Rawson-Neal ramps up efforts to treat mentally ill as local emergency rooms struggle

As Nevada’s Rawson-Neal Psychiatric Hospital works to correct deficiencies and broaden services for the mentally ill, officials at other valley hospitals struggling under the burden of a patient population they’re ill-equipped to serve worry that too little is being done too slowly.

Late last week , there were 164 mentally ill patients at emergency departments throughout the valley awaiting transfer to Rawson-Neal, said Dr. Dale Carrison, chief of staff and head of emergency services at University Medical Center.

Mentally ill patients began stacking up in local emergency rooms soon after Rawson-Neal came under scrutiny in February for discharging James F. Brown, 48, to Sacramento, Calif., with no support or family waiting for him. The subsequent investigation and review slowed patient admissions at Rawson-Neal. That led to a flood of mentally ill patients at UMC, prompting the hospital to declare an “internal disaster” in early May.

The problem continues even though the state has placed a psychologist at UMC to help triage the mentally ill, Carrison said. Patients are still waiting at local emergency rooms for space to become available at Rawson-Neal.

“That’s just ridiculous,” he said. “They haven’t made progress.”

But efforts are under way to improve and expand services at Rawson-Neal in the wake of allegations of patient dumping. The hospital was investigated by several agencies, including the federal Centers for Medicare and Medicaid Services and the Joint Commission, an independent organization that accredits hospitals. A plan of correction submitted by Rawson-Neal was accepted by the federal agency.

“We are moving forward and improving,” said Chelsea Szklany, interim hospital administrator.

This month the hospital opened a 24/7 Psychiatric Urgent Assessment Center and officials are trying to coordinate with emergency departments throughout the valley to ease the transfer of mentally ill patients awaiting services. Rawson-Neal is also expanding.

Officials got the green light to add 19 beds at the old mental state hospital that has the capacity for 77 beds, said Dr. Tracey Green, the state’s chief medical officer. But the facility needs to be renovated first. It’s located on the same campus as Rawson-Neal, near Oakey and Jones boulevards.

Necessary renovations include plumbing repairs, electrical work and other general updates to bring the rooms up to code, she said. The work will be funded with about $1.5 million of the $16 million increase that legislators approved this year for mental health programs.

“We had Public Works out so we are hoping (the renovations) will start as soon as possible,” Green said.

Officials also are considering opening another facility that would accommodate 22 patients, Green said. The building is also on the Rawson-Neal campus. Those beds would be for any patients needing services, she said.

But staff is needed to open the facility, and the Southern Nevada Adult Mental Health Services, which oversees Rawson-Neal, has 79 vacancies, Green said.

“We just need to fill vacancies,” she continued.

The new 24/7 Psychiatric Urgent Assessment Center is inside Rawson-Neal. It’s now only open from 9 a.m. to 5 p.m. Monday through Friday, but the hours will gradually increase. Within 16 months, it will be open 24 hours a day, seven days a week, Green said.

The urgent assessment center will help better serve those patients who may not need inpatient services and will help ease the transfer of patients waiting at local emergency departments.

“The ERs are on board with that,” Szklany said.

The urgent assessment center also will be helpful in assisting hospital staff identify patients who may actually only need stabilization services, housing or other resources available in the community, Szklany said.

In the short time that the urgent assessment center has been open, it has already made a difference, Green said. It has helped lower the number of patients at valley emergency rooms on legal holds. As of Friday morning, she said there were about 84 patients on legal holds.

With the help of deployed psychologists, a mobile crisis team and contracted private providers, officials are clearing patients out of the local emergency departments, Green said. Some of them are being transferred to Rawson-Neal, others are being referred to the new urgent assessment center or to other outpatient clinics.

“We’ve seen a great difference already,” Green said.

Gretchen Papez, spokeswoman for the Valley Hospital Health System, in a statement said representatives from Rawson-Neal are visiting two of their five hospitals and transferring patients who have been medically cleared so they can receive a more appropriate type of care.

“This effort increases the number of beds in our emergency departments to care for patients with critical medical needs,” Papez said.

Brendan Bussmann, vice president for strategic development and marketing at Sunrise Hospital and Medical Center, said the hospital “is very appreciative for the continued efforts by the Nevada Department of Health and Human Services to address this important and challenging issue facing our community.”

The new psychiatric urgent assessment center could help alleviate the problem, Carrison said, but Rawson-Neal needs to figure out a way to get patients there. Many mentally ill patients are brought to UMC by law enforcement or ambulance.

The next step will be to work with law enforcement so they can start taking patients to the psychiatric urgent assessment center, Green said. Officials will work with the Clark County Detention Center.

That’s a practice that’s already done in the northern part of the state, Green said. “We are going to mirror that in the south.”

Contact Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440.