It’s going to take a long time for Nevada to rebuild a remotely passable mental health care system. Including federal funding, the state spends about $85 million less on mental health care than it did before the recession.
But that’s no excuse for what appears to be a lack of urgency in using existing resources to address the valley’s current crisis and provide the best possible care.
What was left of the state’s mental health system was turned upside down earlier this year when news broke that a homeless, mentally ill man was discharged from the Rawson-Neal Psychiatric Hospital in Las Vegas and put on a bus to Sacramento, Calif., a city he had no ties to and had never even visited.
That led to multiple investigations of the hospital, discipline and firings of employees, revelations of other unsafe patient discharges, a lawsuit against the state (with more forthcoming) and sweeping changes to hospital policies. And last week, the Review-Journal’s Yesenia Amaro reported that the Joint Commission — an independent organization that accredits hospitals — issued a preliminary denial of accreditation for Rawson-Neal, a decision state officials said they won’t appeal. Accreditation is voluntary and doesn’t affect the hospital’s funding.
The federal Centers for Medicare and Medicaid signed off on the psychiatric hospital’s correction plan, and this year, the Legislature approved the creation of a 24/7 Psychiatric Urgent Assessment Center, which opened this month. The center is supposed to help keep the mentally ill out of the valley’s emergency rooms and speed the transfer of such patients out of ERs, which aren’t equipped or staffed to treat them.
But the most immediate result of the policy changes and heightened scrutiny at the hospital has been much slower patient processing. Admissions and discharges are far more deliberate. Because it takes longer for Rawson-Neal beds to open, the mentally ill are turning to emergency rooms to wait for a bed to become available.
Late last week, 164 mentally ill patients were 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.
“That’s just ridiculous,” Dr. Carrison said of the state hospital’s pace, which prompted UMC to place a psychologist in the emergency room to triage the mentally ill. “They haven’t made progress.”
Dr. Tracey Green, the state’s chief medical officer, told Ms. Amaro that the new urgent assessment center, along with the work of a mobile crisis team, is cutting the number of mentally ill patients held at emergency rooms.
What really appears to be holding back the state’s ability to adequately treat the mentally ill, however, is its inability to fill 79 vacant positions. If those jobs were filled, more patients could be admitted.
The state already has received approval to add 19 beds to a building at the Rawson-Neal campus, near Oakey and Jones boulevards, once about $1.5 million in renovations are complete. An additional 22 beds could be placed in a different building. Those beds, badly needed, require staff.
These positions have been funded. Leaving them unfilled might save taxpayers money in the short term, but it’s costing valley residents dearly through prolonged emergency room waits.
Health and Human Services officials need to make hiring a higher priority. Yes, there is a shortage of mental health care professionals, and such jobs are hard to fill everywhere. The state should respond to those job market pressures by looking for creative solutions, from contracting with specialized recruiters to boosting the positions’ salary ranges, even if that requires reducing the total number of positions available. And if Rawson-Neal still can’t make progress in admitting more of the valley’s mentally ill, then Gov. Brian Sandoval needs to stay personally involved to make sure things get fixed, as he did last week by calling for an interim finance committee meeting to speed the release of funds for additional improvements.
The current pace of progress in rebuilding mental health care isn’t good enough.