Have a loved one in crisis? Here’s what you can do.

Every year, thousands of people in Acadiana show up in hospital emergency departments with mental health issues. Mental health crises, ranging from suicidal thoughts to episodes of severe confusion or delusion, are difficult to navigate for patients and those around them.

Between April 2022 and March 2023, Acadiana emergency rooms saw 4,695 adult and 1,138 youth patients whose primary diagnosis was a mental health issue, according to data collected by the Louisiana Department of Health. 

The emergency room remains the most common, and in some cases necessary, point of entry for services. But as emergency rooms struggle to handle patient surges, which can lead to prolonged wait times, the department of health and private mental health providers have developed programs to allow other ways of accessing mental health services.

Who can respond in a crisis?

There are several helplines in place to provide different levels of assistance. Last year, the state launched the 988 Suicide and Crisis Lifeline, a local version of the national suicide hotline. Call centers are located in Louisiana, and agents can provide assessments and resources to callers in crisis. 

Locally, 232-HELP is available to connect callers to resources as well, including housing and food assistance. 

“If you look at the statistics, more often than not, suicidal thoughts in Americans are due to financial issues, family issues, health issues,” said Dr. Joshua Sanderson, a psychiatrist who regularly encounters patients in mental crises in his role as a part-time deputy coroner in Lafayette, Jefferson and St. Tammany parishes. Addressing those factors, which are also called “social determinants of health,” can provide one way out of a crisis that doesn’t involve a clinician or can work alongside clinical treatment.

For young people, there are mobile crisis teams available in Acadiana and southwest Louisiana, with similar programs under development across the state. 

In Acadiana, those services, which were rolled out earlier this year, are provided by The Extra Mile. The organization maintains a 24/7 hotline, which families can call to trigger the dispatch of a mental health professional to help them manage a crisis situation. A similar system has been deployed for adults in other parts of the state but has failed to come off the ground in Acadiana and SWLA so far. 

Receiving treatment without entering the ER is possible

Some private behavioral health providers also offer mobile assessments. In Acadiana, Oceans Behavioral Health Hospital, Vermilion Behavioral Health Systems and Compass Health, the three largest private providers, all offer 24/7 phone lines for patients or those helping them in accessing care to start the process. In some cases, community liaisons may be dispatched to meet the patient where they are for an assessment.

The information collected during the assessment is then passed along to a clinical worker, such as a psychiatrist, who will determine the appropriate level of care. If that care includes inpatient treatment, patients can either be admitted to the mental health facility that performed the assessment or they may make a recommendation for a different facility, if they don’t have beds available. 

There are also intensive outpatient programs available that don’t require hospitalization, but offer a higher frequency of sessions than common in regular therapy.

All three providers accept Medicaid and Medicare, along with major private insurance plans.

As of this year, the Acadiana Area Human Services District also offers a same-day access program for mental health services. Since its launch in January, the program has completed roughly 2,000 assessments, a majority of which then led to patients being admitted for services. 

The AAHSD does not offer inpatient or intensive outpatient programs for mental health, although there is some intensive outpatient programming available for substance use disorders. For patients in need of a higher level of services who do not have the insurance coverage to access a private provider directly, the district may have funds available to assist in the coverage of that treatment at a private mental health hospital. Those funds draw from grant programs and are subject to availability.

By visiting one of the district’s five clinics in Lafayette, Crowley, New Iberia, Opelousas or Ville Platte, patients can be set up with a counselor or therapist, as well as medication management. According to AAHSD Director Brad Farmer, the goal is for patients to see a provider within eight days of their initial assessment.

Commitment — what happens when a patient doesn’t want to go

Accessing those services requires the collaboration of the patient. But what happens if a person is in crisis and doesn’t want to seek treatment?

There are complicated laws that govern the involuntary commitment process, but at its very basic level, involuntary commitment in Louisiana usually involves at least two medical professionals’ opinions, confirming that a patient is in need of inpatient treatment whether they want it or not. 

This process typically involves the issuance of several documents. 

If a family member, coworker, partner or friend is concerned that someone might be a danger to themselves or others, or is gravely disabled by their mental health issue, but can’t get them to agree to seek treatment, they may consider involving the coroner’s office, which can issue an order of protective custody, or OPC.

This order, which includes a witness statement from the person seeking the order, triggers a response from law enforcement. Law enforcement is charged with finding the person at the address provided and transporting them to a treatment facility for an assessment. While this is not an arrest and there are no charges associated with this contact with law enforcement, it looks very much like an arrest, and the subject of the order may be put in handcuffs for transit.

Within 12 hours, an assessment is required to continue the person’s confinement to a treatment facility if they remain unwilling to stay on their own. This is called a Physician’s Emergency Certificate (PEC) and it is required to keep a person confined against their will. Within 72 hours of the PEC, a deputy coroner, acting as an independent opinion, examines the patient to determine whether it is also their opinion that the patient meets criteria for continued commitment.  If so, a Coroner’s Emergency Certificate (CEC) can then be issued to extend the treatment period for up to 15 days, if necessary.

Patients, however, have the right to have their confinement reassessed while they’re in treatment and to receive treatment in the least restrictive environment possible.

In some cases, emergency certificates may be issued even though a patient is willing to go, either because ambulance providers refuse to transport patients without them or out of concerns over insurance coverage, according to Sanderson. In either case, patients retain the right to have their case reassessed during treatment.

According to the Lafayette Parish Coroner’s Office, hundreds of PECs are issued each month.