Mentally ill ending up in jail instead of hospitals

Advocate staff photo by PATRICK DENNIS -- EMS Prison Health Care Manager Linda Ottesen talks about their policies and procedures.
Advocate staff photo by PATRICK DENNIS -- EMS Prison Health Care Manager Linda Ottesen talks about their policies and procedures.

About a year ago, Earl K. Long Medical Center and its specialized unit for treating mentally ill patients shut down.

Since then, the number of mentally ill people locked up in the East Baton Rouge Parish Prison has doubled, said Linda Ottesen, director of Prison Medical Services, which runs health care operations there.

“We’re actually becoming a mental health facility,” Ottesen said.

On any given day, about a third of the 2,100 inmates in Parish Prison are mentally ill, she said.

That trend is nationwide and can be traced to the deinstitutionalization of the mentally ill, draconian reductions in community mental health funding and shuttering public mental health facilities, says a 2013 National Institute of Corrections report. About 64 percent of the inmates in the 300,000-plus local jails in the U.S. have some form of mental illness, the report says.

“We’re criminalizing people for an illness,” said David Precise, executive director of the Louisiana office for the National Alliance on Mental Illness. “When somebody has cancer, you don’t send them to jail, you take care of them. When you have a mental illness, you go to jail.”

Jan Kasofsky, executive director of the Capital Area Human Services District, said many mentally ill people who wind up in jail are experiencing a mental health crisis, meaning they are off their medications or they haven’t been keeping up with their treatment.

The Mental Health Emergency Room Extension at Earl K. Long was geared toward treating such people. Kasofsky said the program was so successful that health care leaders from elsewhere studied the system so they could create similar ones.

Opened in summer 2010, the program included a 20-bed stabilization unit that worked as a relief valve to ease the pressure other hospitals faced with the influx of mentally ill patients. LSU physicians and nurses stabilized the patients and determined follow-up care.

But in 2012, state budget cuts left the program with only 10 beds, and a year later, it closed.

“Now, Baton Rouge has nothing,” Kasofsky said.

Kathy Kleibert, who heads the state Department of Health and Hospitals, said her agency is working with Magellan Health Services, the private manager of the state’s Medicaid behavioral health services, to build crisis-stabilization units in several parts of Louisiana. But the process is slow moving, she said, because it is difficult to find qualified people to run the centers. Magellan is working with a provider to acquire the right permits to open a crisis-stabilization unit in Baton Rouge, according to DHH.

For now, though, the choices for where a police officer can take someone in the throes of a mental health crisis are slim: an overburdened emergency room or jail.

To help police officers, Kasofsky’s organization trains them in crisis intervention, focusing on how to deal with the mentally ill. Officers learn about different kinds of mental illness, including how to identify what mentally ill people may be experiencing by looking at the prescription drug bottles in their medicine cabinets.

Kasofsky said about 1,000 officers from East Baton Rouge and surrounding parishes have taken classes, and trainers also teach seminars at law enforcement academies.

Dr. Beau Clark, East Baton Rouge Parish’s coroner, said the lack of treatment options has caused the number of protective custody orders issued by his office to soar from 413 in 2010 to 730 last year. People can seek such orders when they suspect a family member has a mental illness and is in need of immediate treatment. The coroner can place the person in treatment for 72 hours — a period that can be extended if necessary.

Clark said some family members of mentally ill people see jail as an acceptable alternative and a form of protective custody. They view it as a way to get mentally ill relatives off the streets and in a safe place that offers three meals a day, he said.

“But jail is jail,” Clark said. “Jail is not a hospital.”