Dig Baton Rouge

Through the cracks

By Quinn Welsch

@quinnwelsch

Options for many Baton Rougeans with mental illnesses are narrowing down to two: incarceration in the parish prison or commitment to a hospital.

Since Katrina, adult mental health care service has risen from 4,470 persons served to 12, 074 according to Capitol Area Human Services District. However, denial of Medicaid expansion in Louisiana, closure of state health facilities, cuts to the state budget, and high rates of poverty and substance abuse are making the CAHSD’s job increasingly difficult.

Public officials and health care professionals agree that state of mental health care in Baton Rouge is costly, inadequate and, in many cases, inhumane.

In January, Mayor Kip Holden proposed to include a tax increase on the May ballot that would fund the construction and operation of a mental health facility to divert people with mental illness from the jail and emergency rooms. The mayor’s proposal included other facilities, such as renovations to the parish prison and a juvenile facility, though it ultimately failed.

Facilities in the parish prison are not equipped to handle people with mental illness. The prison is already too small and in desperate need of renovations, according the Sheriff and other law enforcement officials. The other alternative for police is to take people experiencing mental health crises to an emergency room, which can occupy officers for hours.

Emergency rooms are “inundated” with people with mental illness, who are often impoverished and have nowhere else to go, said Dr. Robert Blanche, the psychiatrist at the parish prison and at Seaside Healthcare. In a hospital’s emergency room, evaluation of the mentally ill is brief and often lacks crisis intervention. The result is a reactive and costly approach to a long term problem.

Though issues in the city are unique in many ways, communities across the country are experiencing similar mental health crises. This is due to an overall lack of psychiatrists, increasingly complicated medicines, and the after effects of “deinstitutionalization,” said Dr. Jan Kasofsky, the director of the CAHSD.

Deinstitutionalization began in the ‘70s as an otherwise positive effort to move people with mental illnesses out the wards and into community settings. The low cost of housing in many Baton Rouge neighborhoods makes the city an attractive setting for people with mental illness and group homes. However, for many people with mental illness, a “group home” is under a bridge or in an alleyway.

When people with mental illness get picked up by the police, they are often taken to the parish prison on misdemeanor charges, such as “remaining after forbidden,” Blanche said (primarily because many are homeless). Many of them are fearful of police and paranoid, which results in resisting arrest. They end up in jail for longer because they aren’t competent to stand trial, he said.

An entire wing of the jail holds about 30 to 40 people with serious mental illness at any given time, but due to overcrowding they often get mixed in with the others.

“I feel certain that psychotic conditions get worse in jail in an isolated environment,” Blanche said. “The best we can do in jail is brief assessments and medication management.”

About half of the parish prison’s 1,700-person capacity have a mental illness to some degree, Blanche said, whether it’s genetic or triggered by substance abuse – or both.

“They just keep them there until they basically get credit for time served had they been convicted of the crime, and then they’re discharged like that,” Blanche said. “Into the street.”

Without any services for them after release, they’re likely to wind up back in jail. The East Baton Rouge Parish Prison’s recidivism rate as of 2010 is 46 percent, according to the Louisiana Department of Corrections.

A few years back, this was less likely to be the case when the Mental Health Emergency Room Extension (MHERE) at Earl K. Long Medical Center was still running. The 10-bed MHERE would take in people experiencing mental health crises and, after an average stay of about 36 hours, divert about 70 percent of patients to the appropriate facilities or outpatient services, said Blanche, who was the director the MHERE during its nearly 3 years of operation.

The facility served as a type of triage center for the various types of mental illness in Baton Rouge. Without it, the options are reduced to a “one size fits all” mindset at the jail and emergency rooms.

Dr. Jan Kasofsky, the director of CAHSD, estimates that the facility saved $20.6 million during its operation, the brunt of which would have been on the parish.

“That doesn’t even include what you save on people not being incarcerated,” Kasofsky said. “You’re going to pay for it whether you do it the right way, which costs less, or the wrong way, which costs more.

Kasofsky is meeting with the Baton Rouge Area Foundation and other local leaders to discuss the possibility of creating a new MHERE, though the discussion is far from the design phase. Another potential tax could put a new facility on the October ballot, but Blanche and Kasofsky both agree something needs to be done, and now.

 

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