particular need. But what could be done?
Enter the DMH + UCLA Public Partnership for Wellbeing, which connects the largest county mental health agency in the U.S. with one of the nation’s leading public universities in a joint effort both sides describe as “deep, wide and bold.” Born out of UCLA Chancellor Gene Block and L.A. County Department of Mental Health Director Jonathan Sherin’s shared commitment to strengthening the social safety net, the idea was to think bigger than psychiatry, bigger than mental health. “Well-being is possible when human beings have people to love, places to live and purpose in life,” Sherin says. “While we of course have to get everyone the treatment they need and hopefully want, care cannot be effective if not delivered in inclusive, connected communities.”
Launched in 2019, the partnership laid out its priorities: strengthening communities by lessening the impact of traumatic experiences and promoting resilience; engaging and caring for those most in need by reengineering fragmented governmental systems at every level; and revitalizing policy to improve equity. The goals were ambitious, even lofty. But they were also realistic and achievable. “When you look at disparities in people’s ability to access high-quality mental health services, there are many ways in which our system has been letting people down,” says Patricia Lester, the Jane and Marc Nathanson Family Professor of Psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, as well as director of the DMH + UCLA Partnership.
“It has been so good to have someplace of my own to go. Somewhere safe to sleep every night.” — Tashaunda
Tashaunda, who began calling the streets home nearly 20 years ago following a psychotic break, is a perfect example of what Lester is talking about. While homelessness is fundamentally a problem of the scarcity and unaffordability of housing, notes UCLA psychiatrist Elizabeth Bromley, many unsheltered individuals also have a diagnosed severe mental illness, a formidable complicating factor — most notably in their collective resistance to the mental health treatment that could begin to reverse their downward spiral. “We see actively delusional individuals who believe the CIA has stationed them at a particular bus bench to practice surveillance, and if that’s their reality, they’re not going to be persuaded to leave,” Bromley says. “It’s only with treatment, housing and support over time that those beliefs become a little less intense.”
As part of the DMH + UCLA Partnership, Bromley leads a UCLA group that supports L.A. County’s revitalized Homeless Outreach & Mobile Engagement (HOME) program. The program sends teams of mental health specialists, nurse practitioners, social workers and street psychiatrists to intervene with individuals who are experiencing homelessness and who are suffering from a severe mental illness. It’s difficult and challenging work, but the HOME team has logged some great successes by bringing expertise directly to L.A. County’s most vulnerable and providing treatment access on the street. In doing so, the team is able to lessen individuals’ distress, advance their functioning and, hopefully, improve their interest in accepting help — in sum, set them on a path toward more stable living.
The combination of relentless outreach, patience and expertise on the part of DMH’s HOME team ultimately lowered Tashaunda’s defenses. Team members helped her feel safe talking to a street psychiatrist and, eventually, taking medication for her schizophrenia. The voices got quieter. Tashaunda obtained a Section 8 voucher and used it to secure housing. Today, she’s relearning skills such as cooking, cleaning and grocery shopping, and HOME team members drive her to medical appointments. Sitting in the lobby of the apartment building she now calls home, wearing a long black dress and with her hair pulled back neatly, Tashaunda reflects on her journey. “It has been so good to have someplace of my own to go,” she says, tears streaming down her cheeks. “Somewhere safe to sleep every night.”
The DMH + UCLA Partnership’s big vision has meant drawing from well beyond the UCLA Semel Institute, marshaling campus experts in education, policy, law and social welfare, among others. It’s also meant a nontraditional working relationship between a university and a government bureaucracy. “The idea is to join the best of the university with DMH’s expertise in practice and clinical services, and to have a partnership not just about disseminating knowledge from the university but [about] working together and learning from each other to advance well-being for the residents of L.A. County,” Lester says.
Sherin, who has been a very vocal critic of America’s historic underinvestment in mental health and addiction services, says that the DMH + UCLA Partnership gives him hope that progress is possible. “We have massive collective problems that require collective solutions,” he says. “This is a great example of that.”
“We’re taught that whatever happens at home stays at home. My job is to break a tiny hole in that bubble they’re in so they can listen.” — Gloria Leiva
Promotoras like Gloria Leiva are part of DMH’s peer well-being workforce, which works within marginalized communities to reduce the stigma of accessing support by employing trained laypeople. The UCLA Hispanic Neuropsychiatric Center of Excellence trains the promotoras in health education, psychological first aid and case management, all of which they were able to deliver virtually during the height of the COVID-19 pandemic.
