Nevada health officials want to open a 24-hour urgent care center in Las Vegas for the mentally ill as part of a $7.5 million plan to relieve emergency rooms and provide troubled people better access to psychiatric services.
The state budget proposal also includes a program to divert those with mental health problems from prisons and jails where they often don’t get adequate care and are likely to return, crossing the law again if not treated.
"It appears jails and prisons have become our most enduring asylums," said a draft April 2012 report by the Nevada State Office of Epidemiology, which analyzed the Washoe County detention center.
In Washoe County, 16.9 percent of those taken into custody during 2011 suffered from mental illness, the office said. In Carson City, the rate was even higher at 22.8 percent at the capital’s detention center.
In comparison, 10.3 percent of the 55,526 individuals held in the Clark County Detention Center during 2011 had a history of mental illness, according to a draft report the epidemiology office released Friday to the Review-Journal by request. Tourists visiting Las Vegas could have diluted the result, however, with health authorities estimating the rate of mental illness in Nevada could be as high as 20 percent.
"The number of mentally ill individuals involved with the criminal justice system and detained in jails and prisons continues to grow in Clark County, Nevada and nationwide," the five-page draft report said. "This significant increase is attributed in most part to a severe lack in resources available for proper and timely case-management of such unfortunate chronically ill individuals."
The $7.5 million mental health proposal is likely to get serious attention when the Nevada Legislature meets starting Feb. 4 in light of recent gun violence in Nevada and elsewhere involving mentally ill shooters. The Dec. 14 slaying of 20 children and six adults at a Connecticut school by Adam Lanza, a suicidal 20-year-old gunman, sparked a national review of gun laws, school security and mental health care in this country.
Another factor is the expansion of Medicaid, which will cover more poor, troubled patients in the Silver State.
SPECIAL CONSIDERATION ITEM
Democratic leaders of the Nevada Legislature are likely to push for greater mental health spending and even some GOP lawmakers believe that should be the focus rather than stricter gun control laws.
Yet, it’s unknown whether Republican Gov. Brian Sandoval will agree to all or part of the $7.5 million proposal, which is not part of the basic $294 million, biennial budget request submitted to him for fiscal years 2014 and 2015 by the Nevada Division of Mental Health and Development Services.
Instead, the 24-hour urgent care plan is part of a package of "items for special consideration" that each state agency put together, a wish list beyond the flat budgets Sandoval requested they submit for his review.
Sandoval is scheduled on Jan. 16 to deliver his proposed budget and State of the State address in Carson City, where he’ll lay out his spending priorities for the next two years. The governor already has said he’ll propose extending a $600 million tax package to help fund a biennial budget expected to be around $6.5 billion.
Sandoval also has decided to expand Medicaid as part of President Barack Obama’s health care insurance law reforms. Now, about 313,000 Nevadans are enrolled in Medicaid, but another 100,000 could be added with normal caseload growth and by adding more eligible recipients, according to state estimates.
In making his case for Medicaid expansion, Sandoval said the state would save about $17 million for mental health programs now paid for out of the state general fund. The federal government will cover 100 percent of the medical costs of expansion during the first three years, although states will share administrative costs.
FINANCE CHAIR: BOOST FUNDING
Incoming state Senate Finance Committee Chairwoman Debbie Smith, D-Sparks, said mental health spending has been cut by $80 million since 2007 when the state’s budget crisis began with the deep recession. She said it’s time to bolster mental health services to help more Nevadans and keep them out of hospitals and jails.
"It’s really better for everyone involved," Smith said in an interview. "We have to continually be looking at programs that are more cost-effective and help the rest of society. It’s a whole, big picture."
Smith said she hoped Sandoval would "reinvest" that $17 million savings in better mental health coverage.
"We aren’t able to provide enough services now," Smith said. "It’s sort of typical of what ends up happening when you have to cut budgets. You cut the programs that are cheapest and very effective because you have to be able to provide the crisis treatment. But some of these programs also are the most cost-effective."
Richard Whitley, administrator for the Nevada Division of Mental Health and Development Services, called the 24-hour urgent care facility "a priority" and said it would save costs in the long run. He said the state also will push to do better at getting reimbursed by the federal government for Medicaid-eligible services.
Whitley said mental health clinics with limited hours have helped decrease the number of mentally ill seeking treatment in emergency rooms, but a 24-hour facility in populous Clark County could provide better direct care. On Thursday of last week, for example, he said 16 mentally ill patients were in emergency rooms in Las Vegas compared to an average of 50 to 100 a day in past years when the county had reached a crisis point.
"The solution appeared to have been urgent care, where we could prevent costly emergency room visits," Whitley said, explaining how health authorities reduced the burden on hospitals. "Most of these folks are known to us. They don’t need to be in the hospital. They need urgent attention."
