Seeing her daughter Vivienne strapped to a hospital gurney, Linda felt angry, powerless. After hours spent in a room that to her seemed more like a prison cell than a hospital room in its protective austerity, her daughter was to be transported from Ochsner Lafayette General Hospital to a 200-bed mental health hospital in Shreveport, 213 miles away.
From then on, it was primarily through phone calls that she was able to keep in touch with her daughter. A hairdresser, Linda remembers stealing away from clients to speak with the 11-year-old, who struggled with the reality of being at the mental health hospital, with other patients who shared harrowing stories and staff she found to be rude and mean.
“I was very scared to be going to a new place,” her daughter said of the ride up north. Once there, “I just wanted to see my parents,” she said.
Inpatient resources for patients younger than 18 are scarce across Louisiana. Of the 45 hospitals with inpatient beds listed on the Louisiana Health Department’s website, only 12 accept minors for inpatient treatment.
In Acadiana, many families looking for inpatient care for a child or adolescent are likely to find themselves in the same situation as Linda and Vivienne, who asked to keep their last name private. There are few resources available locally, which means getting help often entails sending a young person in crisis to facilities out of the area, hours away from their home, friends and family.
Until this year, there were no inpatient beds for children younger than 12 in Acadiana. Now, there are 10 beds available at the only local facility currently offering those services to patients under 18, but the resources still fall short compared to the growing need for adolescent mental health services.
The area “is under-resourced for inpatient adolescent and pediatric needs, and really all psychiatric needs,” explained Dr. Foster Kordisch, who oversees Lafayette General’s emergency department. ERs are often the entry point into the mental health care system for those in crisis.
Dr. Kordisch said emergencies like Vivienne’s are typically placed “off campus.” Unlike some other hospital systems, Lafayette General doesn’t currently provide its own inpatient psychiatric services for adolescent patients.
An ambulance from Acadian Ambulance Services is parked in front of the back entrance to Brentwood Behavioral Hospital in Shreveport, La., on Monday Dec. 4, 2023.
Before the harrowing trip up to Shreveport, it had been a tough few months for the family. Previously a happy child, Vivienne had increasingly turned inward. She had been attending therapy, but it didn’t seem to help. Then, one afternoon in March 2023, she refused to leave her bed all day, telling Linda “she didn’t want to be here anymore.”
The sixth grader had thought about stabbing herself with a kitchen knife and confessed to holding one sometimes, thoughts of hurting herself swirling around her head. Her parents rushed her to the emergency room too quickly to even discover the Tylenol pills scattered in the bed sheets.
At the hospital, they were told their daughter needed to be admitted. Lafayette General doesn’t have a psychiatric inpatient unit, so the family waited as staff made calls. Eventually, they were told that there were no local beds available and that the only option was at Brentwood Hospital in Shreveport, a few hours drive away.
Brentwood is the state’s largest mental health hospital. Formerly a state-run facility, it is now operated by a subsidiary of Universal Health Services, a for-profit company and one of the largest hospital management companies in the country.
The hospital takes in patients from all over Louisiana, as well as Texas, Arkansas and Oklahoma. According to CEO William Weaver, roughly half of its patients travel more than 100 miles to receive inpatient treatment there.
“Shreveport has been a medical hub for a number of years after Katrina,” Weaver said, referencing the breakdown in resources in the New Orleans area following the storm. “This is a medical mecca, with a lot of specialists.”
Brentwood Behavioral Hospital CEO William Weaver sits at his desk inside the hospital in Shreveport, La., on Monday Dec. 4, 2023.
Brentwood has specialized units for a variety of mental health treatments and patient groups, including a unit specialized on treating veterans and the only inpatient substance abuse program for teens in the state.
For Vivienne, the Lafayette tween, the experience at Brentwood was one of a fish out of water. A depressed young girl from a sheltered background, she was shocked by the severity of other patients’ illness and trauma. Staff, she said, were harsh on patients, and she quickly learned to comply in order to receive preferential treatment or be safe from repercussions.
“I was able to be OK in that environment, but I don’t know about other people,” she said. Mainly, she wanted to be back home with her parents. She understood that she needed help, but wondered if there hadn’t been other options, like an intensive outpatient program, that could have kept her local instead.
For her mother, the distance was difficult to bear. Her first impression of the hospital wasn’t great — the intake room, she remembers, seemed filthy, and when they arrived, she noticed employees talking aggressively during a break outside.
“How can I leave her here?” she remembers thinking. Throughout her stay, she worried about her daughter’s well-being.