“While we’re the mental health experts, the promotoras are the experts in their community,” says Paola Suarez M.D. ’13, clinical neuropsychologist and a clinical professor at UCLA, who has led the training program. “So all of our trainings are co-created, and we receive constant feedback from them.”
When the mother on Leiva’s Zoom presentation demurred when asked if she wanted to talk, Leiva then asked if it was OK to call another day. Over time, she convinced the woman to meet with her. Only then did the woman confide that she had been sexually abused from childhood by her grandfather, father, brother and uncle. It was Leiva’s empathy and persistence, the woman told her, that had given her the courage to finally speak up and ask for help.
Leiva, herself an immigrant from Guatemala, regularly strikes up conversations with people in her neighborhood — on the street, at the bodega, in the laundromat — in an effort to reduce the stigma associated with seeking mental health care in her community. “We’re taught that whatever happens at home stays at home,” Leiva says. “My job is to break a tiny hole in that bubble they’re in so they can listen. Then, once they know someone cares, I can show them how they can get help.”
The black hoodie has seen better days — it sports an ever-expanding rip across the front — but today, nothing can keep Diego from wearing it. He got it as a welcoming gift from the Community Schools Initiative (CSI) office when he started at Azusa High last fall.
The CSI, led by the L.A. County Office of Education, is a school-based program supported by two Partnership teams: the UCLA Prevention Center of Excellence and the Pritzker Center for Strengthening Children and Families, which provide trauma-informed training, prevention resources and evaluation support. The CSI has been designed to set up schools as community access points, bringing mental health and well-being services to struggling families within the schools five days a week. “Many of these kids have experienced trauma or are suffering from depression, anxiety and other issues, and teachers aren’t equipped in how to detect and respond to it,” says Tyrone Howard, UCLA professor of education and co-director of its Pritzker Center. “And even when the school gives the family a referral, it’s to a psychologist across town — and given transportation, work and child care issues, the likelihood the parent or caregiver will follow through on that referral isn’t very high. Community Schools says, ‘Let’s bring those resources to the school,’ as opposed to parents and caregivers having to find them.”
Beyond therapists and behavioral specialists, the Community Schools Initiative looks for local community partners to meet family needs by periodically opening up shop right on the school campus. For other basics, Community Schools’ on-site staff use their know-how and local connections to secure resources and provide access to the services needed.
Azusa is one of 15 campuses currently benefiting from the initiative. By the time Maria registered Diego at the school, her family was reeling: Her husband had lost his construction job when the company shut down during the pandemic, and she was out on disability from a cleaning job at a USC sorority house. Both Maria and her husband contracted COVID-19 in the summer of 2021. “We almost didn’t make it,” she says.
When Maria and Diego arrived at Azusa High to register him, a member of the school’s guidance office escorted them to the Community Schools resource center in Room 5. The bilingual staffers there could better assist Maria, who spoke only Spanish. Learning of Diego’s plight, they explained their office’s role and offered support in the form of donated clothing and school supplies. Over the ensuing months, Maria became a fixture in Room 5. The staff helped her sign up for free technology classes and apply for vital public services, such as CalFresh (California’s Supplemental Nutrition Assistance Program) and Medi-Cal.
“I’m not a social worker or a mental health worker, but I have the motivation and empathy to help parents figure things out,” says Maritza Martinez, an educational community worker at Azusa High. “Our purpose is to be a hand families can hold to navigate around the barriers they experience to getting what they need.”
Today, Diego remains soft-spoken and a bit shy. But something has clearly changed. On Earth Day, the slender 5’8” boy stood before the entire school and presented a talk on deforestation — something that would have been unthinkable for him when he first enrolled. His grades are up, and he’s moved into English-only classes. The critical support he has received through the UCLA + DMH Partnership has done more than merely lift his spirits — it has changed his life. Maria says she is now ready to follow up on an outside mental health assessment for Diego through one of the school’s community partners to address the trauma he’s experienced.
At one point, Maria brings up the hoodie, and she begins to choke up, overcome with emotion. The symbolism is hard to miss: After being left out in the cold, now Diego has something to keep him warm — and a reminder, after a turbulent 14 years, that he’s no longer alone. “It gives him so much joy to know that someone gave a hand to help,” Maria says. “He told me he’s going to keep wearing it until he goes to a university.”