On Thursday, in the third day of a federal hearing to determine whether or not the city will be forced to move forward with building a new mental health facility at the New Orleans jail, the lead psychiatrist at the jail, Dr. Jeffrey Rouse, was called as a witness for the city. It may not have gone as planned.
The city is hoping to convince a federal judge that oversees the jail’s consent decree that a new facility — known as Phase III — is unnecessary, and that adequate mental health care can be provided by retrofitting the current jail. But at the hearing, Rouse admitted that he would prefer Phase III.
“We’ll work wherever it is decided — be it retrofit, be it here…be it the parking lot,” Rouse said as he was being cross-examined by a lawyer for the Sheriff’s Office. “But if you’re asking a doctor, would he prefer to have a newer facility that he had a hand in designing? The honest answer is of course, yes.”
Perhaps it wasn’t a total surprise, however. Rouse, who is a psychiatrist with Tulane — which is contracted by the jail’s healthcare provider, Wellpath — at one point was also listed as a witness for the Sheriff’s Office. The Sheriff’s Office is a proponent of the Phase III facility.
Rouse said on Thursday that while he had been involved in the planning of Phase III, he had not been consulted regarding a retrofit option of the current that the city has put forward as an alternative.
At the same time, Rouse told attorneys for the city that his psychiatric team at the jail was already providing constitutional psychiatric care to patients at the jail — though he noted it requires “constant effort.”
The city attorney, Sunni LeBeouf, called Rouse’s preference for a new facility “understandable,” but asked if it was “also correct that a brand new jail building is not required to meet the psychiatric portions of the consent decree — specific to providing psychiatric care to OPSO inmates?”
“I would have to also agree with that,” Rouse said. “We’re hitting substantial compliance with all of those measures here — so yes.”
But any expansion of space designated for psychiatric care — including through a retrofit — Rouse said, would be an improvement.
“If we get more psychiatric beds — either acute beds or subacute beds — in a retrofit, or in a special needs facility, or in a TDC, that’s going to provide better care.”
(The TDC refers to the Temporary Detention Center, which was recently renovated to provide temporary housing for detainees with acute mental illness.)
Structural deficiencies
In his testimony, Rouse outlined a number of structural deficiencies in the current jail that are not ideal for providing mental health care to the incarcerated population.
Some of those deficiencies were first identified before the jail was even finished being built. Civil rights attorneys and the Department of Justice toured the building in 2013 and noted that the 60-bed pods did not allow for sufficient space to separate “special management populations” of detainees. An ordinance passed by the city council in 2011 required the jail to house all types of detainees, with the exception of those with acute mental illness.
Rouse pointed specifically to the fact that the psychiatric tier in the current jail was on a second floor with a mezzanine which detainees have attempted to utilize for self harm. He called it “quite-problematic.”
“There have been several times that patients have jumped, or attempted suicide, off that second floor,” Rouse said. “If there were to be a retrofit, it would have to completely prevent the ability to jump-off. And I would be concerned that the retrofit wasn’t— for lack of a better word — chicken wire that the patients could climb. It would certainly have to be a sheer surface to prevent climbing or climbing around.”
Rouse told the city attorney, however, that he thought it could possibly be done.
But Rouse also said that there were no counseling rooms on the psychiatric tier, and that lines of sight for deputies — so they can maintain an eye on detainees — was a problem. He seemed to think that in terms of lines of sight, the Phase III option provided a better solution.
The Phase III plan, Rouse said, contained circular pods that allowed for increased visibility and for more flexibility in where to place patients.
“A circle has a central point from which things can be seen, and the sub-pod concept that was in the special needs facility plans that we were involved in consulting in months ago — before COVID — that sub-pod capacity would allow for more individual configuration,” Rouse said. “So you could have the ability to sub-divide patients from one another would be helpful. Preventing enemies from being next to one another, and the like.”
The lawyer for OPSO also asked Rouse if a Phase III facility would make his staff feel safer when providing treatment for people with mental illness, and thus easier to retain.
“Yes is the direct answer,” Rouse said.
He noted the Phase III plan that he had worked on included “clear” interview booths that he said “could be used for particularly violent patients, or difficult patients, in a manner that would provide both confidentiality and adequate back and forth of information, but one that would obviously prevent any difficulties or assaults.”
Rouse estimated that there were somewhere between 60 and 80 detainees currently in the jail that would be housed in a special needs facility, should one be constructed.
While the number of acutely mentall ill patients is more limited, the overall number of people on the mental health caseload is over half the jail population.
Rouse said that last week, on October 1, there were 477 detainees taking psychiatric medication at the jail. According to data available on the city council website, the jail population was 886.
The hearing will continue on Friday.