Mental healthcare in Los Angeles County has long lagged behind the tremendous demand across all levels of care.
Now, one of L.A.’s oldest mental healthcare providers has embarked on an ambitious program to expand its facilities to accommodate this huge unmet demand.
Echo Park-based Gateways Hospital and Mental Health Centers recently raised $170 million – mostly through grants – to fund a multipronged expansion effort, the most ambitious in its 73-year history. The aim: to increase psychiatric, substance use and behavioral health treatment capacity across much of the county.
This expansion includes:
● A new facility in East Hollywood with 125 residential treatment beds;
● A new 27,000-square foot facility adding 37 adolescent inpatient beds next to its flagship location in Echo Park;
● Conversion of an old law school campus in Glendale to handle 40 residential and 110 outpatient clients annually; and
● New administrative offices in Downtown Los Angeles.
“There has been a stigma around mental health for decades, prompting a lower-profile approach,” said Phil Wong, Gateways’ chief executive. “This has led to decades of underinvestment and we were part of that system,” Wong continued. “As a result, there are a lot of people in the county that need services but aren’t getting them. We’re now trying to pick up the pieces with this expansion drive.”
Wong said the expansion program has come about thanks to a surge in funding for mental health treatment facilities and services. The biggest component has come from Proposition 1, a $6.4 billion bond measure enacted by California voters in March 2024. Statewide, the measure when passed was expected to fund more than 11,000 additional behavioral health treatment beds and supportive housing units. Revenue to pay back the bonds is expected to come from a 1% tax hike on California residents reporting more than $1 million in annual income that voters enacted in 2004.
In addition to adding treatment beds and out-patient capacity, Wong said many of Gateways’ facilities are decades old and in desperate need of modernization.
“A lot of our buildings are from the 1930s, 1940s and 1950s,” he said. “A lot of our housing looks like it came straight from the set of ‘One Flew Over the Cuckoo’s Nest,’” he added, referring to the 1975 Oscar-winning film starring Jack Nicholson that was set in a psychiatric hospital.
Focus on all levels of mental healthcare
Gateways Hospital and Mental Health Centers was founded in 1953 as an independent nonprofit facility affiliated with the Jewish Federation Council of Los Angeles; it launched with 12 beds for psychiatric patients. The idea was to be community-focused at a time when most mental health facilities were part of a sprawling statewide system.
In the ensuing decades, Gateways acquired more than a dozen other properties.
As the de-institutionalization movement took hold in the late 1960s and 1970s, a number of other private sector nonprofit operators stepped in to try to care for those that had been forced out of the state-run mental healthcare institutions, according to John O’Malley, board president for the greater Los Angeles chapter of the National Association of Mental Illness.
Unlike many of these organizations, Gateways established beds and treatment programs across the entire continuum of mental healthcare, from acute crisis care to subacute inpatient care to residential treatment and finally to outpatient care.
“Most organizations focus only on one or two of these tiers,” Wong said of private sector-run mental healthcare entities in Los Angeles County. “We focus on all of them.”
Growing unmet demand
O’Malley said that even as the numbers of people suffering from mental health illness steadily grew over the decades, funding for treatment facilities and staff never kept pace.
The passage of the 2004 “millionaires tax” for mental health programs helped a bit, he said, but came nowhere close to closing the gap.
“People haven’t been getting adequate mental health care,” he said. “Many are ending up on the street. That explains why the number of people seeking and/or needing treatment appears to be rising even as the overall population is not growing.”
In this year’s homeless count, 27% of the roughly 73,000 homeless individuals in the county self-reported they have been dealing with serious mental illness. That’s likely an undercount, since it only includes people with enough presence of mind to self-report their mental illness.
Catching up on treatment
On the treatment side, O’Malley cited county figures showing roughly 2,850 beds in the county for acute and subacute mental illness patients. All of these beds are in locked facilities, such as the Gateways Hospital in Echo Park.
That hospital currently only has about 27 adolescent beds. The expansion now under construction will add 37 adolescent beds, while the existing 27 beds will be converted to adult patients.
The next level down the continuum of care is residential treatment: O’Malley said there are roughly 630 funded residential treatment beds in a county-run network and hundreds of other beds in facilities licensed by the state.
And then there are an unspecified number of outpatient mental health facilities, ranging from the 180 or so operated by or on contract with the Los Angeles County Department of Mental Health to psychiatric offices affiliated with hospitals and hundreds of other private practice psychiatric offices.
O’Malley noted that the number of acute, subacute and residential treatment beds for the mentally ill in the county falls far short of the at least 20,000 homeless individuals with serious mental illness in the county.
“And that doesn’t include the thousands of incarcerated folks,” he said.
According to data released last month from the Vera Institute of Justice, about 50% of inmates in the county’s jail population of roughly 13,000 carry a mental illness diagnosis – essentially making the county jail system the largest mental health institution in the nation.
“The real question to me is how long do families tell me they have to wait for their loved one to move out of a tier in the continuum of care?” O’Malley said. “The answer is almost always not good: people wait a long time for beds to become available. And if you look at the people coming out of the jails and do they have a place to go for treatment? The answer is often ‘No.’”
Gateways expansion drive
This treatment shortage is precisely what 2024’s Proposition 1 was crafted to address. For the first time in decades, millions of dollars are now surging to mental health treatment providers for the addition of beds and treatment centers.
“In my 25 years at Gateways, there has never been so much funding for expansion,” chief executive Wong said.
Work on Gateways’ $60 million Echo Park hospital expansion began early last year and is expected to wrap up in the second half of next year.
Design work has been led by downtown-based HMC Architects, while Chicago-based Clayco Inc. is the main construction contractor.
Wong said that the 37 additional beds in the new wing will serve four populations of youths: those struggling with drugs and alcohol, those suffering from trauma, others with eating disorders and the final group dealing with gender identity issues.
Wong said Gateways plans to break ground next spring on the $44 million project to build the new 125-bed residential treatment facility in East Hollywood. That facility will accommodate patients with varying durations of stays, from 30 days up to a year. Completion is now set for late 2029.
Finally, in Glendale, Gateways has acquired an old law school campus and plans to convert it to a combination a 40-bed residential treatment center and outpatient facilities capable of handling 110 patients a year. Gateways is working with the city of Glendale on the project that has an estimated $35 million cost.
Staffing challenge
Beyond building all these facilities and getting the scores of additional beds licensed, Gateways will face a major additional challenge in the months and years to come: finding and retaining sufficient staff.
“Getting more people into this profession – both at the MD level and the skilled nursing level – is so tough these days,” O’Malley said. “You’re dealing with some of the most challenging folks you can imagine, including those with schizophrenia and extreme bipolar disorders. Now that we have all this funding, it will be challenging to hire enough staff to man all the additional beds that will be coming online.”
Wong acknowledged the challenge. He said it’s a bit of a chicken-and-egg situation. The county won’t release more funds for treatment staff until the added beds are in place.
“But we don’t want the beds to sit empty, so we’re working with the county to get financial agreements for treatment funds signed soon so we can hire and train the staff,” Wong added.
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