HJBR Sep/Oct 2022

50 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE COLUMN MEDICAID MENTAL and physical health are inextri- cably, fundamentally linked. The World Health Organization defines health as “a state of complete physical, mental and so- cial well-being and not merely the absence of disease or infirmity” and asserts “there is no health without mental health,” which makes rising mental health issues a signif- icant health problem. By the end of 2021, many American adults found themselves in the worst mental state in years. Accord- ing to the U.S. Census Bureau’s House- hold Pulse Survey, 47% of adults reported symptoms of anxiety, 39% reported symp- toms of depression, and one in five adults disclosed suffering from a mental illness. Despite this, it is estimated that less than half of Americans with a mental disorder get adequate treatment. And because po- lice have become the default first respond- ers for a wide range of social issues — from mental illness to substance use to home- lessness — a person experiencing a mental health crisis is more likely to encounter law enforcement than they are to receive actual medical assistance. But police are ill-equipped to serve someone who is ex- periencing a behavioral health crisis safely and effectively. Too often, encounters be- tween the police and people in crisis end in handcuffs with an enforcement action or emergency department transport that lacks a referral to the long-term treatment and supports needed to thrive. How did we get here? In the 1950s, a campaign to “deinstitu- tionalize” mental illness inadvertently but significantly decreased the availability of state hospital beds for people with men- tal illness. The goal was to treat individu- als in a community-based setting rather than an institutional one, a policy change that represented both fiscal and civil rights advantages. Unfortunately, though, capac- ity for a community-based model was not developed as planned, and local jails began primarily serving as de facto mental health institutions. Today, rates of serious mental illness in jail populations are four to six times higher than in the general popula- tion. In addition, there are more than 2 mil- lion hospitalizations each year related to serious mental illness in the United States. Defined as someone over the age of 18 who has (or had within the past year), a diag- nosable mental, behavioral, or emotional disorder, a serious mental illness causes functional impairment that substantially interferes with or limits one or more ma- jor life activities. One in eight visits to the emergency department (ED) is related to a mental health or substance use issue, a number that has been increasing each year since 2016. Because of a variety of issues, though, including regulations, policies, training, culture, stigma, and the lack of integra- tion and connectivity to other settings in the community, EDs are poorly equipped to address mental health needs. Increased demand for services, coupled with a lim- ited supply of effective processes and ser- vices within EDs, leads to poor outcomes and care experiences for patients and their families, who are likely to spend many hours or even days waiting for care. What is Louisiana doing to improve care for adults experiencing a serious mental illness? Implemented in phases starting in April 2022 by the Office of Behavioral Health in collaboration with key stakeholders, Appropriate Response, Care, & Support Replaces Inadequate Aid, Force, & Restraint A New, Comprehensive Crisis System of Care in Louisiana for Medicaid Recipients