Louisiana’s in the middle of a mental health crisis. What was once both a progressive dream and a way for lawmakers to save money–deinstitutionalization, the closing of state-funded mental health hospitals–has become the cornerstone of one of the most immediate problems facing the state. Without places to put people suffering from severe mental illnesses, where do they go?
The introduction of the first-generation of antipsychotic drugs, like Thorazine, in 1955 encouraged states to begin closing mental “institutions,” which was by and large viewed as a net good. One Flew Over the Cuckoo’s Nest is a scary movie; closing those institutions was both progressive and logical, considering the decrease in the number of patients requiring hospitalization due to those new antipsychotics. But the nation went too far, and Louisiana serves as a poster child for the situation the mental healthcare system has been left in.
According to SAMHSA, the South as a whole suffers from greater prevalence of mental illnesses among adults than the rest of the nation. Like the rest of the nation, Louisiana followed suit in closing inpatient psychiatric hospitals. And as the number of inpatient beds available has decreased, the problem of mental illnesses has done the opposite. From data of 13 reporting parishes, the number of Coroner’s Emergency Certificates (CECs) has risen significantly, by about 50%, since 2012. (A CEC is a form signed by a member of the local coroner’s office after a patient has spent 72 hours in a mental hospital, indicating that the patient should remain in the hospital for a longer stay.)
With the decrease in inpatient beds available, many patients, especially those on Medicare or Medicaid, cannot stay in mental hospitals. Instead they go somewhere else–often to prison. Louisiana has the second highest per capita incarceration rate in the United States, bested by Oklahoma only after a long reign on top. About 16% of LA prisoners meet the criteria for “severe mental illnesses,” indicating that they would benefit from long-term inpatient stay in a hospital. In 2005 Louisiana had 8,233 severely mentally ill prisoners but only 1,807 inpatient psychiatric beds. As of 2016, Louisiana now has 616 inpatient beds available.
Louisiana also fails its citizens before they have a chance to reach an inpatient bed or an emergency room. One solution to the issue of imprisoning the severely mentally ill is crisis intervention teams (CITs). CITs are a group of local police officers trained in responding with sensitivity to people undergoing mental health crises, e.g., a CIT officer would be better able to talk down a person considering suicide or going through psychosis, not immediately handcuffing the person. This approach of treating the severely mentally ill not as criminals has many benefits: reducing the amount of time required to deal with mental health crises and producing cost savings. Memphis, Tennessee, saw an 80% reduction in officer injuries while responding to MI crises following CIT implementation, and Detroit saves about $20,000 per year for every SMI person they direct to treatment instead of jail.
CIT is an evidence-based way to solve some of these problems, but Louisiana falls below the national average in the percentage of citizens living in areas served by CIT officers: 38% vs. the national average of 49%. NOPD have implemented a CIT Program to great success; a 2016 year-end report featured these graphics:
CITs with the New Orleans Police Department succeeded in reducing injuries to both officers and persons in crises to a minuscule fraction of the time–the majority of injuries in these cases (still a low 5% of all cases) occurred before the officer’s arrival. Verbalization was the most common method used by officers; with proper training even handcuffs were used a little over half the time. But despite evidence of CITs’ effectiveness, only 38% of Louisiana residents have access to their services.
Another example of a state-funded solution to reducing the burden upon the already burdened mental healthcare system is the creation of mental health courts, visualized in the scatterplot above. These courts, like community courts or drug courts, focus on rehabilitation, sending people to long-term psychiatric stays instead of prison stays. Again, LA drops the ball on this count: just 8% of Louisiana citizens have access to a mental health court. For perspective, only five states fall below Louisiana; the national average is 41 percentage points higher.
Louisiana is a great state, no doubt. Ruston produced famed indie hipster band Neutral Milk Hotel, Avery Island spawned Tabasco hot sauce, and Jeanerette has a bakery older than time. But Louisiana is facing a severe self-caused mental health crisis. The state throws the severely mentally ill into prisons instead of hospitals, and interventions to fix the crisis are hard to come by, serving small percentages of the overall population and ignoring the state’s many rural citizens. As nice as Louisiana may be, things need to change.
NAMI New Orleans periodically provides news on Louisiana’s mental healthcare system, especially at the social policy level, on their website.
The Treatment Advocacy Center releases thoroughly researched reports on the nation’s mental healthcare system several times a year.