If mental health issues are behind many of these mass shootings - Where are the cracks in the foundation?

Newell Normand
Wednesday, November 8th

So, now we learn the Texas church shooter escaped from a mental hospital in 2012.  If mental health issues are behind many of these mass shootings - what’s the state of the mental health system?  Where are the cracks in the foundation?

This Hours guest:
Dr. Gerry Cvitanovich - Coroner, Jefferson Parish
Chuck Credo - Attorney for Jefferson Parish Coroner


Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

We're back and as we continue our conversation. The state of the mental health system. We're very fortunate to have two individuals that know a lot about this who are engaged. It in in the trenches every day as it relates to the mental health population. In Jefferson Parish doctor Jerry Santana which the corner of Jefferson Parish and chuck Credo. One of the attorneys for the Jefferson Parish coroner who has been very proactive in. Changing legislation. In the state for a long time on mental health related issues and and Jerry's office has always been just a breath of and depth of information in in this regard in many programs that they run so I. You know I don't get many chances to thank you but thank you for your service while our sheriff Vernon Jordan working with you. So let's put that first question arrests. For the previous hour someone said what is the obligation of a metal. Health doctor orphans of any position as it relates to. Revelations. About someone who may have a mental health component in an acting out on on those revelations are our partner idea nations. Well I'll start and I'll let chuck finish yeah I'll tell you the obligation chuckle probably tell you the actual statuette. You the provider. Weather today in an emergency doctor or the psychiatrist most of the time would have an obligation. In any case with a specific threat to get to specific person to notify not only law enforcement and notify the object of threat. Now your child can probably actually give us a lot more information about the actual statuette. When this began as a case that went all the way to the Supreme Court called Harris soft. And it dealt not only with doctors spoke with me all mental health professionals such as MSW workers licensed professional counselors etc. And we embodied that in Louisiana law under RS non colon twenty. Hundred point two which says the terror soft duty is that if a mental health professional. Encounters a patient or consumer. Who expresses. A and danger to self danger to others are gravely disabled idea. And makes a threat that is directed toward being named individual. Then that professional has an obligation to not only contact Pete intended victim but to also contact the law enforcement. Agency in that area. So now the doctors of course have the ability to bright and emergency certificate on an individual right away. So the doctors certainly have an upper hand in that regard but any mental health professional who encounters that particular situation. Does have a duty to act and if they do act then they granted immunity under the law. So there's. You know an area that you all deal with where you interact with law enforcement officials throughout the parish whether it be city departments to sheriff's office or otherwise. And then there are three specific areas wanna yell monitor the physicians emergency commitment where you'll actually inner awkward positions then there is the partners emergency commitment otherwise known as CEC. And then there's the order for protective custody correct correct yeah let's talk about the PC first the CDC in neo pieces. And hit it to Nash absolute. You know alphabet soup of mental health and that you know. Then frequently with parts one is either going to be a obesity or eight PC and OPC. Would be a situation order protective custody would be where somebody. A family member or friend you know acquaintance of somebody who is either dangers to themselves dangerous to others are gravely disabled. They come to us they tell us specific instances. That they experienced. With that individual that leads them to believe that did they follow one of those categories. We review it always reviewed with a physician and we make a determination to. Sign the order for protective custody which is then transferred to the sheriff's department and the media the officers are trained in crisis intervention will go out and and and bring that person in against their will to be evaluated in the emergency room. Once they're in the emergency room they're like any other patient that under a doctor's care. That the provider partly in the providers care provider and then assessed the patient and it in their opinion that person. Falls into one of those three categories. They will write what's called a PC if physicians emergency certificate. The PC allows somebody to be held up to 72 hours against your will for treatment. And during that 72 hours. If they. If it's determined by the admitting physician that that person needs to be admitted longer for their. You for their condition they have to get what's called the CEC which is the corners emergency certificate. Which extends the period another fifteen days. So will the longest then is what eighteen days. Sir it does so on fifteen days under the GO PC process a cut of OPC PECC EC. And it can begin either with a no PC where any credible client comes to the corners office. And based on personal observation. Says that an individual was dangerous to self or others or gravely disabled but remember. There is such a thing as they fall so PC and it is a crime to do that against an individual if in fact you were blogging about it. And that is a one year felony. That's very few people remember about that when they. Sometimes giving contestants a legal cases and wanna have an advantage against the other party. Similar to falsifying a police report back and stuff like that because you know you've got to. That the system has that. Maintain the sanctity of the system as much as possible you don't want people abusing that right that's exactly right which is why we don't do these over the phone we do these face to face. And we notify everybody about the seriousness. Idea of of the process. I mean you're restricting someone's human rights human liberty in Allen and everything else on