How an experimental mental health facility could change New Orleans' prison system

NEW ORLEANS — In June, 18-year-old Marvell Smith arrived at the Orleans Justice Center, nervous and overwhelmed, to await his day in court at the notorious jail. Staff took him up an elevator to the fourth floor and placed him in a unit with more than four dozen other men.

Almost immediately, another inmate began stalking Smith and attempted to physically and verbally intimidate him because of his homosexuality, he said.

For years, inmates say, hazing has been widespread at the prison. Since 2012, the prison has struggled to comply with a settlement from the Justice Department, which is supposed to monitor poor conditions, violence and abuse at the prison. But this time, the outcome was different. The man who followed Smith was promptly removed from the unit by its warden, Lt. Michael Lewis. Had Lewis not taken action, nine other pretrial inmates told NBC News that they would have asked the man to leave.

Smith's experience reflects the larger goals of a new mental health-focused community within the prison that aims to end years of violence and neglect and instead build a sense of camaraderie. Smith said he was relieved that Lewis took action to get rid of his tormentor. “As time goes on, it becomes more and more like we're all human, we're all men,” he said.

Smith is one of the first to test this approach at the prison that New Orleans officials call a “model mental health facility.” The program is led by Sheriff Susan Hutson, who ran for office in 2022 on a promise to reform the prison and fight its continued expansion. The program has a simple goal: to treat pretrial detainees more like patients who have experienced severe trauma and deserve community and medical care.

The men who live in their experimental cell are free to organize their own time and communicate freely with each other, play basketball, cut each other's hair, watch movies and the evening news, and share books. In return, they must commit to a zero-tolerance policy toward harassment and violence, make their beds, do the laundry, and regularly participate in group discussions about conflict resolution, stress, and trauma. Some of the members also receive individual psychiatric treatment.

“You really want to be there for each other,” said pod resident Zachary Terrell, one of the first men to notice Smith feeling unsafe. “When you do that, you create a good environment where the other person can be you and the next person can be you.”

Hutson, the only female sheriff in Louisiana, said the facility has become the largest provider of mental health care in the city of New Orleans. Nineteen years after Hurricane Katrina devastated the region and all city facilities, the sheriff warned that a mental health crisis had metastasized. During the historic storm, Charity Hospital's psychiatric unit was flooded. It has not yet reopened.

In the years that followed, New Orleans followed a pattern seen throughout the United States: large mental institutions and hospitals were closed, many due to reports of mistreatment and abuse. Most American communities, both rural and urban, failed to build enough modern clinics and hospitals to replace the old wards. As a result, prisons in cities like New Orleans, Los Angeles, Chicago, and New York are among the largest mental health care facilities in the country.

More than half of the 1,400 people in Hutson's psychiatric hospital receive medication to treat diagnosed disorders such as schizophrenia, depression and post-traumatic stress disorder. In the model cell, nearly every single man told NBC News he had witnessed a family member or friend killed by gun violence. Many of their families were permanently separated by Hurricane Katrina, and many had to grow up without their parents.

“Prisons are The system,” Hutson told NBC News. “And that's the case across the state and the country. In areas where they don't have them, [mental health] Systems are in place. Prison is the de facto system of mental health care. And that is so wrong.”

Hutson, whose own brother suffered from PTSD after serving in the Navy, said her dream would be to see her prison replaced with treatment and prevention programs.

“I don't want a psychiatric prison,” she said. “I want a psychiatric facility.”

But lawmakers in her state are moving in the opposite direction, leaving Sheriff Hutson swimming against the tide. This year, Louisiana Republicans, who hold overwhelming majorities in the governor's mansion and the state legislature, have pushed through a series of crime and punishment bills, including Senate Bill 3, which requires authorities to treat 17-year-olds accused of crimes as adults who should be housed in adult-only prisons like the one Hutson is in.

NBC News requested interviews with state Sen. Heather Cloud and Rep. Raymond Crews, who pushed the new legislation that the sheriff said would impact the jail, but they did not respond. In April, Louisiana Gov. Jeff Landry wrote on X: “Today marks the beginning of a new justice system here in Louisiana. 17-year-olds who break into homes, steal cars and rob the great people of our state will no longer be treated like children in the courts. These are criminals, and today they will finally be treated as such.”

Since March, Hutson's facility has seen its inmate population increase by 3 to 5 percent each month, according to department data obtained by NBC News. It also has been forced to create a new unit for minors. The new unit has created logistical and financial challenges in an already overcrowded facility, Hutson said, because minors require complete visual and sound isolation from all other adult residents.

According to the criminal justice think tank Prison Policy Initiative, Louisiana not only has more people incarcerated than any other state, but also more than any other independent democratic country. Andrea Armstrong, legal scholar, MacArthur Fellow and professor at Loyola University, also highlighted that by most calculations, Louisiana has the highest per capita incarceration rate and also one of the highest violent crime rates.

“The math doesn't add up, does it?” Armstrong said. “If incarceration kept people safe, we would be the safest state in the country.”

Rather, she said, to solve the mental health and incarceration crisis, officials need to think differently about security and invest in building new psychiatric hospitals.

“And those resources should not be connected to our criminal justice system. Period,” she said. “People in crisis need to be evaluated by experts. They need to develop treatment plans. And then, and only then, can we begin to talk about the actions and behaviors that occurred when they went untreated.”

Model Pod member Leonard Patty, a 42-year-old father who spent most of his childhood in New Orleans without his own parents, called Hutson and Lewis' efforts lifesaving. Before joining the pod community, he didn't realize it wasn't normal to live every day expecting to die.

“This program helped me,” he said. “If I had met the police and they had killed me, I would have been happy. I was.”

He has been in custody for five years after pleading not guilty to second-degree murder charges. The program, he says, has helped him look beyond his own anger and trauma and focus more on how he can help young men like Smith.

Over the past few months, Lewis has been interviewing all of the men in his new unit, collecting data about their childhoods in New Orleans and their need for mental health treatment. He said he hopes to present his findings to the city to expand the program to other parts of the prison.

“The politicians out there don't understand,” he said. “If we as people can choose and treat other people like people, it will make a difference.”