Compelled by a settlement with the U.S. Department of Justice, Louisiana has been building up a statewide system of mental health crisis response services to better serve adults, especially those on Medicaid, experiencing varying degrees of mental distress. Now, the state is starting to roll out a similar program for children and adolescents.
The Louisiana Crisis Response System was designed in response to a lawsuit by the justice department, alleging that Louisiana was overly reliant on nursing homes to treat Medicaid-insured patients who were actually in need of specialized mental health care. In a settlement, the state agreed to do better, starting with a new system designed to serve the target population of adults, which launched in 2022.
That system has since been rolled out across the state’s nine regions, with varying degrees of success.
In some areas, especially the population centers of Baton Rouge and New Orleans on the eastern side of the state, where providers are comparatively plenty, partners were quickly identified.
In other regions, especially in the north and west of the state, the situation has been more dire. In the Lake Charles area, no partners have been identified two years into the program. In Acadiana, a provider who is also partnered with the Louisiana Department of Health’s initiative on the North Shore, pulled out quietly and abruptly in October.
“It’s a great concept, I think it would be a very useful tool,” said Ellen Fontenot, central intake director for Oceans Behavioral Health, who coordinates patient placement for the company’s locations in Louisiana, Texas and Mississippi. But, Fontenot told The Advocate in an October interview, “our state is having trouble getting that infrastructure solidified.”
One of the challenges has been the financial burden of expanding and providing the services outlined in the state’s plan, without meaningful financial assistance for providers who need to ensure staffing, equipment and facilities that meet the state’s goals for various tiers of crisis response.
“Unless you have a mechanism to pay these providers, for clients that they see that aren’t on Medicaid, then that’s going to be an issue,” Tanya McGee, executive director of the Imperial Calcasieu Human Services Authority, told The Advocate in an interview in October, ahead of the youth program roll out. Her agency provides mental health services to people in the Lake Charles area, regardless of their type of insurance or ability to pay.
Even in the case of patients on Medicaid, the numbers are tough to make work, she noted. “Medicaid is the cheapest and the hardest dollar to get,” McGee said.
There is currently no direct LDH funding allocated to the soon-to-be-rolled-out youth crisis response system, according to Ann Darling, program manager with the state’s Office of Behavioral Health, which oversees the program’s rollout. Nevertheless, McGee’s agency is one of the applicants to undergo training and, if selected, will be the service provider for youth in the Lake Charles area.
Participating on the youth side of the initiative will be an easier lift in the case of ImCal HSA, said McGee, because the authority already provides similar services. The staff training offered to applicants through the LSU Center for Evidence and Practice, which coordinates the selection and training of providers as part of the crisis response system, will help elevate the level of those services, she said.
“I’m actually excited about the training for my staff,” McGee said. “I’m really excited that my current staff who are doing this work and have had training in this work, are really going to get trained and honed in on a specific model.”
The model for the state’s behavioral health crisis response targeting youth will be a scaled down version of the adult model, offering only mobile crisis response, which doesn’t require a physical facility or expansion, one of the challenges encountered by providers hoping to participate in the adult system.
“The only reason why we’re doing this for the children is because we’re already running a similar program,” McGee said. “We’re just gonna have to, you know, tweak a little bit.”
How this will affect the extent to which the state’s crisis response system will actually constitute an expansion of services, both on the youth and adult side, remains to be seen.
According to LDH staff, LSU’s Center for Evidence to Practice has received applications from service providers seeking to cover all but two regions, which make up the northern part of the state. For those areas, applications will still be accepted on a rolling basis, while selected providers for the rest of the state will start training in the coming months, with a planned rollout date for services in April.