based on a word of someone else you have to make sure that your. Touch and all the right touchdowns in order to support the premise of the of the notion of torture about it to to go down the path. Remember that as sheriff do you needed probable cause to take anyone's liberty away it's we don't need probable cause and all we need to fought meet the criteria the statute which is based on any credible following it. So that so much less burden much less you know many many years ago when. We were deciding whether or not as it took. And chuck you were very much one and the impetus. Of that it's looking and investigating. And then. Inner Jerry comes in office and and we end up doing it and we end up putting all of the officers to the forty hour training. You know for CIT. Which I think was a huge upside for the Jefferson Parish sheriff's office and I think we were one of the first in the state to do it now we are are not the first and our first and you know it and a reality is when we were looking at it then we were experiencing. A very small number of of other P. c.s CC's a group PCs. And today that's kind of changed I mean I think the incident charade is it is. A lot higher which is now occurring absolutely absolutely so what on average you guys seen in a week. On a yearly basis we do approximately 3500. CPC's. Is from my last behavior house task force meeting. So want a weekly basis we do between. A new one a day actually is when it averages out to be in and sometimes up to three and four day. That's that's for the seat heat for the OP sees the OPCs that we we have the day to order from protective custody you know we usually average you about. One per day that's where we actually have to get the CIT trained officers to go out and and no I think that the other you folks may like to hear the difference between eight CIT trained. Law enforcement officer. And your your other folks and that's that's where I was I was going next we have some we we have those ago to the forty hour class and then we have others that. Go through a lot more extensive training working with the coroner's office and others. That we send out. Pursuant to the orders that you all issued to go and deal with that population so it it's there it's a you bring somebody in against their will is a very. Obviously a potentially very dangerous situation. For everybody involved for the person who's being brought in the family members. And the officers who are obligated to bring them in so it's a very dangerous these guys learn a lot of specific techniques that assist them in dealing with the person in crisis. And it it absolutely cross country series. Lives remembered began in Memphis Tennessee with the Memphis model Memphis model and New York to offices. You reach in key threes war. To an earlier early pioneers who brought that back to Jefferson Parish. We developed it. It became an is announced today the international. Association of crisis intervention training which reaches into. Over ten or twelve countries around the world. And I'm gonna take a moment to congratulate you again. Because I don't think we have got it out the word sufficiently but in 2013 doctor Jerry and I nominated you know as the CIT agency head of the year. And in this international organization you work the chosen as that and in 2015 we chose option key threes. As the CIP officer of the year so we're proud that we're proud of CI AT and and it's got to be the leadership and vision of the pre people we elect. That that make us go down these roads. Thank you so much as one of my proudest moments in a really appreciate it we're gonna continue this conversation and and and dig deeper on on this issue give us a call 260187. Or Texas at 8787. And this is Noual Norman uncovered a real. We're back and in light of some of the revelations. As it relates to the Texas shooter. And and possibly having a mental health component we don't know whether or not that's the case we don't know why he was in there. But it it begs the question of what is the state of our system because we realize that thirty our higher risk if we don't adequately address the issues. Day in and day out and our communities will go on wanna talk to Michael what say you Michael. Hey are you aren't doing well. I had a quick question on of the silly but not but now my question was. Is choose sides considered. Legal or he legal and if it is considered. Not illegal then is it more early just for governments do all ought to get their oil or something that's not illegal it there's. Chart Michael I think your confusion in that area results from the death with dignity movement. That occurred out in the west in Washington and Oregon. Suicide is legal in those states. And but we here in Louisiana have not adopted that and in fact have a criminal statute. Criminal assistance to suicide. Which if you remember if you watch in the news lately there was a lady up in Boston who just got convicted of that in Boston. For urging a seventeen year old kill himself and his garage with carbon monoxide. So in Louisiana we value life. Differently than they do in Washington and in Oregon and suicide is in fact. A crime here criminal assistance to suicide is also a crime and but. Be aware that if you beat feel differently than you might wanna be in Washington and Oregon where that is one of. Yeah but I'm I'm pretty sure chuck in it in those states where assisted suicide is legal. You're putting a gun to your head is actually still easily. Absolutely as a methodology methodology is different so but it is called death with dignity and if you read those articles he could confuse anyone. As to whether or not suicide is still an equal. But legal or illegal the fact of the matter is as we said earlier you'll take it very seriously as it relates to the process. As a relates to the evidence that's that's presented did it before you even go down this OPC or CEC. Trail in dealing with folks that you gotta make sure that they are a danger to themselves and or others and that there's some kind of overt manifestations. Or something. There too before you start taking people's liberties or rights away from the. You have to meet criteria I think is what doctor Jerry and I agree on. And the doctors and the mental health and medical professionals are very very adamant about meeting criteria. You may not like your particular. Neighbor and he or