NEW ORLEANS— As part of its ongoing plan to bolster and transform the public mental health system in the New Orleans area and the state, the Louisiana Department of Health will soon open two, new community-based clinics in the city; add new, high-end child/adolescent outpatient services to its network; and move inpatient services from a state hospital in Uptown to one in St. Tammany Parish.
Changes to the city’s community-based infrastructure began last year under the direction of Gov. Bobby Jindal and LDH Secretary Alan Levine, and included the infusion of millions of dollars of new state money, the implementation of new evidence-based community treatment services and child/adolescent crisis response teams, the reform of the Metropolitan Human Services District and the passage of legislation to strengthen the public safety component of the mental health system.
With the additional reforms being implemented this year, New Orleans will undergo the most significant transformation of its mental health system in recent history. The city and the state will move closer to the evidence-supported models employed by other states, which have reduced their reliance on inpatient services while increasing family contact in the community and home setting.
The new outpatient services will be located closer to the people who use them—in two clinics on public transportation routes in neighborhoods on both sides of the river, and even, in some cases, in residents’ homes. These access points were shut down after Hurricane Katrina, and will now be made available again.
Maintaining Quality of Care
LDH announced in March of this year that it would deliver more effective hospital care at a more efficient cost to the state by merging its inpatient mental health operations at the New Orleans Adolescent Hospital into Southeast Louisiana Hospital.
Combining the mental health operations of NOAH and Southeast allows LDH staff to separate units for adolescents and children—a national best practice that the agency had not been able to institute before at NOAH or Southeast because patient counts at both were too low.
Both the child and adolescent patient groups will benefit from hospital treatments re-designed for their appropriate developmental stages and ages, rather than something aimed for the middle ground.
To guide the tasks and activities needed to make the merger happen and ensure that all patient and staff concerns were considered and addressed, the state formed a steering committee consisting of representatives from NOAH and Southeast.
Representatives included the chief executive officers, medical directors and directors of nursing services of each hospital; the clinical director, hospital services director, and acute unit and youth services coordinators from Southeast; the social services director of NOAH; and the fiscal and human resources directors from the state’s regional department.
The steering committee, in turn, created task groups in four key areas: client care, staffing and support services, physical plant (hospital buildings and facilities), and contracts. The client care task group has worked to develop an integration plan which optimizes the services available to clients.
As patients are discharged from NOAH, the vacant beds are closed and a corresponding number of beds at Southeast are opened.
Three vacant adult beds have already been moved. On July 20, five child/youth beds and five adult beds will move from NOAH to Southeast, to be followed by five more adult beds on July 27. Five child/youth beds and seven adult beds are scheduled to move August 3.
While it is expected only a few child and adolescent patients may be moved from NOAH to Southeast, the client care task group identified case managers from both hospitals to work with families and/or custody agencies of these patients to ensure awareness and understanding of how care will be continued.
Children who receive treatment in state hospitals also receive educational support from the state. The steering committee has been working closely with the area Special School District coordinator to assure that the education these patients’ receive is uninterrupted.
LDH is also offering transportation to and from two new outpatient clinics on the East and West Bank to Southeast. Transportation from the new outpatient clinics, one in Mid-City and one in Algiers, to Southeast is scheduled five days each week, including Saturday and Sunday. The schedule will be evaluated periodically and revised as needed.
Addressing Needs of Staff
The changes taking place in the mental health care system in the Greater New Orleans area require a shift in staffing, including job transfers from NOAH to Southeast and to the two new outpatient clinics in Mid-City and Algiers, and a layoff of some state employees at NOAH.
Of NOAH’s total workforce, about 141 employees will transfer to Southeast or one of the new outpatient clinics to open in Orleans Parish. Some employees—no more than 49—will be laid off. The total layoffs will most likely decrease from 49 due to early retirement or resignations.
Inpatient workers needed to staff beds will transfer to Southeast as beds are moved to Southeast, while outpatient staff will transfer when the new clinics open.
To help employees who will be transferring from NOAH to Southeast, the nursing and education departments of both hospitals have been collaborating on orientation and training schedules to accommodate the gradual transition of staff while assuring workers are prepared to assume their new responsibilities in their assigned unit. All orientation takes place through the respective departments of their assigned unit, i.e. nursing services, social services, etc.
To help employees who will be laid off, LDH will offer outplacement services, including counseling and employee assistance services. All layoff processes will be conducted in accordance with Civil Service Rules and guidelines, which govern state employment, under the oversight of the Department of Civil Service and the Department of Health Human Resources.
According to Civil Service Rules, all impacted employees must be given a general layoff notice and five calendar days to review them before Civil Service can approve the plan. The general layoff notice was delivered July 15.
If Civil Service approves the plan as submitted, a final layoff notice will be delivered to each impacted employee in late July, and layoffs will be effective August 14, 2009.
Outpatient Clinics, New Services Where Families Need Them
With an investment of more than $14 million in new services in 2008, the state introduced to New Orleans highly proven services such as Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) teams, a Child and Adolescent Response Team (CART), a Supportive Housing Program and a Mental Health Emergency Room Extension/crisis receiving service.
These services, new to New Orleans, have made it possible for hundreds of area residents to receive evidence-based mental health treatment in their homes and communities rather than in institutions, and have provided additional supports, such as housing assistance, that help people with mental illness achieve stability in ways that treatment alone cannot provide.
Additional new outpatient services coming soon feature some of the most highly regarded, evidence-based outpatient treatments currently in use nationwide.
These include mental health therapies such as Dialectical Behavior Therapy (DBT), which has been proven through years of research to result in 50 to 60 percent reductions in suicidal thoughts and behaviors among child and adolescent patients and 40 to 70 percent reductions in the rate of re-hospitalization for patients who have been hospitalized previously. These are remarkable outcomes that can be delivered through community-based programs in outpatient clinics.
Other new or expanded services will include Multisystemic Therapy (MST) and Functional Family Therapy (FFT), which will be offered in homes.
These therapies not only produce better results in a more dignified manner for patients and their families, but can be delivered much more cost-effectively than hospital-based services.
The state is now completing renovations of the new Mid-City outpatient clinic, which will be known as the Mid-Town Child/Adolescent Behavioral Health Center, and expects to open by mid-August. The center will serve as the outpatient clinic for the East Bank of Orleans Parish, and will feature:
screening and assessment services,
psychiatry and medication management services,
life skills treatment for youth, and
substance abuse prevention and treatment services.
The Office of Mental Health has contracted with the Tulane University Department of Psychiatry to provide both psychiatric and psychological services at the center.
A second new outpatient clinic in Algiers will open by the end of August. The Algiers Child/Adolescent Behavioral Health Center will house the regional administrative offices for DHH’s Office of Mental Health and will serve as the outpatient clinic for the West Bank of Orleans Parish and for St. Bernard and Plaquemines parishes, featuring:
screening and assessment services,
psychiatry and medication management services,
life skills treatment for youth,
substance abuse prevention and treatment services, and
a mobile van for community-based services.
The Office of Mental Health has contracted with the LSU Department of Psychiatry to provide both psychiatric and psychological services at the center.
Both the Mid-Town Behavioral Health Center and the Algiers Behavioral Health Center will share a new “Access Unit,” a service that manages community-based treatment for children and youth who may be dangerous to self and/or others. The Access Unit will be available at each facility.
Until these new clinics open, outpatient services will continue to be provided at NOAH and Chartres-Pontchartrain outpatient services clinic.
The transformation of mental health services is an ongoing priority of LDH, guided primarily by data and evidence shown to be effective in other states.
The Louisiana Department of Health serves to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visit http://www.dhh.louisiana.gov .