BusinessReport.com

The Capital Region is not in the midst of a mental health care crisis—at least not yet.

“For a long time, we’ve just been a whisker away,” says Dr. Gerald Heintz, medical director and a psychiatrist with Capital Area Human Services District, which works with people who have acute mental illnesses.

As one would expect, CAHSD saw the demand for its services spike after Hurricane Katrina. But as the parish population declines from its post-Katrina high, demand on CAHSD’s services continues to rise; the number of people served at the district’s adult mental health centers has increased about 40% since 2005. Not only are they seeing more patients, but the patients’ conditions tend to be more severe, says Jan Kasofsky, the district’s executive director.

“This is what has really been disturbing me,” Kasofsky says, pointing to statistics showing the district received nearly twice as many discharges from state-paid, acute-unit hospital beds in 2008 than its sister agency in New Orleans. “Why are they coming here when they all obviously didn’t come from here?”

One possible reason is a proliferation of unlicensed group homes in the Baton Rouge area. It’s hard to prove Kasofsky’s theory, since unlicensed homes by definition aren’t on any public record, but her staff knows all the licensed homes and finds out about the illicit ones through word of mouth. With a nationwide shortage of affordable housing, group homes at least provide some sort of shelter.

“The hospitals can’t discharge them to nowhere; they have to discharge them to an address,” Kasofsky says. “It stands to reason with the loss of facilities in New Orleans, that’s correlating with the number of people being discharged into this region.”

“The population we serve seems to be disproportionately represented in what remains an increase in the parish,” Heintz says.

The loss of housing and medical services in New Orleans can’t help but have an impact on Baton Rouge, but this isn’t purely a local issue. Heintz says the roots of the problem date to the 1960s, when a national push towards de-institutionalization shifted patients from hospitals to newly created community health centers. Unfortunately, authorities didn’t transfer enough resources to support the new system.

“There was a large spike post-Katrina, but that spike has never gone away,” says Dr. William Freeman, medical director of the emergency department at Earl K. Long Medical Center.

Freeman’s department is seeing a lot more recidivism, as patients with severe mental illnesses are treated and released to a psychiatric facility, but end up back in the emergency room within days or weeks.

“It’s almost like a revolving door,” he says. “They’re coming in almost as soon as they’re getting out.”

The loss of beds in New Orleans means patients are being sent to Baton Rouge and other areas, Freeman says.

“We wind up having to see more patients that have psychiatric illnesses,” he says. Those patients might have to stay in an emergency-room bed for as long as 48 hours before a hospital bed frees up.

“It delays me getting to other people that need medical care,” he says.

A 20-bed, $1.3 million modular unit at Earl K. Long Medical Center, known as the Mental Health Emergency Room Extension, will help ease the stress on the emergency room and others around the city, Freeman says. Officials hope to open the unit by late May, although staffing has been a challenge.

Not surprisingly, law enforcement has been dealing with more calls involving people with acute mental illnesses, along with an increase in homelessness and drug addiction, says Lt. Danny Williamson, coordinator of the Baton Rouge Police Department’s Crisis Intervention Team. The CIT concept originated in Memphis, Tenn., following a controversial police shooting of someone who was later found to be mentally ill. Officers are trained to manage situations “where the mentally ill are in a state of crisis,” reduceing the chance of injury to both patient and officer and helping to make sure the patient receives the proper care.

The Capital Area Human Services District provides the local version of the 40-hour course. While only five officers have completed the course, according to police records checked by a department spokesman, BRPD hopes to have at least two CIT-trained officers per shift in each patrol district.

CAHSD is a division of the Louisiana Department of Health and Hospitals. When deficits loom, health care is often one of the first state budget areas on the chopping block, although the budget does not yet include cuts for CAHSD. Every department is being asked to review its operations, and Kasofsky says the Division of Administration has asked what a $1 million cut would look like.

Kasofsky and her staff have reason to be hopeful, however. Gov. Bobby Jindal had a hand in creating the district when he was secretary at DHH, and in a 2007 Business Report interview, he cited CAHSD as an example of efficient, community-based health care delivery.

A National Alliance on Mental Health report released March 11 gave Louisiana’s mental health care system a “D,” but cited Capital Area Human Services District—specifically its mobile unit—as one of the bright spots that kept the state from receiving an “F.”

“The only thing that I can tell you is that, as of today, we have not been cut for this year,” Kasofsky says.

AT A GLANCE

Organization: Capital Area Human Services District

Executive director: Jan Kasofsky

Parishes: East Baton Rouge, West Baton Rouge, East Feliciana, West Feliciana, Pointe Coupee, Iberville, Ascension

Annual budget: About $35 million

Employees: About 320

Functions: Provides community-based services for people with mental illnesses, addictions and/or developmental disabilities, including operating or funding three large adult mental health centers and several satellite clinics, substance abuse treatment clinics, a child behavioral health unit, 34 school-based clinics and an inpatient drug treatment facility; has contracts with more than 50 agencies

On the Internet: cahsd.org