The Interconnection of Race, Class & Mental Health in New Orleans

By Cassie Hayno

Jessie Smith III, a 55-year-old born and bred New Orleanian, has a wonderful energy that transfers to any person who has an interaction with him. Jessie is kind, jubilant, and happy to talk to or listen to anyone about any topic. Jessie makes a person feel as if they are the only one in the room. When talking with Jessie, the struggles that he experienced growing up and that at one point he described himself as antisocial, aloof and unable to relate to other people seems almost unbelievable. Jessie’s astonishing past stems from his diagnosis of bipolar type schizoaffective disorder and anxiety. It took nearly 30 years for Jessie to get this diagnosis through the New Orleans public mental health care system.

Jessie first started showing signs of having a mental health disorder as early as age five when he would talk to his pencils in class. It was not until he was 16, though, that his mental health struggles started to impact him negatively and he began his journey in the public mental health care system of New Orleans. From the age of 16 to 30, Jessie attended three different universities and lost over 30 jobs, but still did not have an official diagnosis from the New Orleans public mental health care system. Jessie finally received his diagnosis of schizoaffective disorder when he was 29 and had an altercation with this grandfather that led to an arrest. It was in April 1996, after two months on his new medications, that Jessie realized he was no longer suffering from delusions, mania, or anxiety. “All of a sudden, it was like being in Snow White … It was as if a prince had kissed me and I was suddenly awake” he said joyfully of the experience. From that day on, Jessie was able to hold a job and become more successful than he had ever imagined. What cause it to take nearly 30 years for him to get to that point, though?

Jessie grew up in Hollygrove, a neighborhood in the 17th ward of New Orleans which is known for its association with low income and high crime. According to current demographics obtained from the U.S. Census, Hollygrove is 91 percent African American, and the median household income is less than $25,000 a year. For comparison, the neighboring Lakewood area is 95.5 percent white with a median household income of over $163,000 a year. The trend of concentrated race and income is seen all throughout New Orleans. Prosperity Now, a Washington, D.C. based organization which advocates for financial security in the United States, showed that “The white population’s income is $5,377 higher in New Orleans than it is nationwide, while the Black population’s income is $10,194 lower [than it is nationwide]”. Six times more African American households in New Orleans are under the poverty line than white households in the city. Jessie admitted that at some points in his journey to get a diagnosis, public mental health care center doctors attributed his depression and anxiety to his race and class.

Jessie’s story is an example of the inability to receive help when one grows up low-income. Jessie explained how his misdiagnosed and improperly treated mental illness affected his ability to hold down a job. Jessie believes that he was unable to keep steady employment because of his mental illness. After another job loss at 29, Jessie became increasingly suicidal and stopped taking the antidepressants that his public mental health care provider prescribed to him. Jessie lost over 150 pounds, suffered from severe delusions, and became homeless for a year. The delusions, which he had kept hidden away, became public as he walked around New Orleans talking to himself and people who were only present in his mind. Poverty affects mental health, and mental health affects poverty.

“In the black neighborhood, you went to Charity [Hospital]. If Charity couldn’t fix it, no one could.” However, after extensive damage from Hurricane Katrina in 2005, Charity Hospital was shut down indefinitely.

There is often a connection between poverty and mental illness. Catherine Santiago, an associate professor in clinical psychology for Loyola University in Chicago, pointed out that there is an increased chance for mental health issues for low-income adults, yet “many low‐income adults and families do not receive treatment because of logistical, attitudinal, and systemic barriers.” Jessie explained that, being a low-income, African American male, he was embarrassed and even at times discouraged from receiving treatment for the various issues he had growing up. Susan Norwood, president of the board of directors for the National Alliance on Mental Illness (NAMI) New Orleans, is a caregiver for her son who struggles with his mental health. Norwood believes that a great deal of people’s access to mental health services depends on the money and backing of their family. “We have resources to support my son, and when he is ill we can get him to his psychiatrist. If he needs to be hospitalized we have resources beyond his insurance to cover whatever needs to be covered … we are able to support him practically in an unlimited fashion,” she explained. “Of course, that’s not true of the majority of people living with mental illness.”

