There’s a mental health crisis in Louisiana jails

Henry Gaymon speaks quickly, racing through the many stages of his troubled past, jumping back and forth between time spent in school, jail and mental institutions. One thing is clear: Living a normal life has been difficult, almost impossible, for the 46-year-old.

“I just try to get by every day,” Henry said. 

Henry was a bright student, who traveled to Europe as part of an exchange program during his high school years and received a scholarship to attend Grambling State University, carrying on a family tradition. Then substance abuse and mental health issues took him off track — and eventually landed him in jail.

“I struggled in jail the first time I went — I fought,” said Henry, who incurred an additional charge for fighting a correctional officer while locked up. But that first visit wouldn’t be his last. Over the years, his 73-year-old mother would call the police repeatedly, unable to handle her son’s violent outbursts. 

With fewer public resources for mental health care available, jails and correctional facilities have increasingly become a holding space for those with mental illness who struggle to function in the outside world. Mental health providers, families and correctional staff say they’re ill-equipped to deal with inmates’ mental health challenges — leaving them to suffer in a cycle of untreated illness and incarceration.

Across the country over the past five decades, states have been moving away from providing mental health care through state-run hospitals. 

That nationwide trend, often referred to as “deinstitutionalization” or “transinstitutionalization,” aimed to shift mental health care from long-term care at state psychiatric hospitals to more local services and started during the Civil Rights movement. Advocates criticized the often deplorable conditions in underfunded and deteriorating state-run facilities and the deprivation of liberty that involuntary commitment into those facilities represented.

California was among the first states to close its state hospitals in the 1960s. Ejected from state-run hospitals, many patients ended up in local for-profit board-and-care homes or on the street, something experts today say contributed significantly to the state’s long-standing homelessness crisis. 

In 1975, a study by a California psychiatrist found that approximately 11,000 ex-state-hospital patients lived in board-and-care facilities in Los Angeles County alone. Across the state, communities began seeing encampments of former psychiatric patients who were kicked out of closing state hospitals with nowhere to go. 

While states created some local government-funded clinics, their offerings have fallen short of covering the needs of the local communities.

As the number of patients in state mental health hospitals decreased, the number of inmates in correctional institutions increased, a trend that researchers, at least in part, attribute to the lack of inpatient psychiatric facilities available to the severely mentally ill.

In Louisiana, the final push to do away with those public hospitals came under the administration of Gov. Bobby Jindal, who oversaw the sale and privatization of two of the four remaining state hospitals to cut spending, leaving only two remaining today.

We have become the mental [health] institutions for the state, in every parish.

Cpt. John Mowell, Lafayette Parish Sheriff’s Office

Similar to the trend researchers observed in California over the time of its deinstitutionalization process, this has likely pushed more mentally ill people into the correctional system. “We have become the mental [health] institutions for the state, in every parish,” said Cpt. John Mowell, public affairs director at the Lafayette Parish Sheriff’s Office, which runs the local jail. 

For family members like Joyce Gaymon, the correctional system has become a resource of last resort. 

Joyce, who lives in Lafayette, has repeatedly obtained emergency certificates for her son Henry, legal documents that allow a patient to be detained for diagnosis and treatment for up to 15 days. The documents are prepared by either physicians, often when a patient in crisis shows up in the emergency department, or the coroner’s office.

From there, patients like Henry are transported to whichever facility has inpatient beds available. Staff at those facilities decide how long the patient is kept there for treatment and are supposed to provide a treatment plan for the time following the patient’s release, such as placement with an outpatient program or other follow-up care, but Joyce said she wasn’t aware of any such plans following Henry’s recent hospitalizations.

Instead, Henry tried to make it in the outside world on his own, at times seeking out drug rehabilitation groups, finding odd jobs and even his own apartment. But again and again, the tentacles of his mental health and substance abuse struggles pulled him back. In the best cases, that meant another round of short-term inpatient treatment with no follow-up; in the worst it meant going back behind bars. 

In one instance, Henry became so irate at his mother’s refusal to allow him into her house while she was sick with Covid that he kicked down the front door. Terrified and at her wit’s end, she called 911. Henry was arrested and charged with home invasion, something Joyce said wasn’t her intention. She just didn’t know what else to do.

Clinical social workers at the jail see an average of 90 clients per month with diagnosed mental health issues, comprising roughly 20% of all inmates. But that number doesn’t account for all inmates with mental health issues, Mowell noted, since many never received a diagnosis before arriving at the jail.

The Lafayette Parish jail has four therapists and two substance abuse counselors tending to inmates, but the correctional setting isn’t the right one to treat mental health patients, Mental Health Director Sarah McMillan said. 

Counselors speak with patients through a narrow slot in the metal cell door, sitting on a small stool in the hallway. As the jail operates around them, deputies and inmates pass through, with heavy security doors slamming loudly. They’re unable to see their patients and vice versa.

