West Jefferson Medical Center confronts mental health crisis

New Orleans CityBusiness, Jun 29, 2007 by Richard A. Webster

The survival and well-being of the mentally ill post-Hurricane Katrina sometimes comes down to being in the right place at the right time.

Charlie Hart, manager of behavioral medicines at West Jefferson Medical Center, said he recently received a call from a WJMC emergency room doctor. A 24-year-old crack addict was growing increasingly erratic and suicidal as he came down from his high. The ER was at capacity and the staff didn't have the resources to properly treat the man's worsening condition.

"He had burned all of his bridges and didn't have any money," said Hart, director of the 24-bed WJMC Transitional Care Center.

The facility offers temporary housing for substance abusers and the mentally ill after they are discharged from Jefferson Parish emergency rooms. Doctors and nurses provide medical and psychiatric care while searching for a permanent facility to place patients if required.

WJMC is the only general hospital in the area with a dedicated mental health transitional facility.

Hart said the crack addict was held for 12 days and placed in long-term treatment.

"He wanted to get his GED and move on with his life, but crack had him where he couldn't break that cycle. It's a wonderful thing when you have someone so highly motivated. He was a model patient and he keeps doing well. The key is we had the opportunity to do it right and weren't under the pressure to get rid of somebody quickly to clear bed space."

Not everybody is as lucky.

Touro Infirmary closed its 48-bed psychiatric ward after the storm. In April, Touro released a mentally ill patient, Willie Lewis, after he refused care, according to police reports. He left without being evaluated by a psychiatrist or a doctor, returned home and repeatedly stabbed his 77-year-old mother, stopping just short of killing her.

Lisa Romback, program director for the New Orleans chapter of the National Alliance on Mental Illness, said in addition to a severe shortage of inpatient mental health beds, the area is sorely short on transitional and outpatient services so vital in ensuring a safe return to the community for the mentally ill.

"The system is very fragmented right now and it depends on whether you have insurance and what type of insurance you have to take advantage of outpatient services," Romback said. "A lot of these individuals are extremely disabled and aren't able to navigate a complicated system like this," she said. "So many wind up falling through the cracks. They end up homeless or in jail or in a hospital, and there are so few beds they may not get admitted or stay long enough to be stabilized."

The storm forced Louisiana State University Health Sciences Center to close Charity Hospital along with its 100 psychiatric beds. Hart said WJMC knew the closure would send hundreds of mentally ill patients into its emergency room. So, it opened a 12- bed transitional care center in November and increased its capacity to 24 in February.

The Transitional Care Center was designed to relieve the pressure on emergency rooms at East Jefferson General Hospital and Ochsner Health System. Without the center, emergency rooms must use their beds for weeks at a time to care for the mentally ill.

Given the demands on the emergency rooms post-Katrina, many don't have the time to find permanent facilities or provide mental health care during the wait, Hart said.

"Our challenge is to get them out of the acute care unit then find a way to put them in the appropriate setting so they won't relapse and wind up on our doorstep again in two to three days," he said.

TCC typically finds patients a permanent facility in 10 to 14 days and has saved emergency rooms more than 3,000 inpatient days since its inception, said Hart.

It also offers transportation for patients to obtain identification, Social Security cards and benefits.

And to help speed up the transition of patients to mental health facilities, WJMC is adding 12 acute psychiatric care beds within its emergency room. The observation area will be staffed 24 hours a day with a registered nurse and a mental health specialist. Construction began in May and is scheduled to be completed by summer's end.

"This will allow us to begin psychiatric treatment while they're in the ER and will assist us in moving patients more rapidly through the acute care unit," said Hart. "There are absolutely not enough services out there, but we're in the trenches and all you can do is keep your head down and keep shooting your bullets and hope someone in Baton Rouge will see what's happening and send help."