Legislative task force examines La.'s mental health crisis

Lawmakers working to address the state’s mental health crisis heard from various medical professionals on issues feeding the problem.
Members of the House Committee on Health and Welfare’s Subcommittee on Mental Health continued efforts to understand the factors driving the mental health crisis that has accelerated with the pandemic and possible action lawmakers can take to counter the trend.
The meeting featured testimony from representatives from nearly a dozen professional organizations, from the Louisiana State Board of Medical Examiners to the Louisiana Psychological Association.
Roy Salgado, chair of the Licensed Professional Counselor Board of Examiners, and others highlighted medical insurance issues that prohibit residents from receiving mental health care services.
It’s a similar issue with provisionally licensed mental health counselors and marriage or family therapists, which number about 1,900 statewide.
“The issue is they currently do not get reimbursed through third-party payers, so it makes it a little difficult for employers, agencies, hospitals, clinics to hire them because there is no reimbursement,” Salgado said.
“The work provided by provisionally licensed mental health professionals (overseen by doctors) is generally not reimbursable by Medicaid,” he said. “If you were to change this with a stroke of a pen we would immediately increase access to care for residents who rely on Medicaid by approximately 1,900 providers.”
Karen Lyon, executive director for the Louisiana State Board of Nursing, explained that the six graduate programs in the state that offer psychiatric mental health training for advanced practice registered nurses are struggling to fill instructor positions due to many leaving the field following the pandemic.
Currently, only about 6% of the roughly 7,000 practicing advanced practice registered nurses, or about 425, are certified in psychiatric mental health nursing, she said.
Many of the most experienced over 65 are “now … beginning to retire and resign and they’re not renewing their licenses,” Lyon said. “The good news is we have increased enrollments in nursing schools, but of course we have the challenge of not having enough nursing faculty.”
Other issues highlighted revolved around funding for parish coroners, who serve as the safety net for those suffering a mental health crisis. Gerry Cvitanovich, the Jefferson Parish coroner and president of the Louisiana State Coroner’s Association, told the committee that requests for protective custody orders that trigger a mental evaluation have increased from 416 in Jefferson Parish five years ago to 663 last year.
“Those numbers are concerning,” he said. “A lot of this does fall on the coroners for evaluation.”
Chuck Credo, attorney for the coroner’s association, noted the situation puts added financial stress on parishes because “there’s absolutely no state funding for any coroner’s office on any level.”
The result is the loss of 11 non-term-limited coroners in the last election cycle who “simply gave up,” he said.
Still other funding issues revolved around “cost prohibitive” reimbursement rates through Medicaid and Medicare for proper psychological testing if the services are approved. Oftentimes, especially for children, they’re not, said Jesse Lambert, president of the Louisiana Psychological Association.
“We have seen a rather large exodus of not only psychologists but clinicians in general leave Medicaid because the reimbursement rates are cost prohibitive,” he said.
Psychology interns and externs, those preparing for licensure through required training, also cannot bill for services, which imposes constraints on training programs that have resulted in closures, Lambert said.