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May 26 , 2007 - The Clarion Herald
Mental health concern to archdiocese medical director
By Peter Finney, Jr.
Dr. Elmore Rigamer, the medical director of Catholic Charities Archdiocese of New Orleans, is a practicing psychiatrist who knows intuitively and also by hard experience that the mental health crisis in the region, already a powder keg, is getting ready to explode.
Even though it has been 21 months since Hurricane Katrina, Rigamer said the untreated mental health problems of an entire region, percolating below the surface, could result in a crisis that needs to be addressed immediately in a systematic way.
“We are in a psychiatric crisis, and, yes, we need more in-patient beds,” Rigamer said. “But we also need a very effective out-patient system. When people get out of the hospital and don’t get good after-care or good medicines, more beds are just a Band-aid. Beds are necessary but not sufficient.”
Rigamer is so convinced a crisis is at hand he is spending most of his waking hours coordinating the Behavioral Health Action Network (BHAN), a partnership of mental health providers that brings together doctors, clinics, hospitals and emergency responders and asks them to share information so that care can be better coordinated.
“There’s a long history of looking at individual components of a health care system in a silo,” Rigamer said. “This is trying to make them integrated. Anyone who has a stake in dealing with the mentally ill has been invited to be a member of BHAN to make care along the nodes of the system more seamless and less obstructive to the patient.”
Under a state contract, Catholic Charities of New Orleans operated the Louisiana Spirit program for the last 18 months, sending persons door-to-door to provide information on mental health and counseling services that are available. While that program will continue under state auspices beginning June 1, Catholic Charities has decided the mental health needs of the community need to be tackled with a different approach.
“Louisiana Spirit was good for the time it lasted, but it was funded only to give crisis service,” Rigamer said. “Under the Stafford Act, it allowed people to be seen three to five times, but then they would move on. It was not meant to treat ongoing psychological problems or moderate mental illness. Frankly, three to five sessions is not going to do it.” Certain mental illnesses have spiked 40 to 100 percent in the months since Katrina, Rigamer said.
“I have nowhere where I can refer people to,” Rigamer said. “Louisiana Spirit didn’t allow them to see people for the amount of time we felt they needed. We thought we would let the state continue with the crisis intervention and then we could bring together all of the services that Catholic Charities brings to bear.”
Among those programs is Counseling Solutions, which offers mental health evaluations and counseling to individuals on a sliding fee scale basis for those without insurance. Rigamer is searching for additional funding “to help us develop a more robust outpatient program.”
Even before Katrina, Rigamer decried the two-tiered health care system that often left the uninsured or underinsured with little options for help.
“What I’m seeing – like with every other system – is that Katrina revealed existing fault lines in health care,” Rigamer said. “The city fragmented health care by delivering hundreds of people every day to Charity. The city is now hoping for more community-based prevention and primary care, with the money following the patient and the patient electing where she wants to go. This is really the national conversation about health care.”
Rigamer also is trying to develop church-based health clinics that would offer a full array of services.
“We are still looking for a site, preferably in the city on a transportation line,” Rigamer said. “We’d welcome the donation of a building.”
BHAN has garnered grants from the Fry Foundation in Chicago and the Robert Wood Johnson Foundation and is receiving advice and counsel from Kaiser Permanente, a nonprofit health organization based in California.
Rigamer said because of the low number of practicing psychiatrists in Orleans Parish, the model he would like to develop would include “maximizing” how those psychiatrists might be used.
“If you had a team of people with varying skills – a spiritual counselor, a psychologist, a licensed clinical social worker, a psychiatrist – you could triage the patient and refer to the psychiatrist only those people who needed medication or psychiatric evaluation,” Rigamer said. “Yes, we need more psychiatrists, but if we had a multidisciplinary approach, with each person doing what he or she is skilled to do, that would help ease the crisis.
“What I’d like to do is put behavioral health care more into a primary care setting by treating anxiety and depression, which is the biggest cause of mental illness in New Orleans. These are issues of the broken infrastructure, the brokenness of the recovery, broken leadership, loss of confidence and the terrible bureaucratic hassles people have had to put up with.”
Rigamer said his involvement with Catholic Charities is an indication the church wants to get into health care with a multidisciplinary approach.
“The beauty is this health care can be backed up by social services, housing, Food for Families,” he said.
(Anyone who needs information on mental health counseling provided by Catholic Charities should call 835-5007 for the Metairie office; (985) 652-4330, Luling/LaPlace office; (985) 641-8120, Northshore office.) |
