La. Mental Health Bill Unveiled

Not sure what to think about this yet...but it seems like a step in the right direction.

Jindal unveils plan to aid mentally ill
By Laura Maggi
Originally Published in the New Orleans Times-Picayne

Nicola's Law, named for officer, would mandate treatment Tuesday, March 25, 2008
Potentially violent patients suffering from mental illness who are vulnerable to slipping through the cracks of a fractured post-Katrina health care system would be more effectively treated under a proposed law that gives judges the authority to mandate treatment for certain people, Gov. Bobby Jindal and other state leaders said Monday.

Jindal unveiled a package of legislation at a news conference in New Orleans, including a proposal to require involuntary outpatient mental health treatment that was prompted by the late January shooting of New Orleans police officer Nicola Cotton. Cotton was killed with her own gun, allegedly by a man described by his family as a paranoid schizophrenic in and out of mental institutions his entire adult life.

"Nicola's Law is designed to balance the issue of public safety with ensuring that people have the dignity of getting the care they need," Department of Health and Hospitals Secretary Alan Levine said at St. Thomas Community Health Center on St. Andrew Street.

Bernel Johnson, the man charged with killing Cotton in Central City, had made threats of violence against family members and often stopped taking his medications when he was not in an institution, his sister said earlier this year.

A state grand jury indicted Johnson, 44, on a charge of first-degree murder in February. A hearing to determine whether he is competent to stand trial is scheduled for next month.

Jindal's proposal is modeled after a New York law passed in 1999. It would give Louisiana judges the authority to require that certain patients comply with prescribed treatment, take their medication, go to therapy and obtain substance abuse counseling. Judges also could require patients to undergo blood testing to ensure medicines are being taken.

Patients would not be affected by the law unless they demonstrate a history of failing to comply with treatment. A judge first would have to find that the person was either hospitalized twice in the past three years for a mental illness or in some way acted violently or threatened violence during that same period.

Under current Louisiana law, the mentally ill can be sent to a facility against their will, but there are no provisions to require people to follow medical treatment plans after they are released.

$26 million from state

Mandating treatment -- and checking on patients to ensure they are complying with court orders -- would require a massive expansion of the outpatient services available in the New Orleans area, which have been significantly lacking since Hurricane Katrina.

But Levine said his agency's new focus on the issue, including an infusion of $26 million in state money announced last month, will result in services that can support such court orders. For example, the state announced the creation of "assertive community treatment teams" of social workers, psychiatrists, nurses and employment counselors who would go to clients' homes and help them stay on their medication, find housing or jobs, or kick substance abuse habits.

New York's state legislature adopted Kendra's Law in 1999, inspired by the death of a Manhattan office worker who was pushed into the path of an oncoming subway train by a paranoid schizophrenic man. Jindal cited several statistics that show hospitalization, arrests and homelessness of mentally ill people in New York have plummeted since the law was enacted.

A controversial proposal

While more than 40 states have since passed laws that allow judges to require outpatient treatment of mentally ill patients, the concept remains controversial.

Part of the criticism is that no studies have been conducted that directly link the forced-treatment aspect of the law with the decreases in hospital stays and arrests, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services. The wide expansion of available services could also explain the more successful treatment rates of the mentally ill, he said.

Rosenthal said there is a human-rights objection to mandated treatment.

"Policies forged in an atmosphere that condemns people with psychiatric disabilities of being uncooperative increases fear and distrust of services," Rosenthal said.

Several states that have recently considered similar proposals -- including Virginia, in the wake of the Virginia Tech shooting that left 32 people dead -- have rejected the concept, he said.

Along with Nicola's Law, Jindal announced a series of legislative proposals meant to address the shortcomings in Louisiana's mental health system for the uninsured.

"Our goal is not just to repair the damage done from Katrina," Jindal said. "Our goal here is to improve a safety net that wasn't even adequate before Katrina."

One bill would create regional "crisis centers," places where police could bring people in the throes of a mental crisis instead of to local emergency rooms. The first crisis center would open in New Orleans, hopefully six months after the legislation is approved, Levine said.

Another proposal would expand local control of public health dollars across Louisiana, while also trying to impose more oversight on "human services districts." Levine said the Jindal administration supports the idea of local districts deciding to spend health money on problems specific to their areas, proposing to create more districts across the state.

Strict supervision

But persistent problems with the Metropolitan Human Services District, which controls many of the mental health and substance abuse programs in New Orleans, St. Bernard Parish and Plaquemines Parish, prompted the Jindal administration to embrace stricter supervision of the independent agencies. The new law would allow the state health agency to hold districts "accountable" if they can't meet standards.

A final bill would allow doctors to use "telemedicine" technology -- essentially video conferencing -- to interview patients in the throes of a mental health crisis in order to issue emergency commitments. This provision would make it easier for patients in remote locations to receive an emergency evaluation by a doctor, Levine said.