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Former jailhouse counselor Taylor Francis, near a set of picnic tables close to the Lafayette Parish jail where she still occasionally meets with former inmates in need of advice.

Photo by Alena Maschke

“It’s not the right environment for health care,” said Taylor Francis, a former therapist at the jail who recently left to work for a local community provider, in part because of burnout from her previous job working with inmates at the local jail and a state prison prior to that. 

Plans for a new jail, the construction of which is estimated to cost $100 million, include better infrastructure for mental health appointments. 

But just building a jail that is more accommodating to mental health treatment isn’t the solution, McMillan pointed out, as there need to be alternatives to support mentally ill people before they end up in jail.

“We need long-term treatment facilities. We need transitional housing with different levels of supervision and wraparound services to keep them stable,” McMillan said. “Mental illness is a chronic disease, and it’s not just you give them treatment one time and they’re better.”

The responsibility to provide that, Mowell added, “really lies at the state level.”

With few state resources available, mental health workers at the jail do what they can. “Our goal is to help them become stable to where they don’t reoffend and become incarcerated again,” McMillan said.

But for many, that isn’t enough. 

Lafayette resident Joicey Escano, 80, still remembers the sweet child her grandson Anthony Eskano once was, with a love for drawing and making up songs he’d sing spontaneously. Anthony was just a teenager when his mother died following a life-long struggle with substance abuse. He soon started showing symptoms of mental health issues. 

Joicey remembers how it became more and more difficult to break through to him, recalling episodes of Anthony talking to himself, or possibly his mother, unaware of his surroundings. That’s when his legal troubles started, often associated with his mental illness or the substance abuse he fell into in the years to come. 

Now 27, Anthony has a growing criminal record, and has spent much of his young life cycling through incarceration, homelessness and brief stints in private mental institutions.

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Unable to find long-term care for her son, Joyce Gaymon constantly finds herself on the phone with mental health facilities, his sponsor, the coroner’s office and law enforcement. 

Photo by Alena Maschke

Those institutions, according to Francis, don’t provide the level, length and stability of care someone like Anthony needs. Treatment plans are created prior to a patient’s release, but rarely followed up on, she noted. “It’s like telling a 5-year-old: Here’s what you need to do to succeed, go ahead,” Francis said. “It’s a real disservice.”

Mental health providers and family members of those incarcerated agree that what is needed are long-term facilities, but those are scarce, and it is difficult to get insurance to cover long-term treatment. “It’s more based on insurance than actual needs,” Francis noted. Both Henry Gaymon and Anthony Eskano spent time in a variety of mental health institutions, but never for long.

State-run hospitals have traditionally been key providers for such long-term care, but that changed as the supply of these hospitals dwindled nationwide.

A task force under Gov. Kathleen Babineaux Blanco in 2006 found that Louisiana was spending significantly more on state-run psychiatric hospitals than the national average and concluded that the state could be saving money by shifting to more community-based services. Her successor, Jindal, then went on to close and sell state-run institutions as a cost-saving measure.

At the Lafayette Parish Sheriff’s Department, almost 20 years later, Mowell questioned the overall long-term cost savings.

“They couched it as, ‘Hey, we’re saving the state all this money,’” he said. “But what ended up happening, the unintended consequence of that, was it pushed everything down to the parish level.”

In the current fiscal year, Lafayette Consolidated Government, which covers the majority of inmate medical costs, budgeted just under $600,000 specifically for mental health services, although the total expense is likely to be higher as some of the costs of providing mental health services to inmates are lumped in with other medical services.

Government-funded insurance carries a large part of the cost burden of treating low-income mentally ill patients in private facilities. For example, Henry, who is covered by Medicare, racked up a total of $57,741 in billed charges from emergency rooms and short-term stays at a for-profit mental health hospital over the span of just three months at the beginning of 2022.

After a rare longer-term hospital stay, Henry felt better, even got a job at a movie theater and for a while things went well, his mother remembers. But eventually, Joyce says, he stopped taking his medication and everything fell apart again. That cycle has repeated itself ever since. Recently, after a few months of sobriety and living on his own in Lake Charles, Henry was admitted to a mental health facility again after he relapsed and failed to keep up with his bills.

Joyce said that while she and her son, who now lives in Lake Charles, have been working on their relationship and speak every day, their struggle with his mental health issues has left cracks.

He still gets upset with her, at times telling her in conversations, “You put me in jail.” 

“It was a bad experience for him, and he holds it against me now,” Joyce said. “But I say, ‘Henry, I had nowhere else for you to go.’”

Mental Health in Louisiana jails

• Louisiana has two state-operated mental institutions
• The burden of mental health care has landed on local jails
• Lafayette spends at least $600,000 annually on mental health services
• 20% of local inmates have diagnosed mental health issues, complicating jail management