Mental Health Crisis Plagues New Orleans

The US House of Representatives will possible vote on a bill today that will require parity for mental health coverage by insurers. Mental health parity is the theory that mental illness should be covered at the same level as other ailments. The subject is a highly controversial and largely ignored matter in US health policy. However, this matter is really coming to the forefront now with recent news about the high rate of untreated mentally ill people in New Orleans, and specifically the closing of Charity Hospital, which housed many of the city’s mentally ill.

By Rick Jervis
Originally published in USA Today

NEW ORLEANS — Bernel Johnson showed all the signs.

He was diagnosed by a psychiatrist as aggressive, homeless and schizophrenic. He was kicked out of a Salvation Army homeless shelter late last year for holding a fork to a fellow resident's throat. On Jan. 4, Johnson was committed to a psychiatric facility for causing a disturbance at a bank. He was released and, a few weeks later, attacked New Orleans police Officer Nicola Cotton, 24, in a parking lot.
Johnson wrestled Cotton's service handgun from her and shot her 15 times, killing the officer, police said. Johnson remains in jail without bond, charged with first-degree murder.

New Orleans health and law enforcement officials say more cases such as this could unfold if the city's mental health crisis isn't resolved soon. Since Hurricane Katrina ravaged the city 2½ years ago, the number of public mental health facilities and community outreach centers has decreased dramatically, leaving the mentally ill without medication and monitoring.

Cotton's slaying, another recent high-profile killing involving a mentally ill suspect and an increased percentage of mentally ill inmates at Orleans Parish Prison have galvanized state and local health agencies into trying to resolve the crisis. Last week, state health officials unveiled a $90 million plan to improve the city's mental health facilities, including community-based treatments and housing subsidies for the mentally ill.

Cotton's killing was one of at least eight slayings since Katrina involving mentally ill people, says Orleans Parish Criminal District Court Judge Arthur Hunter, who also runs the state's only Mental Health Court.

"Nos. 9 and 10 could happen at anytime, anyplace," he says. "This is more than just a public crisis. This is a dangerous situation."
One of the casualties of Katrina's 2005 floods was Charity Hospital, a state-run facility that housed a psychiatric ward equipped with 140 inpatient beds and round-the-clock psychiatrists and social workers. It was the bulwark here for treating mentally ill patients, particularly those with violent tendencies, says Jeffrey Rouse, the Orleans Parish deputy coroner and psychiatrist who diagnosed Johnson in January. The hospital has been closed since Katrina.

'Treatment system collapses'

Now, instead of being treated at Charity, mentally ill criminal suspects often are arrested, burdening the city's overtaxed judicial system, Rouse says. That worsens the problem for patients, who may not get proper medication or monitoring in jail, he adds. The patients usually suffer from schizophrenia, bipolar disorder or depression.

"When your regular mental health treatment system collapses, the patients become criminalized," Rouse says.

Besides Cotton's killing, there was an incident last month involving a mentally ill suspect. Latina Williams, 23, a nursing student, gunned down two classmates at Louisiana Technical College in Baton Rouge on Feb. 8 before killing herself. Williams had shown signs of paranoia and had called a crisis counselor the morning of the shooting to say she was planning to kill herself.

New Orleans has a smaller prison population today than before Katrina, but an increasing percentage of those arrested have been mentally ill, says Sam Gore, a physician and medical director for the Orleans Parish Criminal Sheriff, which runs the city's jails.

"We've clearly noticed there's been an increase in demand for psychiatric treatment post-Katrina," Gore says.

Currently, Orleans Parish Prison, which has 60 psychiatric inpatient beds, is the city's biggest public ward for treating the mentally ill, Hunter says.
The patients get some treatment at the prison but are released without further monitoring, Hunter says.

"They have to get arrested to get any type of treatment," he says. "It makes no sense."

The lack of services comes as mental illness generally has multiplied in New Orleans. The percentage of the city's population showing some sign of mental illness has doubled from 6% before Katrina to 12% today, estimates Kevin Stephens, director of the city's health department.

Illness afflicts homeless

Mental illness also is rampant among the city's homeless, whose population has spiked since the storm from 6,200 to 12,000 today, says Sam Scaffidi of the New Orleans Police Homeless Assistance Unit. Under the Interstate 10 overpass at the corner of Claiborne Avenue and Canal Street downtown, homeless encampments have multiplied since Katrina into a sprawling colony of tents, soiled sleeping bags and cardboard caves.

Scaffidi says the number of mentally ill homeless people he encounters each day around the city has increased from about 10 before Katrina to more than 20 today.
Like the woman under the bridge who defecates each day into a bucket and throws it into Canal Street, yelling at anyone who passes near her, Scaffidi says. Or the woman in the French Quarter who drinks bottle after bottle of vodka and blocks the doorways of shops. Both women show signs of schizophrenia and have been arrested, he says. A few days later, they're back on the street, he adds.

Though the vast majority of homeless are harmless, some show violent traits, Scaffidi says. On Feb. 14, a 42-year-old homeless man living under the interstate stabbed another homeless man in the back and fled, police said. The victim survived.

"It's frustrating," says Scaffidi, a 10-year veteran of working with the homeless. "How do I talk to a person and convince him to get help when I have nowhere to bring him?"

State health officials are considering enhancing the city's community outreach centers, which monitor patients over weeks and months, and increasing affordable and public housing to get some of the patients off the streets, says William Payne, assistant secretary at the state Department of Health and Hospitals.
"There is significant demand and the demand currently exceeds the capacity to address it," Payne says. "It's clearly a critical situation."

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