It's a recurring theme in Southern Nevada. Between 50 and 100 mentally ill people are housed daily in hospital emergency rooms, awaiting transfer to a psychiatric facility that's probably already at capacity.

That might be a safe alternative to the streets for someone in the throes of a manic episode, but holding the mentally ill can be an expensive use of limited resources for hospital emergency rooms already overcrowded with medical patients.

And this cycling in and out of psychiatric patients has done little to help get them the care they truly need, health officials say.

State Sen. Joe Heck and Assemblywoman Sheila Leslie think they might have some short-term solutions.

Their first idea, proposed by Leslie during a recent state Legislative Committee on Health Care meeting, is to specify in the law where someone who is mentally ill can be medically cleared before being taken to a psychiatric facility.

Currently, hospital emergency rooms are the only facilities capable of providing medical clearances, she said.

"The way I understand it, when the original law was written, all medical clearances had to happen in hospitals because we wanted to make sure that person didn't have an overriding medical issue,'' Leslie said.

"What we've found out is that's really not necessary. A lot of these tests can be done at the bedside and not in an emergency room.''

Under Leslie's plan, people detained on what's known as a Legal 2000 hold could receive medical clearance at a "community triage center,'' such as at WestCare Nevada, a nonprofit crisis center on Martin Luther King Boulevard near Bonneville Avenue.

Legal 2000 is a statewide system used to initiate involuntary commitment of a severely mentally ill person into a Nevada psychiatric hospital.

They are individuals who appear to be in danger of harming themselves or others.

Legal 2000 status can be initiated only by law enforcement, a licensed mental health clinician or a physician.

Under Nevada law, before a person assumed to be mentally ill can be taken to a private mental health facility they must be examined by a licensed physician, a physician assistant or an advanced nurse practitioner to determine whether the person has a medical problem other than a psychiatric problem.

However, nowhere in the law does it state where an exam must be performed, Heck said.

Though they believe that it's already permissible to triage the mentally ill at a crisis center or other mental health facilities, Leslie and Heck would like the law to be clearer.

The second idea, proposed by Heck, would combine the community triage and crisis centers, creating something of a one-stop shop for people with mental or substance abuse problems.

Carlos Brandenburg, director of the Division of Mental Health and Developmental Services, is behind the plan, said Annie Uccelli, a spokeswoman for the department that oversees the division.

Uccelli said Brandenburg already has spoken with Heck and Leslie about moving the triage and crisis center to a building at Southern Nevada Adult Mental Health Services' West Charleston Boulevard location, once the new Rawson-Neal psychiatric facility is up and running.

The Rawson-Neal facility, at Oakey and Jones boulevards, is scheduled to open in early September, Uccelli said.

Heck pitched a similar idea last year, but it failed because it was part of a bigger Senate health bill that had a huge price tag, Leslie said.

Additionally, there was a mental health bill coming out of the Assembly with a fiscal note that addressed other issues in the area of mental health. That bill passed instead of Heck's.

Heck expects a different outcome this time, because the project won't be buried in another bill, and the Rawson-Neal hospital will create space at the West Charleston location that can be used for triage, crisis intervention and medical clearance.

A pilot project, including the crisis and triage centers in one location, is expected to begin this fall to determine whether the plan will be cost-effective.

Heck and Leslie also are proposing that the state's Interim Finance Committee allow the Division of Mental Health and Developmental Services to go over its budget and spend $3.6 million to keep 50 beds at WestCare open until March 2007.

Those beds were made available last year after the Clark County Commission declared a state of emergency relating to inadequate psychiatric beds in the Las Vegas area.

The county dipped into state funding to spend $7 million for psychiatric beds at WestCare.

That funding is set to expire Sept. 5, Heck said.

Bill Welch, president of the Nevada Hospital Association, says he supports any efforts to get the mentally ill out of hospital emergency rooms.

Welch also said state officials need to look at acquiring more pediatric psychiatric beds.

During the Legislative Committee on Health Care's recent meeting, Sen. Maurice Washington asked Leslie and Heck to inquire about negotiating with private mental health hospitals to increase the number of psychiatric beds in the area.