Psychiatry - July 2008 - (Page 36)

situation, on many parts. It’s a good thing no one was seriously injured or we would be in a far different position than we are today.”29 CASE 3—WHEN LAW ENFORCEMENT BECOMES THE PROVIDER OF MENTAL HEALTHCARE “When the police department is forced to do the job of the mental health system, it’s a lose-lose situation for everyone.”30 The quote above is from Jeffrey C. Rouse, MD, Chief Deputy Coroner for Orleans Parish. Dr. Rouse is responsible for mental health commitments in New Orleans. Although the quote is his alone, it reflects a sentiment often heard and shared by police officers, emergency room providers, and mental health professionals in New Orleans. As touched upon previously, the police have found themselves the de facto provider of front-line mental health care in New Orleans. It is not a job that they desired. Soon after Katrina’s landfall, the police encountered frequent problems dealing with the mentally ill. The day after Christmas, 2005, the police confronted Anthony Hayes, a 38-year-old man who had been diagnosed with schizophrenia.31 Hayes came to the attention of the police after he confronted a Walgreen’s store manager. Hayes was chased by police for several blocks and was shot and killed as he backpedaled down St. Charles Avenue with a knife in his hand.34 Part of this incident was filmed by a local videographer and was shown widely on national media. In early May, 2006, Ronald Goodman was killed after a standoff with his police outside his Algiers home. Mr. Goodman also had a long history of mental illness and began shooting at police officers after refusing to be taken into protective custody for psychiatric evaluation.32 Police tried several times to coax Mr. Goodman out of his house but shot and killed him after a round from Goodman’s rifle came within inches of hitting the head of an officer.33 36 Psychiatry 2008 [JULY] Late in the following month, police had to subdue Percy Matthews, a 43year-old man who was threatening people in the Riverbend section of New Orleans. The police also brought another man into protective custody on the day of Matthews’s arrest after he was found to be walking naked along the interstate.34 The case that has had the largest impact—and is still being acutely felt —involves slain police officer Nicola Cotton and her accused assailant Bernel Johnson. On Monday morning, January 28, 2008, New Orleans Police Officer Nicola Cotton approached a man sitting down in a small strip mall in the Central City section of New Orleans who matched the description of a rape suspect. Surveillance footage from one of the store’s security cameras showed that she motioned for the man to come toward her. The man then attacked Officer Cotton and they struggled in the parking lot for seven minutes. Eventually, the man took Officer Cotton’s gun and shot her 15 times, killing her. The man then sat down in the parking lot and waited as other police responded to Cotton’s radio calls for help. He then surrendered without incident. The man, Bernel Johnson, was charged with first-degree murder of a police officer.35 Within 24 hours after the shooting, local media revealed that Mr. Johnson was not the sought-after rape suspect, but had a similar name. Mr. Johnson did have a history of chronic paranoid schizophrenia with many past psychiatric hospitalizations in the New Orleans area before and after Hurricane Katrina.36 Johnson’s family also described that his repeated abuse of drugs and nonadherence with psychiatric care contributed to Mr. Johnson being homeless, an exploding population of New Orleans. It is presently estimated that four percent, or 1-in-25, of the city’s residents are homeless, one of the highest rates recorded in the United States since the 1980s.35 Cotton’s death opened an outpouring of anger and grief. She had graduated from the first New Orleans Police Academy class after the storm.37 Police officers recounted that Cotton had even camped out in a FEMA trailer so that she could return to New Orleans to continue her training. Adding to their grief was the fact that Cotton was the second female NOPD officer to be killed in the line of duty. The first female officer had also been fatally shot by another mentally ill man she was trying to take into protective custody.38 Tempers were only heightened when autopsy results revealed that Cotton was eight weeks pregnant.39 These strong emotions caused Crisis Unit Commander James Arey to lash out at Louisiana’s broken mental health system, saying, “The State of Louisiana had ample time to figure out this guy. And because they weren’t doing their job, this officer, my friend, is dead.”40 The issues brought up in Nicola Cotton’s killing—the lack of inpatient psychiatric beds and outpatient services after discharge and difficulty in protecting patients and the public from violence associated with psychiatric illness, substance abuse, and homelessness—has prompted action. The Louisiana Secretary for Health and Hospitals has announced a four-point plan to improve outpatient mental healthcare, including a “Nicola’s Law” provision similar to New York State’s well-known “Kendra’s Law.”41 This plan has already been introduced as a bill before the state legislature with $26 million in funding to achieve its goals.42 Louisiana Governor Bobby Jindal has also championed these plans and other improvements in the mental health system totaling $89 million, even though it was a topic he had previously rarely discussed in his recent successful political campaign.43 At the present time, Mr. Johnson remains in Orleans Parish Prison. He is being held in the part of the prison that houses mentally ill inmates. In fact, he was seen recently by reporters who were being given a tour of this dilapidated and crumbling wing of the prison.44 He has recently undergone examinations by forensic psychiatrists to determine if he is competent to proceed to trial on a capital murder charge.45

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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