Concerns about the institutionalization of patients with mental health issues, including adolescents, continue to play out in the courts.
The Southern Poverty Law Center in 2019 filed a lawsuit based on the experiences of five children insured through Louisiana's Medicaid program. The young patients, the lawsuit argued, either received insufficient care or were unnecessarily sent to psychiatric hospitals hours away from home, a reality the SPLC and its lawyers argue amounts to discrimination against them based on the disability their mental health challenges represent.
In November, the judge presiding over the case granted class status, meaning the relief asked for by SPLC — mainly an improvement in the level of services available to Medicaid-insured youth in mental health crises — would be applicable to all 47,500 Louisiana Medicaid-eligible children and youth under the age of 21. The case is currently going through a final round of appeals before it can be scheduled for trial.
The state has been fighting the case in court but is also trying to set up a crisis response system for youth. That system is modeled after a similar one set up for adults following a 2018 settlement between the Louisiana Department of Health and the federal government, concluding a lawsuit that argued the state failed “to serve people with serious mental illness in the most integrated setting appropriate to their needs,” violating the Americans with Disabilities Act.
Both programs are yet to become operational in Acadiana, making emergency departments the primary point of entry to crisis care for patients with mental health needs.
Once a person in crisis, including young patients, presents to an emergency department operated by one of Lafayette’s two major hospital systems and is determined to need inpatient treatment, a partnership agency is charged with finding a bed for them.
In the case of Ochsner, which operates Lafayette General, that partner agency is Oceans Behavioral Health, which also operates several inpatient and outpatient treatment centers in the area, none of which admit patients under 18.
Front steps lead up to the entrance to Brentwood Behavioral Hospital in Shreveport, La., on Monday Dec. 4, 2023.
According to the company’s chief administrative officer, Amy Dysart-Credeur, finding local placement for those patients can be extremely difficult.
“It is to me alarmingly small and unfortunate,” Dysart-Credeur said. “If it was my child, I would certainly want them in the community that I live in.”
Meanwhile, out of the roughly 30 children and adolescents from Acadiana who are placed in inpatient care by Oceans every month, only about 2% are placed locally, according to company data.
Growth in specialized behavioral providers, especially for adolescents, isn’t keeping up with the need, Dysart-Credeur said. Inadequate pay is likely part of the root cause, she noted, because many teens with behavioral health issues are insured through the state’s Medicaid program, which reimburses at lower rates than specialty care costs, she said.
The need, on the other hand, is larger than ever. America is facing a youth mental health crisis, and young girls, like Linda’s daughter, are at the center of it.
A 2021 survey by the Centers for Disease Control and Prevention found that nearly a third of teen girls had seriously considered suicide. More than half of teen girls, 57%, reported feeling "persistently sad or hopeless" — a record number. Overall, 22% of high schoolers said they have considered suicide.
Experts have placed part of the blame for this trend, which marks a continuation of worsening mental health among young people that began prior to the pandemic, on the isolation and anxiety caused by the COVID-19 global health crisis. The effects of around-the-clock social media and technology use are also considered a contributing factor.
Whatever the cause may be, young Americans are reporting mental anguish at higher rates and are showing up in emergency departments seeking treatment in larger numbers.
Plushies, which the family said they were not allowed to bring to the Shreveport psychiatric hospital, sit on Vivienne’s bed in Lafayette, La., on Monday, April 29, 2024.
And there have been some efforts to respond to this growing demand. Vermilion Behavioral Health Systems, the only local provider offering services to children and adolescents, has added 10 beds to its kids’ unit, allowing it to now serve patients as young as 7 years old. Vermilion CEO Amy Apperson in a previous interview said she hopes to eventually dedicate all of the system's 78 beds to patients under 18. Vermilion currently still serves a mix of young and adult patients.
Oceans and Ochsner in 2022 announced plans to partner on a new mental health facility to include inpatient services for adolescents. According to Dysart-Credeur, that facility would add 70 beds to the company’s existing behavioral health campus in Broussard. The facility is slated to open its doors later this year.
Meanwhile, Vivienne has steadily improved with the help of medication and under the supervision and care of a therapist and a psychiatrist. “She is the kid from before,” Linda said. Still, she said, she’s in a state of constant vigilance. “Every day is a test, and I just try to be observant."
Editor's note: This story has been changed to correct a description of mental health patient rooms at Ochsner Lafayette General Hospital as well as the inpatient resources available within the Lafayette General system. Lafayette General offers adult inpatient services at off-campus locations.