Grading the States 2006: Louisiana - Narrative
Hurricanes Katrina and Rita devastated Louisiana in 2005, tilting the state's already fragile mental health system towards virtual collapse. Within this tragedy, however, resides the potential for a silver lining. As with its communities, so too the state's mental health system has an opportunity to rebuild.
In the wake of the storms, the Louisiana Office of Mental Health (OMH) has done an incredible job of deploying all available resources to deliver mental health services in a disaster zone. OMH staff responded to the storms' fury with flexibility and bravery to meet the tremendous need in for mental healthcare. And, months after the initial impact, the OMH continues to demonstrate commitment to the people of Louisiana for what will be a long recovery from the hurricanes.
NAMI would like especially to thank the OMH for participating in our questionnaire for this project at a time of such need. OMH's response demonstrated remarkable responsiveness and transparency to consumers and family members in a time of disaster. Thank you.
But, even with the Herculean efforts of those on the ground in Louisiana, the mental health system in the state has imploded.
Tremendous challenges impede service delivery. Emergency rooms, already taxed before the storms, have turned into ground zero in their aftermath. In the New Orleans area, emergency rooms are deluged with individuals needing mental health care as the city has lost over 100 psychiatric inpatient beds. As a result, ERs are clogged with individuals in need of more intensive, longer-term care, but with the city's loss of inpatient beds, there often is no where else to go for individuals in crisis. In a January 26, 2003, article, The New York Times documented the impact on ERs, including long waits and transfers of patients to hospitals further away that are "overwhelmed with urban psychiatric patients" they would not otherwise have seen.
The state's capacity to provide community services has been similarly battered. Louisiana's community system is a maze of three main service areas that include an additional eight regions for service delivery. Some, such as Region V around Lake Charles, receive their mental health services directly from community mental health clinics that are part of OMH. Other regions, such as the Baton Rouge area, receive their services from contracted providers such as the Capitol Area Human Service District (Capitol Area). Coordination and consistency of services across the state, therefore, are scattershot, contributing to the system's fragmentation and perpetuating communications challenges.
Many regions have been deluged with the influx of storm evacuees. In the months since the storms, requests to Capitol Area in Baton Rouge have increased by 40 percent - rates similar to other parts of the state. Wait times to see community providers that used to be only hours or days long are now months. Providers are doing the best they can with limited resources and capacity, but the system is in grave crisis.
While supply of services has been diminished, research shows that the demand may continue to increase months after the hurricanes. The Center for Disease Control surveyed storm survivors and found that nearly half (49.8 percent) exhibit levels of emotional distress that could indicate a need for mental health services. OMH responded to these findings with the establishment of a crisis counseling program. But it is hard to imagine that a system already stressed beyond capacity before the hurricanes will be able to accommodate such large numbers of new clients.
Other storm-related complications include the hurricanes' toll on the state's mental health workforce. OMH has suffered a hemorrhage of its leadership, with recent resignations in two top-level positions: the Assistant Secretary for the OMH and its medical director. As the former head of the public mental health system in the state, Dr. Cheryl Bowers-Stevens noted in an interview with National Public Radio on January 24, 2006, that with the limited resources given to the system, she would be able to help Louisianans with mental illness more effectively in the private sector. Additionally, many of the state's providers have either not yet returned to the state, or are being stressed to the breaking point with the current demand for services, and many mid-level employees of the system are opting for early retirement, leaving an even greater leadership deficit.
And the situation promises to get even grimmer, as the state has recently imposed a 22 percent cut to the OMH budget as part of a $1.7 billion across-the-board cut applied to all state agencies. This most recent cut, and other late 2005 budget cuts to the OMH, have resulted in the elimination of 520 staff positions, a reduction in an already skeletal intermediate crisis bed supply, and the closure of 15 community clinics. Louisiana's government should remember that short-term cuts for mental health care often have unintended, long-term consequences that ripple through other state systems. These cuts will surely be felt in the jails, and streets of Louisiana as services for individuals withmental illnesses will be reduced, leaving many people in crisis with nowhere else to go.
It is important to remember that despite the current desperate situation of Louisiana's mental health system, it was near implosion even before the hurricanes touched ground. Systemic barriers to care were identified in a June 2005 report to the Governor's Health Care Reform Panel, including:
- Lack of understanding of mental health as central to overall physical health status
- Lack of process for capturing data on the need for mental health services and impact of untreated disorders
- Low treatment rates
- Insufficient awareness on the public's part as to when, how, and where to access needed mental health services
- Lack of resources to fund mental health services either through government or insurance carriers
- Insufficient infrastructure and adequately trained staff to ensure coordination across agencies and settings and to implement evidence-based practices
Additionally, Louisiana's mental health funding disproportionately flows to inpatient services at the expense of community services. While 97 percent of OMH's clients are served in the community, 60 percent of OMH's budget and 72 percent of staff support goes towards inpatient settings. A huge growth in the influx of forensic patients in state hospitals, and maintenance for the state's large inpatient facilities, accounts for some of this spending, but it is a trend that must be reversed.
Now is the time for the OMH and the state of Louisiana to meet the crisis in mental health care and seize this moment to rebuild a better system in the wake of the hurricanes than existed before.
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