Coauthored by:
Janet Hays – Director, Healing Minds NOLA & Robyn Burchfield, RN, NRP
A mother was at her wits end. So when a family friend called to say her son had overdosed on one of his medications, she could not bear to hear that he might be dead. “Please call to see if my son is dead”, the sobbing mother asked on the phone after learning that her 25 year old son who suffers with paranoid schizophrenia swallowed a bottle of Clonidine, one of the 7 prescriptions he was discharged with, 2 involuntary commitments ago. His most recent commitment, his 96th, was Monday May 31 2021, four days following discharge from his previous commitment.
At the ER he was admitted in critical condition. “They never do nothin’ for people with schizophrenia,” a family member said outside the facility. “Substance use, ya, but for serious mental illness, hospitals and insurance companies are just making money on ‘em. No one gives a shit”.
Meanwhile, at the June 3rd New Orleans City Council Meeting, a resolution was introduced to create a task force to explore ways to replace police with crisis workers on crisis calls. Councilmember Banks pointed out that mental illness is a health issue, not a crime. Removing police, he says, will help to remove “stigma”. “Stigma is the black hole of advocacy” DJ Jaffe used to say. Unlike other diseases, removing “stigma” is a politicians “feel good” excuse to do nothing.
Activists are calling for “help not handcuffs”. This is understandable given national headlines where, in many cities, police often use force against people with unstabilized serious mental illnesses (SMI), but activists have failed to explore their own backyard.
Including mental health professionals in crisis intervention calls is worthy, but such a thing already exists in New Orleans. Metropolitan Human Services District has the Metro Crisis Response Team (MCRT) where licensed mental health professionals attend to individuals in crisis via phone triage and in the community. If you or someone you care about needs help, you can access Metro Crisis Response Team 24/7 at (504) 826 2675. Still, in 40% of those interactions, MCRT calls NOPD to assist in encounters with volatile people in psychiatric distress.
It is absurd that police should be involved in psychiatric crises, however, in Louisiana, our civil commitment law REQUIRES dangerousness to self/others or grave disability before we can intervene to help. Most people living with serious mental illness are not violent, but when symptomatic, UNTREATED hallucinations and delusions can cause them to act violently. According to the Treatment Advocacy Center, untreated SMI have 15-fold-higher rates of violence.
Missing from the rhetoric of the City Council resolution is how deeply involved the New Orleans Police Department has been in providing for the safety and well-being of our community. The NOPD Crisis Intervention Team (CIT) program was enacted in 2015. In addition to the NOPD cadre of specialist CIT Officers, NOPD conducts initial and refresher CIT training, including de-escalation techniques, for every member of the Field Operations Bureau who respond to 911 calls. The NOPD CIT program is based on the Memphis model which is a nationally recognized best practice in police intervening for persons in crisis from serious mental illness. At quarterly NOPD CIT meetings that I attend, data shows police responded to 6535 psychiatric crisis calls in 2020. Of those, 75% of people were taken by NOPD to hospitals, and only 0.4% were arrested. The annual numbers are similar since NOPD began CIT. NOPD CIT has produced reductions in use of force and injuries to SMI community members and to officers. Police, like families, are frustrated that once taken to hospitals, people are released and often untreated, sometimes within hours.
Additionally, for 17 years, the New Orleans Police Department has had its own Homeless Assistance Unit (HAU) run by a civilian, B.B. St. Roman, a diversion program before diversion was a buzzword. The NOPD HAU helps thousands of street dwelling persons per year.
In a press release about the task force initiative, Councilmember Moreno urges implementation of response models such as in Los Angeles county. Yet, Los Angeles is the worst of “progressive” counties where, as a result of inadequate and inappropriate treatment options, homelessness is ballooning at unprecedented rates. 30 to 40,000 people with chronic Serious Mental Illness and substance use disorders are living on the streets while burned out clinicians and peers struggle to help.
Psychiatrists say that there are not enough intermediate levels of care between the State Hospitals and jails. Intermediate levels of care include supervised intensive coordinated programs and services for those who can live independently in the community. For those who can’t, the elephant in the room is the lack of secured and unsecured long term residential treatment facilities with 24/7 on-site support and services commensurate to need. The lack of residential treatment facilities is especially devastating for people whose severe mental illness is persistent and often treatment resistant (i.e., unresponsive to medications), and who remain psychotic and unable to live safely in the community. There are no psychiatric care facilities for people who are seriously mentally ill and persistently violent – except jails or prisons, after they have deteriorated to the point of injuring or killing someone as a result.
The Mom’s son is alive, for now but she, her son and her family exist in a never-ending nightmare of no system luck and heroics. He has already cost the state more than $3M. Without help, it’s hard to have hope.
It is a fact that people living with serious mental illnesses are not getting the specialized help they need but let’s point the finger of blame where it belongs. The blame belongs with Federal and State policies that shift funding away from serious mental illness, not the police.
In New Orleans, the hashtag, “Help not Handcuffs” is being used to fulfill an agenda that will not help alleviate the suffering of people who have untreated serious mental illnesses such as schizophrenia or bipolar disorder, and it won’t help the families who are watching their loved ones deteriorate as psychiatry and residential treatment has been defunded.
What is needed is a full continuum of coordinated psychiatric treatment and care to provide people who have brain diseases with science-based outcome driven programs, services and facilities that truly meet them where they are right now and through time. Psychiatric crisis response is the only part of the fragmented system that is not broken in New Orleans. Don’t waste tax dollars to break what works. Instead, fix what is broken.
Coauthors:
Janet Hays – Director, Healing Minds NOLA
Robyn Burchfield – RN, NRP
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