Public access to mental health care has never been a simple topic in New Orleans. For many years, Charity Hospital was the main source of mental health care for the general public in New Orleans. Jessie was admitted to Charity Hospital seven times in his life, and it is where he received his official diagnosis of schizoaffective disorder. For many people like Jessie, Charity Hospital was the most help they received. Jessie explained that “in the black neighborhood, you went to Charity [Hospital]. If Charity couldn’t fix it, no one could.” However, after extensive damage from Hurricane Katrina in 2005, Charity Hospital was shut down indefinitely. Charity still stands today, an empty shell on Tulane Avenue surrounded by chain link fence and a façade of shattered windows and No Trespassing signs. The building is a painful metaphor of the decaying mental health of the city. Since the shutdown of Charity, many New Orleanians who cannot find the funds for treatment find themselves in the hands of the New Orleans penal system.

According to the New Orleans Health Department, 43 percent of New Orleans residents who are in treatment for mental health concerns are referred by the criminal justice system, much how Jessie was after he was arrested for the fight with his grandfather. Lisa Romback, director of NAMI New Orleans said that “For people who can’t afford [mental health care], what usually happens is that they … end up getting care on an emergency or crisis basis by either going to an emergency room … or having an interaction with the police which may lead them to be hospitalized against their will or possibly incarcerated.” In fact, in New Orleans, interactions of mentally ill people with law enforcement has become so common that in November 2017, the City of New Orleans Behavioral Health Department implemented a Law Enforcement Assisted Diversion model, otherwise known as LEAD. The website explains, “LEAD provides NOPD officers in New Orleans’ 8th Police District the opportunity to divert an individual at the point of arrest for a low-level, non-violent municipal offense to intensive case management when the alleged offense is believed to be a product of underlying mental illness, substance abuse, or social challenges.” LEAD relies on police intervention for mental health assistance, and NOLA.com announced that 68 percent of police stops in New Orleans were stops of black people while only 29 percent of stops were that of white people in 2015.

Racial disparities like that of police stops have always been a part of New Orleans news. In 2013, the New Orleans Health Department released a report which focused specifically on the racial health disparities in the city. The report revealed that 32.3 percent of African Americans between the ages of 18 and 64 were completely uninsured while only 16.6 percent of whites in New Orleans were uninsured. Those uninsured people have no access to any affordable health care in New Orleans, much less any mental health care. While Medicaid expansion has allowed more people living in poverty to gain health insurance, the wait lists for the limited amount of mental health care providers who accept Medicaid can be weeks or even months. Those who cannot afford private health insurance or who cannot pay out of pocket for mental health services find themselves waiting extended periods of time without any diagnoses or temporary treatment.

Jessie explained that growing up without any health insurance was a direct cause of why it took so long to get a proper diagnosis. Jessie mentioned that when he was 18 and seeing a public psychiatrist for what was diagnosed as a “personality disorder,” Jessie requested the doctor provide documentation so that he could receive social security benefits. As Jessie explained, however, the common assumption was that any black male requesting social security was simply looking for a free ride, so his request fell through the cracks. When Jessie was able to get his social security benefits at 30 years old with his official diagnosis from Charity Hospital, he was finally able to get proper health insurance via Medicaid. Jessie says that had his doctors trusted in him and not made assumptions based on his race and class, that he would have been able to receive the social security benefits that qualified him for Medicaid sooner.

While my brief descriptions of Jessie Smith III’s life are eye-opening, it is impossible to really appreciate the strength and perseverance it took him to be the person he is today. Jessie, like many, continues to fight for proper, affordable mental health care in New Orleans. Today, he works as a peer support specialist at NAMI New Orleans and is working towards a degree in social work so that he can make sure as many people as possible do not struggle the way he did. Jessie tells his story with a passion and it shows the underlying issues of race, class, and mental health in the city that many people fail to notice. While there have been improvements in mental health care access such as Medicaid expansion, it is just as difficult for African Americans under the poverty line to get a diagnosis and/or treatment for their mental health issues today as it was when Jessie was growing up. Not only should there be an obvious increase in publicly accessible mental health care, but New Orleans needs to see a particular shift in the treatment of racial and socioeconomic minorities in order for there to be overall improvement in mental health in the city.

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