she may are not may or may not act in a strange way. But that doctor in that emergency room who views that person has to go by criteria you either meet the criteria or you do not. And so we we we go by that law every day sometimes people really enjoy the fact that we we can enforce a law other people don't. In the first hour we had doctor stops being on from relish you helped fuel and school of medicine and we were talking about the state of the system. What are you guys see you know it it we were dealing with these mental health cuts all the time in and how much of a burden or stresses that putting. You know these things on on the population yell a serving out there in dealing with when you talk about 3500. You know contacts that you had in a year in dealing with that that's nine today. You know I know that on Sundays you may be twenty and better and 99 average and that's a lot of activity. It I think we're seeing more of a revolving door. Of admissions and some people because what that the beds are limited there's a tremendous amount of pressure. On. And in patients providers to. Get patients stabilized. And discharge so that because they have a backlog. Of people waiting to be admitted. So there is a lot of pressure a lot of people wind up in just charged and days or weeks later are back to the same behavior that got him admitted the first place and the family members are back seeking another OPC. And the and another thing about the stress the system. Is. You back in my days as leverage your doctor. You know we used to have people that we would to a piece sealant and we have the social workers in the emergency room. Looked to find a mental health bed for that patient if our facility was full which frequently was. And we were be shipping people around. Our local region. Now. You see frequently people who get peace seat at our local emergency rooms who wind up having bush reef as far away Shreveport. Which is definitely not optimal. If for some based care now now we're new thinking that. Their support system is so very important to them you know dealing with a particular challenges and issues that they have to deal work than you see this around the country. We got to take a break we'll go to CBS news stay with us 260187. He will be right. Rebecca we're talking about the state of the mental health system with doctor Jerry Santana Richard corner for Jefferson Parish and chart Credo who also works for a doctor's Stenavich. We'll go to the talk lines on line one talked to James from Metairie what say you James. Thank you very much showed you'll have a question you guessed mention. That this it was side that would babysit it's that we are always a bit of I would say the problem down the equities oxy more. It's decided that we go with the penalty to someone who killed himself a bit. And and the person is quite successful. And let's say what happened jaw. And after there recover medically. I think prosecutors were trying to kill themselves were for crimes. That that's what I think it's always been among. Well I think the state law is it that it is a little bit of I guess an oxymoron. In a you know but the thing is is that there are a bunch of things that flow. From that in and chuck earlier was pointing out. This preservation of life. Situation which is actually what he was pointing out was. Not his stance of being on pro life but what the legislative intent was behind the law. That that actually had passed so what are the things that flow chart from this suicide didn't go ahead. I've. Upon marketing and I'll listen to accurately and its support public support. Position assisted suicide and that's not good here in Louisiana where people can didn't act but. I don't like human suffering I don't think's stopping as any benefit in any medical. Jibril benefit now you can go into the year theological. Benefits people claim to have been. They're one of the goals of humanity should be tendered to minimize suffering and that's like support what goes on in Washington and in Oregon. I'm suffering you know I'm should be have the right to make that decision or anyone else. I believe in the in Iraq on a personal autonomy when it comes to and then of course that's being awed by. Certain factions are on the right but that's so I think. Yeah now look James I think you bring up a good point. The carnage doesn't make the laws he just has to enforce the law all the same way with the with law enforcement. And I think what they were talking about that was the legislative intent Mary. Well so let's talk about what the downstream applications aren't answer james' first question as it relates to why is suicide illegal and we don't go book and anybody. War torn up suicide. But we do it allows us to have a criminal investigation. In order to determine whether or not there was any foul play or anything else by it being out. All right and certainly. We want to make sure that when James is in his home tonight. And his neighbor comes over. Who doesn't like James to begin with and puts a gun to his forehead and pulls the trigger nothing personal nothing personal things but it looks like a suicide. We wanna make sure that we have the investigative means to determine whether in fact that's a murder or suicide. And one of the determinations that forensic pathologists make on a daily basis in our office. Is cause and manner of death. So my only. Point before and certainly you have a right to the opinion that. The but he is suffering is bad in and you don't want that. And use support Washington Oregon and people out there obviously due to the vote of the people put it in. So. But here. The intent to the legislature was to put a short and long term system or mental health law which is what we were talking about. And that's what I wanted to get to more than anything was that the intent of the legislature here. Does not follow the intent of the legislature is up there so is suicide a crime. Is it moral objectionable thing I you don't know that's not the point of the discussion which tried to make him. Greg if it is that is absolutely. Gerri any observations. 