CARE CENTER DETAILS
Under the proposal, the 24-hour urgent care center would be located at the Southern Nevada Adult Mental Health Services Psychiatric Hospital at 6161 W. Charleston Blvd., in Las Vegas. The hospital is funded by the state to provide 190 beds, including 160 for acute care and 30 for observation.
As part of the plan, one of Southern Nevada’s more than half a dozen outpatient clinics would close with the staff moving to the hospital along with two new psychiatric physicians, according to budget documents reviewed by the Review-Journal. The Downtown Clinic, now opened Monday through Friday from 8 a.m. to 5 p.m., at 720 S. Seventh St., would likely be shuttered, although officials cautioned nothing has been settled.
"This will divert individuals from the local hospital emergency rooms, provide quicker access to inpatient and outpatient psychiatric services, and … more effectively manage the flow of individuals seeking psychiatric services," according to the agency’s budget document.
In addressing the problem of follow-up care for mentally ill detainees and patients, the health agency wants to hire a clinical program manager to "provide a continuum of care for clients re-entering the community when being released from jails, prisons, and forensic hospitals." The cost would be about $158,000 over two years.
The agency also would use existing funding to establish statewide "forensic medical health teams."
To care for mentally ill individuals in transition, the agency is requesting nearly $1.5 million to pay for temporary housing, including 60 beds in Clark County, 40 beds in Washoe County and 20 in rural Nevada.
Another $830,000 would pay for 200 beds for convicts who leave prison and are being treated for mental health or substance abuse and need continuing support to stay on their medication or away from drugs and alcohol.
JAIL CALLED BAD OPTION
Whitley argued many mentally ill people, whom he said aren’t usually violent, shouldn’t be in detention centers and police shouldn’t have to deal with them instead of fighting serious crime.
The goal is to "prevent the mentally ill from taking up law enforcement time," Whitley said. "I don’t think anyone could argue with that."
Dr. Tracey Green, the state health officer, said a common reason the mentally ill end up in jail, prison or emergency rooms is because they have stopped taking medication that stabilizes their behavior.
She said health officials want to work more closely with law enforcement to ensure those troubled people are released with adequate medication, a quick mental health appointment and social services help.
"You need a continuum of care," Green said, adding there are often several "intervention points" where the mentally ill can get help if it’s readily available. "We have to address the root cause of the problem."
Contact Laura Myers at lmyers @reviewjournal.com or 702-387-2919. Follow @lmyerslvrj on Twitter.Prisoners and Mental Illness
The Nevada Office of Epidemiology cross-matched mental illness data against criminal justice records to determine how many mentally ill prisoners were held in the Clark County Detention Center in 2011. Here’s a snapshot of the findings:
• 10.3 percent – rate of mental illness among 55,526 detainees
• 65 percent – share of males among mentally ill detainees
• 35 percent – share of females among mentally ill detainees
• 10.6 percent – mentally ill detainees younger than 18 years old
• 24.4 percent – mentally ill detainees age 18-24
• 27.5 percent – mentally ill detainees age 25-34
• 23.4 percent – mentally ill detainees age 35-44
• 11.4 percent – mentally ill detainees age 45-54
• 1.8 percent – mentally ill detainees age 55-64
• 0.04 percent – mentally ill detainees age 65 and older
• 49.1 percent – share of Caucasians among mentally ill detainees
• 29.3 percent – share of unknown race among mentally ill detainees
• 20.8 percent – share of African-Americans among mentally ill detainees
• 2.1 percent – share of Asian/Pacific Islanders among mentally ill detainees
• 0.2 percent – share of American Indian/Alaska natives among mentally ill detainees
• 65 percent – share of non-Hispanics among mentally ill detainees
• 26 percent – share of unknown ethnicity among mentally ill detainees
• 9 percent – share of Hispanics among mentally ill detainees
• 55.1 percent – share of mentally ill detainees who were unemployed
• 21.3 percent – share of mentally ill detainees whose employment status was missing
• 6 percent – share of mentally ill detainees full-time employed
• 4.7 percent – share of mentally ill detainees part-time employed
• 2.3 percent – share of mentally ill detainees with unknown employment status
• 1.2 percent – share of mentally ill detainees who were students
• 0.7 percent – share of mentally ill detainees who were homemakers
• 0.1 percent – share of mentally ill detainees who were members of the military
Summary of Nevada mental health expenditures:
• $137,095,867 – actual expenditures fiscal year 2012
• $150,046,432 – legislatively approved budget fiscal year 2013
• $147,460,309 – agency budget request fiscal year 2014
• $146,735,926 – agency budget request fiscal year 2015
• $4,096,752 – items for special consideration fiscal year 2014
• $3,449,729 – items for special consideration fiscal year 2015