Mental health emergencies requiring involuntary commitment skyrocketed last year, and local authorities blame a lack of psychiatric resources and the closure of facilities.
This week, East Baton Rouge Parish Coroner Beau Clark released his office’s 2015 report. In addition to the coroner’s responsibilities in suspicious death and sexual assault investigations, his office wields substantial power when determining when mentally ill patients may be committed to a hospital against their will.
The coroner may issue a 72-hour protective custody order to require a suicidal or possibly dangerous patient be hospitalized and evaluated by a doctor. Later, if a doctor determines a patient is “gravely disabled” or a threat to himself or others, the Coroner’s Office must review the case and may issue an emergency certificate that allows the patient to be institutionalized for up to 15 days, after which a judge determines how to proceed.
In 2015, the number of 72-hour custody orders shot up 31 percent over the previous year, and 15-day certificates rose 19 percent to 7,785. That follows recent trends, as these orders have steadily increased from year to year.
Exactly what might be responsible for this growth is unclear, with mental health officials diagnosing different flaws with access to treatment in Baton Rouge and across Louisiana.
For his part, Clark sees the rise as an end result of the shuttering or privatization of facilities, especially for long-term care. Louisiana is down to two public psychiatric hospitals that provide long-term care. The facility in Pineville has 60 beds for long-term adult care, and the state hospital in Jackson has 541, though about half are for people who have been deemed mentally unfit to stand trial or who have pleaded insanity.
As a result, people who should be in long-term care fill up beds at short-term facilities, leaving fewer options for everyone else — often just the hospital or jail, Clark said.
At the same time, local facilities are closing as well, including the Earl K. Long Medical Center in 2013 and Baton Rouge General’s Mid City emergency room last year.
“We have fewer and fewer places to take these patients, so the system is backlogged. … The patient ends up in limbo,” he said.
Hospital officials see the struggles with mental health care, which they agree exist, differently. It’s not at the emergency room level, they said. Baton Rouge General, for example, recently expanded the acute behavioral health unit at the Mid-City location to 50 beds, Behavioral Health Executive Director Ann Wilder said in a statement.
Hospital spokeswoman Rebekah Maricelli said the unit is not typically at capacity, though clarified that it serves only people over 50 years old.
Our Lady of the Lake Regional Medical Center, which handles cases involving both indigent patients for the state and people with insurance, in August dedicated 22 beds for adult mental health emergencies, said Vice President of Mission Coletta Barrett. She said she’s never seen more than 18 beds in use at a time.
“There is a huge demand (for mental health services), but it’s not for the emergency room beds,” she said.
The issue is where to send patients once the immediate crisis ends.
At the Lake, about 60 percent of emergency mental health patients who require additional care can stay on-site, but the rest can wind up at a hospital in New Orleans or Shreveport or “wherever there are acute psychiatric beds,” Barrett said.
Some patients may stay at a hospital for months at a time “because there’s no other place for them to go” when their symptoms are severe enough that they can’t be discharged, she continued.
Many people with psychiatric diagnoses just end up homeless or in jail, said state Rep. Barbara Carpenter, D-Baton Rouge.
“A lot of these people aren’t criminal, they are mentally ill,” Carpenter said.
She is working with the Capital Area Human Services District to devise a plan for a new mental health facility in the area.
The Baton Rouge Area Foundation also has taken steps to address the issue and has worked with local law enforcement agencies and the Coroner’s Office to develop a specific plan.
As the Coroner’s Office reports increasing calls for mental health emergencies, local authorities are calling for units that can respond quickly to crises.
“You need to have an urgent care-type place,” said Jan Kasofsky, executive director of the Capital Area Human Services District.
The facilities being discussed likely would need to be supported with a new tax or other public funding, but health officials said the community ends up paying for a lack of services too.
There are public safety risks associated with underfunding community mental health, Kasofsky said. Furthermore, emergency rooms are expensive, and while they can receive patients, psychiatric treatment shouldn’t begin there.
And if people in crisis get taken to jail, the taxpayers are picking up the tab for their room and board, Clark pointed out.
“Wouldn’t it be wiser to spend the money to get them mental health help if that’s what they need?” the coroner asked.
To that end, he has worked with BRAF to design a mental health facility. In 2014, the organization, the mayor-president and law enforcement leaders took a $335 million public safety tax proposal to the East Baton Rouge Parish Metro Council with the aim of building a mental health center and a new, larger jail. Council members shot down the idea, though, saying the plan, especially for the new jail, seemed rushed.
Earlier this year, BRAF released a report with specific designs for a mental health facility. For about $2 million, it could renovate space at the Baton Rouge Detox Center on South Foster Drive to make room for 30 beds.
Project Manager Patricia Calfee said that would allow 10 beds for substance abusers to get sober, 10 for detox once they’re sober and 10 for psychiatric care. It is not intended to be a long-term care facility, and patients likely would stay only a couple days, she said.
Case workers would follow up with patients for three months after they’re discharged and help them with issues like applying for benefits and finding housing. The plan also calls for a nurse and social worker duo to help law enforcement out in the community with psychiatric patients around the clock.
It will take about $5.7 million annually to operate the facility, Calfee said. BRAF is still looking for funding opportunities, but Calfee said it ultimately will require taxes to support. If BRAF can find some public or private money, she would like to open the relatively inexpensive sobering unit first to show that the facility would be a sound investment.
Carpenter, the local legislator, has penned a bill with input from the Capital Area Human Services District that would authorize “behavioral health intervention and stabilization units.”
She described a plan similar to BRAF’s — a short-term local facility operating independently from existing facilities, though perhaps with less emphasis on substance abuse and more focus on accepting the coroner’s involuntary patients. However, Carpenter’s plan is much less specific than BRAF’s and does not yet address funding.
Louisiana still needs more long-term residential care also and should look to the state government for answers, Barrett, of Our Lady of the Lake, said. But at the local level, she and others said the community must begin treating mental health like other chronic diseases that can strike patients of all backgrounds but can be managed with preventative primary care.
“Mental health is a problem. It’s a challenge,” Barrett said. “We’ve all struggled with this for years.”
Follow Steve Hardy on Twitter, @SteveRHardy.