By Dr. Rachel Bervell July 7, 2025 Louisiana Illuminator
In New Orleans, it’s not uncommon for police to bring someone to the hospital from the streets, disoriented, confused and in psychiatric crisis.
As a young physician, I’ve come to recognize the pattern: young adults, unstably housed, cycling through jails, shelters and emergency rooms while grappling with severe psychosis unresponsive to conventional approaches. Some I’ve seen before. Many I’ll see again.
One such patient arrived in my care this past spring agitated and paranoid. Over several weeks, we adjusted his drug regimen, consulted specialists, and navigated the ethics of compelled medications after he stopped eating, convinced fasting would bring spiritual clarity as directed by his hallucinations.
Clozapine, the gold standard for treatment-resistant schizophrenia, wasn’t an option. Without stable housing or a reliable system for routine blood monitoring, it simply wasn’t safe; its use demands regularity to avoid life-threatening side effects. We had to settle for a less effective, but more practical, substitute.
By discharge, he was calmer, eating and talking more. He agreed to a long-acting injectable antipsychotic, and we arranged for transportation to a shelter with appointments at a public clinic. It wasn’t ideal, but it was something. His story, like so many others, reflects a broader, broken system. And like I’ve done so many times before, I let him go into uncertainty, hoping it would be enough.
This is not a mental health system. It’s crisis management on repeat.
Stories like his are painfully familiar. As a psychiatry resident working in Louisiana’s only public safety-net hospital, I see versions of this every day. Many of our patients spend their 20s bouncing between detention centers, psychiatric wards, and the streets. They’re denied consistent connection to care in systems shaped more by surveillance than by support.
Legislation like Senate Bill 196, House Bill 619, and House Bill 262 advance policies that may further isolate and penalize unhoused citizens by imposing criminal penalties for “unauthorized public camping.” Though including language about supportive interventions and rehabilitation, in practice, strict enforcement of these bills means prison time and fines for unhoused individuals, many of whom live with untreated psychiatric illness.
For decades, Louisiana has chronically underfunded mental health care. Rather than investing in recovery, the state is now leaning into penalizing homelessness, a condition many of my psychiatric patients experience, through newly proposed legislation. Such disinvestment makes healing nearly impossible for those with severe mental illness. Even after surviving years of trauma and reaching brief stability in clinical settings, patients often return to the circumstances that contributed to their illness in the first place. This return, however, may soon come with the added risk of criminalization.
After Hurricane Katrina shuttered Charity Hospital, followed by the closure of several other public psychiatric facilities, Louisiana promised to shift to a modern, community-based mental health network. That vision never fully materialized. Instead, the state adopted a crisis-oriented model: short inpatient stays, fragmented outpatient services, and minimal housing support.
Community mental health clinics are overwhelmed. Few psychiatrists accept Medicaid, and statewide reimbursement rates remain among the lowest in the United States, making it hard for providers to serve those who need us most. As of 2023, Louisiana only had 689 state hospital psychiatric beds, well below national recommendations. Just a handful of Assertive Community Treatment (ACT) teams operate across the state despite widespread demand for this kind of wraparound support.
Mental illness affects people of all races and socioeconomic backgrounds too, yet its consequences reflect entrenched inequities. Black Louisianans disproportionately affected as many experience delayed diagnoses, higher hospitalization rates, and increased criminalization.
Meanwhile, Louisiana, already home to one of the highest incarceration rates in the country, routinely relies on jails and prisons as de facto psychiatric facilities, a ramification of closed state mental health institutions and underfunded alternatives.
Inside our hospitals, we do everything we can no matter the patient. We titrate medications, discuss with social work and chaplains, and coordinate outpatient plans. But far too often, we discharge patients with little more than prescriptions and a list of follow-up appointments, knowing that without stability, recovery may not hold. We need more bridges across housing, outpatient care, and long-term community support.
What troubles me most isn’t how sick some of my patients are when they arrive to my care. It’s where they have to go when they start getting better.
I earn their trust. I see glimpses of the person beneath the illness. Then they are discharged… back into the very conditions that perpetuated their suffering.
In these cases, they don’t fail treatment; the system fails them. And that failure is the result of policy decisions that we have the power to change.
While Louisiana faces real limitations in resources, we need solutions rooted in continuity, compassion, and care that work, not more laws like Senate Bill 196.
This means investing in strategies that treat housing as health care like expanding Housing First initiatives that embed behavioral health care into living environments; establishing ACT teams especially in rural parishes; equipping mobile crisis teams to intervene early; fully funding community clinics serving patients with complex needs; creating psychiatric step-down facilities to offer structure without the trauma of institutionalization; and raising Medicaid reimbursement rates so more providers can serve this vulnerable population.
Above all, we must reject policies that punish illness and deepen despair. Lack of mental health access is a public crisis, not a crime, and our response must reflect that.
We cannot treat a delusion with a shelter cot alone. But we also cannot medicate someone into recovery only to abandon them at discharge. Bills like SB 196 don’t offer real answers. They present care as a reward for pleading guilty, not a right. In doing so, they are punitive for unhoused people with psychiatric illness and force clinicians like me to watch as patients are pushed from hospitals into handcuffs.
The safety net shouldn’t just catch people when they fall. It should be a bridge, to healing, to housing, to hope. Until we build that bridge, we will keep watching people fall through.