88 it is via via eBay could point of we. You know in enforce the laws that are given to us and certainly they'll have a personal opinions about how low end of life issues should be handled but that's. Not our duty to legislate. So let's jump to another I mean but thank you were appreciated James thanks so much let's jump to an. Other issues. There's a move across the country mental health courts. Because of the very unique. Nuances. Dealing. With individuals suffering. From some metal. Illness or mental disorder. You know it it really helps to have judges advocates. And others who are. Well experienced and learned in in all of the areas in dealing with this and what the appropriate accommodations. Or outcomes or otherwise should be. Once they enter the system. I think the Chief Justice of Louisiana Supreme Court long ago saw the value of problem solving courts. And so we began a drug court movement twenty years ago. A witch and are you familiar with new and I was at Mineta original committee yes sure. And so that it's that has evolved into other problems solving courts such as VA courts need to BI quartz. But the most interesting I think is a mental health court movement in Louisiana we have seven mental health courts which are functioning today. Of the closest one to us is certainly. Judge Karen Herman runs a mental health court New Orleans criminal district court in judge Peter Garcia runs one in saint Tammany parish. Those courts modeled on the drug court model take individuals who are suffering chronic mental illness. And provide a system over resources. Which in a move that individual. To function as normally as possible. On any given day. The chronic mentally deal is what we deal with on a long and short term basis every day in the mental health system. So if you think of the mental health system in short term and long term. Mental health courts or certainly one of the long term solutions the most exciting development in that area. Is a new thing called DOT courts. This is coming out of San Antonio Texas where judge Oscar k.s and spoke to us last week in fact. About an AOT court the difference between an what does that stand for AO TI ansari is assisted outpatient treatment. We have assisted outpatient treatment on the books on our laws and so the difference between a OT courts and and how courts is a OT courts have a judge and an act team which is an assertive community treatment team and they deal individually with the with the people will. Continue this conversation we wanna hear from you 260187. Here at Texas sedate 7870. On the state of the mental health system will be right back with doctor Jerry Santana pitched this is Noual Norman and Everett area we're back and we're talking to doctor Jerry said Tenet said corner of Jefferson Parish and chuck Credo whose an attorney for. The coroner's office and has been very proactive with legislation. Surrounding these issues will go to talk line online wanna talk to Roy in Madison bill what say you rolling. And I don't. I have two cases of mental well. That I have been deal wit one well about three years ago in a white retired lieutenant. And she is bipolar. And so we went through that again. Are being in it 75 to one year a guy who becomes an exclusion. That we can't do it quality. Health care mental health care here so we have to literally go to miss. Okay. And then I trust her mental well very well. That say that. Well it's good and it's good and it's bad. I'm glad I'm able to get it in the the problem here in junior highlighting what I've said all along we cut mental health every time we get into a crisis and that's. Credit I'd gotten. A better question is her her care to the VA system. No we had the lead because of the day applies not doing their job. Okay and so we have to leave here. We've heard that a lot of swell too you know dish grew up out. And they ask you have yell interacted with nominee the national alliance of mental illness. The man out there that narrow I think there's chapters and now. Now I'm really yet let me let me recommend to you that there is a very active chapter a nominee which is the National Alliance on Mental Illness. In saint Tammany parish. And it works in conjunction with judge Peter Morrissey is mental health court. You've got some strong mental health advocates in saint Tammany parish I heard and say you're from and Mandel area so. I would recommend seriously that you talked to nominee saint Tammany and two. The mental health court. We have for example a Family Guy that we put out from nominee. Numbing new wall and I happen to be the president numbing new long ones and some a little bit for remote you with this and the family died in the family resource guide. Has a number of resources for folks that are just in your position and who or consumers and need guidance. In fact. Numbing New Orleans has a mental health navigation team. One phone call on a month numbing new loans or put you in touch with a counselor who can help you navigate this system the system as we've been talking about all morning. Is one that needs navigation is not an easy one and it's not an easy one for the average consumer. To do so. I certainly I'm a share your your your pain as for as having to go long distances to get mental health treatment. But I'll also point out to you that we are getting better and we are working on an every day and there are some resources. That may may help you. LeRoy thanks so much for Colin and ensure that experience with this we really appreciate it will be back and we'll talk more about this issue when we return. This is dual Norman on WWL. What doc or back in it nominee give you less comments about the trials and tribulations of this mental health system in you know that we face budget cuts and and it does put pressure on everybody. Well you know. When could they can say about the people who are involved in mental health. It's people are very committed to it that are that have led themselves. To do it they're committed to working within the system as best they can that includes chuck myself and the people in our office. Yeah we're working our hardest and it's a deal on going fight. And I thank you so much chock. Doctor Jerry Stenavich that Carter and Sharpton in his office who have been advocates far. The mental health population not only in Jefferson Parish but throughout the state of Louisiana in trying to. Bring some cooperation and collaboration on this issue to get the biggest bang for everybody's buck in dealing with the mental health issues in our community. The place that we call home. We just wanted to be a safe place to live work and raise our family.