In The News › Cuts force changes in mental health care

Cuts force changes in mental health care

By Katy Reckdahl
The Times-Picayune
April 26, 2012

Cuts to mental-health services at Interim LSU Public Hospital were “a punch in the stomach,” but they have forced necessary conversations and better identification of high-risk patients, according to city health commissioner Dr. Karen DeSalvo. “The system has started to talk to each other in a way that’s more meaningful,” DeSalvo said Wednesday during a forum on the impact of the cuts hosted by the nonprofit Bureau of Governmental Research.

The city’s mental-health framework still is underfinanced, she said. But in the wake of the cuts, officials and advocates found new ways to work more efficiently, she said.

For instance, DeSalvo said, because the cuts hit hardest on the Interim LSU Public Hospital’s mental-health crisis beds, Metropolitan Human Services District asked for a list of “frequent flyers” who repeatedly returned to the emergency-room beds.

In December, 21 mental-health patients were responsible for 109 emergency room visits. One person alone made eight visits.

Now, when Metropolitan patients end up in the emergency room, the ER notifies agency staffers, who pick them up, said Metropolitan head Calvin Johnson.

LSU’s cuts included half of the emergency mental-health beds, nine out of 38 mental-health inpatient beds and all chemical detox beds.

Metropolitan and other providers have also worked with the city to open up “stepdown” crisis beds on nearby Tulane Avenue that provide medical supervision for mental-health patients but not at the same level as hospitals, DeSalvo said. Odyssey House provides similar services for substance-abuse patients requiring medically supervised detox.

Like other correctional systems across the nation, the Orleans Parish jail deals with a high level of mental illness. But in the past, some people with mental-health diagnoses had been released with “only a piece of paper,” because the jail’s records were separate from medical providers, DeSalvo said. Now those systems are linked, allowing electronic information sharing so that anyone discharged from jail should have a clinic appointment before they roll out, she said.

An inadequate, disconnected mental-health system forces judges, jailers, doctors and cops to act as social workers, DeSalvo said. “We’ve created a system that is trying to funnel people in the wrong places,” she said.

But once patients land in the wrong place, the threadbare system doesn’t have enough services to pull them out, she said.

Jefferson Parish has an inter-agency council that coordinates all the pieces of its mental-health system, and DeSalvo said she would like to see a similar structure in Orleans.

Another recent sea change for the mental-health system is that since March 1, all Medicaid-reimbursed and uninsured patients have had to navigate Magellan Health Services Inc., a privately run coordinated-care network hired by the state, said Dr. Richard Dalton, a professor of child and adolescent psychiatry at Tulane University School of Medicine who also spoke at Wednesday’s forum.

Dalton said it will be difficult for anyone to “hold Magellan’s feet to the fire,” given that the network’s contract with the state doesn’t require the network to show measurable results for each patient.

Fair Use Notice

This site occasionally reprints copyrighted material, the use of which has not always been specifically authorized by the copyright owner. We make such material available in our efforts to advance understanding of issues and to highlight the accomplishments of our affiliates. We believe this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is available without profit. For more information go to: US CODE: Title 17,107. Limitations on exclusive rights: Fair use. If you wish to use copyrighted material from this site for purposes of your own that go beyond ‘fair use’, you must obtain permission from the copyright owner.