by Allen Powell II
New Orleans bureau
October 20, 2012
New Orleans — The horrifying deaths of Kendall and Kelsey Adams, who were allegedly killed by their mother Chelsea Thornton on Wednesday, stunned and dismayed many in the metropolitan area.
Those deaths also provoked serious discussions about the availability of mental health services for low-income individuals in the region.
Thornton has admitted to shooting her 3-year-old son and drowning her 4-year-old daughter at their Gert Town apartment, according to New Orleans police. She’s been booked with two counts of first-degree murder and is being held without bond.
A persistent theme in conversations with Thornton’s family, and the family of the children’s father, is that Thornton has struggled with mental illness for years. Her mother, Eleanor Chapman, said Thornton has been diagnosed with schizophrenia and has spent time in the Southeast Louisiana Hospital in Mandeville and other facilities.
Thornton was apparently on medication for her condition, and a failure to stick to that drug regimen may have led to the incident, relatives and acquaintances said.
But according to mental health professionals, it wasn’t just a failure on the part of Thornton and her family, but also on the part of the state’s mental health system as a whole. Some advocates say Thornton is a casualty of ever-growing budget cuts that have slashed resources for low-income residents, and, sadly, she’s just the tip of the iceberg.
Cecile Tebo, a social worker and mental health advocate, said she and others have been warning that cuts in the number of psychiatric beds available in New Orleans, along with a variety of other budget cuts, are creating a dangerous situation. People struggling with mental illness need a robust support system and a variety of treatment options, but Tebo said the state has been pushing all of its resources toward outpatient residential care. There is a place for those services, but they don’t replace the need for psychiatric beds.
“We’ve been screaming this for five years,” Tebo said. “The people who are chronically mentally ill are being forced to live independently without the proper support.”
Support is a word used often by those in the mental health field. City Health Commissioner Dr. Karen DeSalvo said that’s because there is not one single magic solution that will solve the city’s mental health crisis. Instead, the city needs to rebuild a support system, or “mental health continuum,” for those already identified with illnesses. It also needs to create a way to seek out those who are ill but who have not been diagnosed.
DeSalvo said the city has about 157 psychiatric beds, or roughly half of what it should have, but even if that number doubled, there would still be other gaps.
“The resources we have for mental health in this community are insufficient to meet the need,” DeSalvo said. “The solution to the problem is not to just add more psychiatric beds.”
New Orleans and the surrounding region need more teams dedicated to treating different severities of mental illness and a system that allows seamless follow-up and care. The area needs more outpatient centers, more “step-down” beds outside of hospitals and more crisis response teams so the mentally ill don’t end up erroneously placed in prison, DeSalvo said.
She agreed that the region needs more psychiatric beds, particularly after nine were eliminated at the DePaul-Tulane Behavioral Health Clinic earlier this year, and nearly 190 will disappear when Southeast Louisiana Hospital in Mandeville closes. DeSalvo estimates that the area needs to add about $5 million to the current $27 million budget for the Metropolitan Human Services District to create the proper system.
“The need right now is not to cut, it’s to invest,” DeSalvo said.
But Lisa Faust, spokeswoman for Magellan Health Services, said there are more resources available in the New Orleans region than people realize.
Magellan manages mental health services for the state, and Faust said the company has partnerships with providers who deliver many of the services DeSalvo has mentioned. Those providers have about 400 inpatient beds available for Medicaid enrollees, although Magellan is trying to increase the use of outpatient and home-based services. Magellan does not manage individuals who do not have any insurance, Faust said.
Magellan has a 24-hour hot line that patients and their families can use to access care and coordinate follow-up treatment as well. Faust speculated many patients are unaware of their options because she says the state’s mental health management was disorganized before Magellan assumed control. The company is building the proper infrastructure to ensure correct treatment, she said.
“There’s just a lot of transition happening in the state right now,” said Faust, adding that the hot line number is (800) 424-4399. “The state has really had a nonexistent system of behavioral health.”
However, Dr. Mordecai Potash, a psychiatrist at Tulane University Hospital and Clinic, scoffed at Faust’s claims that Magellan is improving care.
Potash works in the hospital’s emergency room and said he sees many patients who have been caught up in “72-hour shuffle.” Over a short period of time, those patients are admitted to multiple hospitals for a 72-hour stay because that’s the bare minimum of coverage allowed by law.
Private hospitals cannot afford to provide long-term care to patients on Medicaid or who are uninsured, which means those patients are discharged as quickly as possible. It also means they receive very little follow-up care or support, Potash said.
“It’s a total sweeping-it-under-the-rug approach” said Potash, who noted that Magellan’s system is based on patients and families managing their care themselves, which can lead to serious problems. “My impression is that Magellan has been setting up a system that is unrealistic.”
Could a support system have made a difference to Chelsea Thornton?
Dr. Carl Weems, a psychology professor at the University of New Orleans, said schizophrenics often have trouble maintaining their medication regimes. Some individuals struggle with side effects from the drugs, and others decide to stop taking them when they feel better.
Weems said that without medication, schizophrenics can begin to have trouble understanding reality.
Judy Andrews, one of the grandmothers of the two victims, said Thornton believed that the babies were in a better place.
Weems said that’s possible.
“When you’re schizophrenic, you can believe killing your children is sending them to a better place,” he said.