Uncoordinated system of care. To add to the problems associated with accessing mental health treatment in Louisiana, the delivery of behavioral health services in the state is usually separate and uncoordinated from the broader health care delivery system (AHA, 2012). This fragmentation of care can often compromise the quality of care and clinical outcomes for patients with co-morbid behavioral and physical health conditions (AHA, 2012). Unlike the rest of the country in the last 50 years, which was moving towards a community-based model of rehabilitation and recovery in outpatient settings, Louisiana followed a much different path. While Louisiana reduced its resident inpatient population at a rate similar to nationwide reductions, the state prior to Hurricane Xxxxxxx in 2005, did not close any of its long-term mental hospital facilities (Hood, 2009). Counter to the trend in other states, Louisiana actually expanded the number of state psychiatric institutions from five to six in the mid 1980’s (Hood, 2009). Prior to Hurricane Xxxxxxx, Louisiana essentially had a “two tier” health system, in which the insured population (including those with Medicare and Medicaid) had access to a range of community hospitals and physicians, while the poor and uninsured were mostly cared for through the state-run safety net system of public hospitals (Rudowitz, Rowland, & Xxxxxxxx, 2006). There were ten hospitals across the state within the charity system, including Xxxx X. Xxxx Medical Center in central Louisiana (PAR, 2013). Prior to 2013, the charity hospital system, which had existed in Louisiana since the 1700’s, would treat anyone, who resided in the state of Louisiana, regardless of ability to pay (PAR, 2013). The state public hospitals offered care for acute conditions, but provided fewer options for preventative care for the uninsured (PAR, 2013). Many uninsured in Louisiana lived far from a state public hospital because the hospitals were spread throughout the state (PAR, 2013). Consequently, this has led to an overutilization of expensive emergency care (PAR, 2013). The uninsured in the state with mental and behavioral health disorders often came to rely on being able to receive help in hospital EDs (PAR, 2013). Within the charity system of hospitals, Louisiana had historically high rates of ED visits, which is an indication of the limited access to primary care and preventative services in the state (Xxxxxxxx, et al, 2006). In 2004, the year before Hurricane Xxxxxxx, the state ranked fourth...
