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Whose Safety Net? 

Last month, we criticized Gov. Bobby Jindal's proposed budget cuts to Louisiana's already-overtaxed mental health system ("Breaking Down," March 13). Simply put, Louisiana ranks near the bottom among states in terms of mental health services — and the problem is worse in New Orleans, thanks to prior cuts made by the governor. If Jindal's budget passes in its current form, the result will be a loose patchwork of mental health options for those in need of services, and few of those options (if any) will be ideal.

  Making things worse: Orleans Parish Prison's acute mental health inpatient unit, which used to be on the 10th floor of the House of Detention, closed when Sheriff Marlin Gusman shut down the "House of D" on April 10. Mentally ill inmates now will be shipped out of New Orleans or put up elsewhere within the sprawling local prison — probably in temporary facilities — further decentralizing what should be the mental health facility of last resort.

  Meanwhile, things are not much better for those outside of jail as cities and parishes face some grim statistics. For example, St. Tammany Parish saw 500 attempted suicides in 2011 — one-quarter of them among minors. That's one of the highest suicide rates in the state. If the mental health picture is that bleak in relatively affluent St. Tammany, we can only imagine how ugly things must look in poorer parishes.

  There is hope. Several area legislators are sponsoring bills to prevent the fragile safety net from deteriorating further. State Rep. Jared Brossett, D-New Orleans, has authored House Bill 952, the Mental Health Services Preservation Act, which he calls a "policy statement" affirming the state's commitment to "vital state funding and ensuring access to quality health care." Brossett's bill, though not an appropriation, would require the Louisiana Department of Health and Hospitals (DHH) to establish funding priorities with an eye toward maximizing federal matching funds and eliminating duplicative systems. It also would require DHH to evaluate spending and establish best-practices rules.

  The New Orleans City Council has endorsed Brossett's bill, which passed the House Health & Welfare Committee April 11 by a vote of 13-2. The bill comes up for a vote by the full House on April 23. Brossett's bill comes just weeks after the state revamped administration of its mental health coordination and billing practices under the new Louisiana Behavioral Health Partnership (LBHP), which privatizes some services. The privatization initiative, a priority of Jindal, was rolled out amid some speed bumps, according to mental health clinics (see "Louisiana's Medicaid Billing Snafu," March 20).

  Brossett told Gambit last week that he's not trying to control or criticize the LBHP. "It's only been in existence a month," he said, noting that he just wants the state to affirm its commitment to strong mental health care. Despite this, the Jindal Administration opposes Brossett's bill, saying it might not allow DHH the flexibility it needs when it comes to allocating funds. If "flexibility" means closing down mental health facilities, reducing the number of hospital beds, cutting back on clinical services and similar draconian measures — all of which have occurred in New Orleans under Jindal — then we say it's high time lawmakers disallowed some of DHH's "flexibility."

  Two other bills under consideration also seek to strengthen mental health services in Louisiana. State Rep. Scott Simon, R-Abita Springs, has authored House Bill 846, which has been hailed as a bill of rights for mentally ill patients. HB 846 emphasizes a patient's "self-determination" and states, "Persons with mental illness are generally best able to determine their own needs, rather than their needs being determined by others." Simon's bill, like Brossett's, won approval from the Health & Welfare Committee, which Simon chairs. Both bills await action by the full House.

  Meanwhile, State Sen. Karen Carter Peterson, D-New Orleans, has authored Senate Bill 446, which would prohibit discrimination against mentally ill patients by primary care physicians and medical providers. "With increasingly limited mental health care dollars causing statewide shortages, we must prevent any barriers to access for those who need help," Peterson wrote to her supporters. Her bill has passed the Senate and is now before Simon's committee.

  Collectively, these three measures make an important statement about mental health as a budgetary priority. Unfortunately, our governor doesn't share that priority. Under Jindal, mental health services — especially in New Orleans — have been gutted while Jindal's travel and personal security budgets have mushroomed. No doubt he sleeps well knowing his "safety net" is secure. Too bad the same can't be said for so many of his constituents.

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