Transforming the New Orleans Behavioral Health Crisis System
In the last several years, Orleans Parish has climbed the county health rankings chart to 40th of 64 parishes. While New Orleans has made progress, the city continues to rank low in Louisiana and the U.S. overall on many socioeconomic factors such as poverty and employment, housing security, and violent crime.
To address many of these challenges and continue progress toward a healthy community, the New Orleans Health Department and Metropolitan Human Services District co-chair the New Orleans Behavioral Health Council (NO-BHC) that is comprised of about 54 organizations across four sectors: education, housing, criminal justice, and health and hospitals. The members of the council are key stakeholders in transforming the behavioral health delivery system.
To better understand these barriers across programs and services for adult crisis, LPHI partnered with Baptist Community Ministries (BCM), the New Orleans Health Department (NOHD), and the Metropolitan Human Services District (MHSD) to conduct a preliminary assessment of the current state of the behavioral health crisis system in Orleans Parish focusing on adult services. To best understand the realities of people involved directly in crisis response, interviews of front-line staff of organizations involved in behavioral health crisis were conducted.
This report is part of an ongoing process to assess and improve the behavioral health continuum of care in New Orleans, and is a tool supporting the NO-BHC and key stakeholders to make informed decisions. Several system assets and challenges were identified. From those, opportunities for further improvement and discovery were uncovered.
The crisis system assets identified in this report include: trained and engaged first responders; engaged criminal justice sector; growing hospital capacity; and strong networks of community-based safety net service providers.
The crisis system challenges identified in this report include: redundancy and inefficiency in crisis response protocols; lack of crisis receiving services, police and ems wall time; long wait times and slow patient flow in hospitals; gaps in hospital discharge planning and transitions of care; limited availability of substance use treatment services; delays in access to outpatient mental health services; few residential treatment options; limitations of case management programs; and homelessness and housing insecurity.
Opportunities to enhance the crisis response system include many elements, including: clarity and standards on roles, responsibilities, and safety protocols; pathways for inter-agency alignment and collaboration; specific cost analysis; exploration of evidence-based models; enhanced data collection, analysis, and use for decision making; increasing training for providers; clarity of the pathway for the establishment of licensed group homes within the Greater New Orleans area
Throughout the key informant interviews, representatives of all sectors and organizations expressed interest in working together to address the systemic challenges facing individuals and families, service providers, and other stakeholders in the behavioral health crisis system.
There are two priority opportunities to activate immediate next steps in working toward the desired future state and to enhance local capacity for system-wide change, which are described below.
First, the New Orleans Behavioral Health Council must double down on prior commitments to fulfill its role as: the central facilitator of shared decision making and priority setting across sectors and settings, the hub for collaboration and ongoing education, and the leader of continuous behavioral health improvement and monitoring efforts.
Second, the financial costs and benefits associated with operating the behavioral health system must be determined and analyzed to incorporate cost considerations into the strategic planning and prioritization of system improvement activities. There is a need to understand what each entity in the system (insurers, health and social service providers, the criminal justice system, and other local and state agencies) is paying for to identify any redundancies, inefficiencies, or gaps in city-wide investments.
To supplement this preliminary assessment and to most effectively pursue the opportunities and next steps identified here, a larger-scale assessment and planning process is needed to enable system-wide progress toward achieving NO-BHCs’ vision for the future. LPHI, NOHD, and MHSD are actively pursuing additional grant funds for that purpose.