By DR. REBEKAH GEE | Louisiana Department of Health Secretary
Last fall, NOLA.com | The Times-Picayune's series “A Fragile State” placed a spotlight on one of our most vulnerable populations. Full of heartbreak and sometimes hope, these courageous stories reminded us of the tragic impact of mental illness on families and individuals in our state. Because May is National Mental Health Month, I turn to these stories once more as a call to awareness and action.
“A Fragile State” vividly portrayed the enduring impact of years of financial cuts and psychiatric hospital closures that occurred under the Jindal administration, actions that left thousands of people without some vital services. Now, however, the ball is in our court, and Louisiana can and must do better.
These individual stories are heartbreaking and the solutions are complex. More inpatient beds are needed as well as adequate numbers of doctors who can treat patients who have mental health and substance use illnesses. True solutions start with addressing poverty, health disparities, early childhood trauma and violence – issues beyond the walls of a doctor’s office or hospital. The seeds of mental illness and addiction are sown in the pain of trauma and neglect. Louisiana must also invest new funds and renewed dedication to ensuring quality care options in the community – more crisis services and greater access to these services – are available for people when they need them most.
A lifetime of care
We need to demand care that occurs throughout the life course. This means a pregnant mom with mental illness is treated and there is help available as she parents her child. When and if a school-age child suffers from mental illness, she is diagnosed and treated instead of failing and dropping out.
It means that a family with a son in a sudden crisis is treated for mental illness instead of ending up in the criminal justice system, leaving a trail of pain in his wake. It means that individuals and families always know who to call and what to expect when help is needed.
Care throughout a person’s life, with a strong focus on immediately helping those who are facing a crisis, is the mental health system Louisiana must commit to building. This system will require more providers, more resources and greater investments from our communities.
An ideal system includes easily accessible mental health services in the community. Inpatient beds will be a component of this continuum, but not its foundation. We must address crises via mobile crisis response or specialized drop-in centers, for example, and the system should address homelessness and lack of transportation that can get in the way of recovery.
The Louisiana Department of Health is focusing on four critical areas: ensuring there is a full continuum of care, implementing effective crisis services, improving the access to and quality of care, and making the mental care system easier to navigate.
First and foremost, under Gov. John Bel Edwards’ leadership, we led the charge for coverage under Medicaid expansion. Prior to expansion, most low-income adults in Louisiana had no health insurance and no access to treatment for mental health. Rather than treating mental illness, it fell to the correctional system to remove mentally ill individuals from society, rather than treating people and preventing harm to others.
Since Medicaid expansion, more than 485,000 adults are now covered, of whom more than 65,000 have received specialized outpatient mental health services and more than 15,000 have received inpatient mental health care at a psychiatric facility. Tens of thousands of people have received treatment for addiction. We have sought and received millions of new federal dollars for addiction treatment and are rebuilding our system of mental health care in partnership with local human service districts that serve as the safety net for mental health care.
The way forward
The journey for families with a loved one with mental illness can be excruciating, even for our citizens with high incomes and the means to pay for care. The Louisiana Department of Health is charged with taking care of those in the shadows, individuals who are sometimes forgotten, neglected, the most vulnerable and complex. We are failing in that charge.
“A Fragile State” is a raw and honest account of a system that needs to change. That change will be led by the Department of Health, but it is bigger than a single state agency. Change will come only when we work in tandem with the community, with law enforcement, with the judicial system and any other stakeholders in mental health.
We commit that as a Department we will continue to fight this battle on all available fronts — to rebuild and strengthen a system of care that too often fails those who are desperately in need of help. This will not be easy, but we commit to fight for the systems of care and the resources needed to win the struggle against mental illness and addiction so that people can thrive. Only then will our communities reach their full potential.