Grim reports estimate that there may be as many as 60,000 people now experiencing homelessness across Los Angeles County on any given night—a 23 percent increase since 2015. The city of Los Angeles has promised to spend more than $100 million—out of a recommended $1.85 billion—solving the crisis, but it has barely put a dent in the problem.
One solution to help the region’s most vulnerable homeless residents is already working on the streets of Hollywood. It’s called the Top 14, and it offers a hopeful model for housing the neighborhood’s most service-resistant homeless individuals—people who routinely refuse treatment and who are often disabled or mentally ill.
Top 14 was started by a coalition called Hollywood4WRD. The documentary follows Anthony Ruffin, a case manager with Housing Works, a local homelessness group. He relentlessly checks in with the 14 people on the list until they are housed, often visiting them on the streets in the middle of the night.
The program was started in 2013, and, in the first 15 months that Top 14 was active, three individuals on the list were placed in housing. Four years later, a total of five people from the original list remain permanently housed, allowing Hollywood4WRD to add more names to the list.
Housing only one-third of the people on the list may not sound like a total victory, but here’s the kicker: The city doesn’t spend any money on it; Ruffin and others from local homeless organizations have taken on the cases on top of their day jobs. Yet it’s likely saving Los Angeles money that can be spent helping more people—one unsheltered individual can cost a city hundreds of thousands of dollars each year.
"The Top 14 has been an experiment, and we've held it together with duct tape,” says Kerry Morrison, executive director of the Hollywood Property Owners Alliance, which helped organize the program in 2013.
The Top 14 are all defined as chronically homeless—people who have been homeless for at least a year or live with a disabling condition. Many people experiencing chronic homelessness refuse services, but eventually become sick enough that they end up being treated in emergency rooms, then are released back onto the streets.
Emergency room visits not only do little to improve long-term health, they end up costing taxpayers about twice the cost of providing housing and preventative care in the first place. That’s why a “housing first” approach that helps identify and house the most medically vulnerable homeless residents has been embraced by many cities.
But the success of Hollywood’s Top 14 program illustrates some crucial flaws in the way LA treats its mentally ill residents.
Police are the ones making snap decisions about the mental health of homeless residents, including deciding when to place them under an involuntary hold known as a 5150 (which is another temporary, expensive solution). If the citywide policy were to send mental health professionals to act as first responders, with case workers like Ruffin tracking these citizens through treatment, it could make a huge difference in the way LA serves its chronically homeless.
"What if the psychiatrist came out into the streets to see the person in the condition that they're living in and made the decision there?” says Morrison, who is also an appointee to the Los Angeles Homeless Services Authority (LAHSA) and was recently awarded a fellowship for her homelessness work. “It should not be the police—they’re not criminals. They’re mentally ill."
That policy might change in the near future.
A motion introduced in April by Los Angeles County Supervisor Kathryn Barger proposes changes to the way the county defines and treats mental illness, especially for homeless individuals who refuse treatment. The county’s newish mental health director, Dr. Jonathan Sherin, is open to new solutions that bring mental health workers out into the community; he notably turned the county’s fenced-off Koreatown offices into a peer-to-peer resource center that opened in May. And, of course, the passages of ballot initiatives Measures H and HHH are delivering funding to programs, including ones which specifically address mental illness.
Morrison’s goal for the Top 14 is to fund a pilot that could pay three people like Ruffin to track 40 to 50 people in the neighborhood. For about $300,000 per year she could pay three full-time salaries with benefits and have $50,000 to cover overhead costs like vehicles, insurance, and case management fees. For comparison: Leaving a chronically homeless individual on the streets can cost cities an average of $40,000 per year.
She also thinks the approach is scalable—about 30 percent of the county’s homeless population is mentally ill, so it would require identifying the 3 to 5 percent of that community who are most in need. "That’s less than 1000 people throughout the entire county, but arguably the sickest, and those who create the greatest strain on government, health, and law enforcement resources," she says. "You could go to any given neighborhood and say, ‘Tell us the five people you're most worried about.’”
I haven’t lived in Hollywood for almost 10 years—I lived there from 2005 to 2008—and yet I recognize almost all the homeless individuals in the video. Most of the Top 14 stick to the same few blocks, and many have lived at the same location for more than a decade, says Morrison. I worried about these folks when I lived in Hollywood. But I was more worried when I did not see these familiar faces on my daily commute.
It would be reassuring to know that someone like Ruffin was keeping tabs on our neighborhoods’ forgotten residents to help keep them moving through the housing system, which is what Top 14 is really doing at its core. “What we’ve been doing for four years is not losing track of these people,” says Morrison. “By documenting these case studies, there are so many places in the system where they fall through the cracks."
As Morrison notes, the Top 14 do not always get removed from the list because they are housed—some have been incarcerated and three people from the original list have died. People experiencing homelessness for years at a time only have a life expectancy ranging from 42 to 52. That means the city faces a choice: We can quickly adopt a better way to help our sickest citizens, or allow them to slowly die on our streets.