Tuesday, October 19, 2010

DHH Promises ‘Community-Based Care’ but People with Mental Health Needs Imprisoned Instead

The mental health care system in New Orleans and the greater metropolitan area is failing. Governor Jindal and the Louisiana Department of Health and Hospitals (DHH) have promised to develop community-based, outpatient mental health care throughout the state but have not adequately funded the initiative, and the mental health services presently available fail to meet the needs of our communities. The severe underdevelopment of state-funded community-based services in combination with the scarcity of inpatient beds in the greater New Orleans Metropolitan area has had a deleterious impact on people in need of services and their families, hospital emergency rooms, outpatient clinics, and the legal system.

At a recent Health Care and Social Services Committee meeting, DHH Deputy Secretary Tony Keck criticized local advocates for requesting greater access to inpatients beds in the New Orleans Metropolitan area. Keck maintained that the state should not be directing funds towards inpatient hospital care, arguing that state-run mental health hospitals are “No different from locking [people with mental illness] in prison…it has the same effect on their lives.” Many patients and former patients of state-run mental health hospitals as well as their advocates would agree with this comparison. However, what DDH refuses to recognize is that prisons – not hospitals or community-based clinics – are exactly where people with serious mental health issues are being funneled and warehoused by the state.

Last year, the state closed the New Orleans Adolescent Hospital, which provided inpatient care for children and adolescents with serious mental health needs. In its place, two outpatient mental health clinics have been opened and together the clinics have the capacity to serve 1,200 children, adolescents and their families annually. Yet no similar developments were made for adults in need of care following the illegal closure of Charity Hospital. According to a study released through the Mayor’s Office in March 2010, there are only 135 inpatient psychiatric beds for adults in all of the greater New Orleans Metropolitan area (Orleans, Jefferson, St. Bernard, and Plaquemines Parishes) for a population of nearly 860,000.

Meanwhile, Orleans Parish Prison (OPP) is home to the largest number of inpatient psychiatric beds in New Orleans. Treatment at OPP is only available through an order by the city’s mental health court. That is, a person in need of mental health services must first be arrested in order to access “treatment” at the prison facility. Furthermore, a 2009 investigation of OPP by the Department of Justice found that the prison failed to meet numerous constitutional standards with respect to treatment of the people imprisoned there, including dangerous administration of medication; failure to obtain informed consent in the provision of medication; inadequate suicide prevention; failure to provide timely psychiatric assessment and treatment; and the failure to protect people from harm who have been put in restraints.

Comprehensive mental health services should not primarily nor solely focus on the provision of inpatient care in hospitals. The reason local advocates are asking for more inpatient beds is because there is no place for people who are suicidal or experience acute psychiatric episodes to go for help. The shift towards community-based services, such as Assertive Community Treatment (ACT) teams which provides home mental health care, are welcome changes to the mental health system. However, the state has not adequately funded nor developed these programs. Cecile Tebo, leader of the volunteer-based New Orleans Police Department Crisis Unit, explained that ACT teams are merely “Chipping the tip of a large iceberg.

The deinstitutionalization of people with mental health needs in the absence of a comprehensive plan to adequately address mental health has simply led to another kind of institutionalization – prison. Louisiana is not alone, as many states across the country have cut funding for mental health services and have decided instead to warehouse people with mental health needs in jail. A comprehensive mental health plan would not only provide for a broad range of treatment and services but would also recognize the ways in which mental health intersects with economic exploitation, access to housing and food, racism, heterosexism, transphobia, gender-based violence and other forms of systemic oppression.

The absence of a comprehensive plan to address mental health affects our whole community. In a city where an estimated one third of residents experience symptoms of depression or post-traumatic stress disorder, where the suicide rate is steadily increasing, and the attempted suicide rate is well above the national average, it is our responsibility to ensure that our communities are receiving the services and support they want and need. Sherriff Gusman’s plan to build a larger jail is, unequivocally, not the solution to this mental health crisis. We need free, culturally competent, non-punitive, comprehensive, and sustainable mental health services and we need it now.

Maggie Zambolla is a graduate of the City University of New York School of Law where she was a Haywood Burns Fellow in Civil and Human Rights. As a 2010 Justice Revius Ortique, Jr. Internship recipient, Maggie is deeply committed to racial and economic justice and aspires to use her legal education as a tool for social change.

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