Effects of cuts outlined

The warning came during a town hall meeting last month. The director of the state's Division of Mental Health and Developmental Services said the agency might soon be able to afford only basic services such as food, shelter, medications and hospitalization.

Harold Cook accentuated that point Friday as he explained how an 8.8 percent reduction to the division's budget in the coming fiscal year would result in the elimination of about 200 positions, cutting of services, and the closure of 11 of 21 rural clinics.

"This isn't an ideal solution,'' Cook said at a Legislative hearing to review the division's budget on Friday, part of a series of sessions lawmakers are having before the Legislature convenes Feb. 2.

Under the governor's budget plan, Cook said the division will lose $33 million in fiscal year 2010 and $25 million in 2011. Most of that shortfall will affect the state's three mental health agencies, Southern Nevada Adult Mental Health Services, Northern Nevada Adult Mental Health Services and the Rural Clinics.

Lawmakers seemed unhappy with the report, particularly Sheila Leslie, D-Reno, who called it "beyond depressing."

Southern Nevada Adult Mental Health Services and Rural Clinics are hit hardest come July, officials said.

Under the proposal Southern Nevada services loses 137 positions, including 96 at the Rawson-Neal Psychiatric Hospital. Also, it is eliminating four senior psychiatric positions that are currently vacant because the division has had trouble recruiting for those slots.

Eliminating positions at Rawson-Neal will lower the psychiatric facility's staff-to-patient ratio to about 2-to-1, down from 2-to-4, Cook said. However, he said higher staff-to-patient ratios in psychiatric facilities don't necessarily translate into better care.

Cook said his office conducted surveys at some public and private in-patient psychiatric facilities throughout the West, which found the average staff-to-patient ratio ranged from 1-to-2 to 2-to-1, though Cook didn't say which facilities he surveyed.

So the reductions still place the division in the higher end of these ranges, Cook said.

"There is also research that shows the effects of staff-to-patient ratios on treatment outcomes at psychiatric hospitals," he said. "One important effect of higher staffing ratios is that there is a greater tendency for staff to interact with each other rather than with clients. ... I'm comfortable that with this reduction we can still maintain quality services."

But Leslie and other lawmakers appeared irritated with Cook's presentation. Leslie said she especially had concerns about eliminating positions at Rawson-Neal, which in recent weeks has come under scrutiny for violent acts that allegedly occurred there.

Last month, Cook told the Review-Journal that federal, state and local authorities were investigating two allegations of sexual assault at the hospital.

Nurses and mental health technicians there have said that both patient and employee safety are jeopardized by the inclusion of violent individuals and sexual predators within the general population. They say it is common for both staff and patients to be punched, kicked and knocked to the floor.

Some employees said that both patients and staff are at risk at the facility because budget constraints are leaving positions unfilled, creating less supervision than necessary. And Rawson-Neal was recently fined $1,000 by the Nevada State Bureau of Licensure and Certification for not protecting a female patient from an assault.

Because of safety concerns, Leslie told Cook he better be able to provide more details about keeping patients safe at the hospital with fewer staff. Leslie also said she was disturbed that the division would eliminate senior psychiatric positions simply because it was having recruiting problems.

In the report Cook presented to lawmakers, he acknowledged that losing those senior psychiatry positions within Southern Nevada services would "directly result in unnecessary delays in obtaining medication appointments and subsequent hospitalizations."

Leslie characterized this approach as "We can't recruit so we'll just get rid of them."

Leslie went on to say that closing 11 out of 21 rural clinics is "completely unacceptable" because it will place impractical logistical burdens on people from places such as Hawthorne or Yerington who need mental health care.

"So what this means is that those people are not going to get mental health care,'' Leslie said, throwing up her hands. "Let's be real honest about what we're doing here. We're completely destroying the mental health system in rural Nevada. ...These people are going to end up in local jails and prisons, or else homeless. ...We just have to find a better way.''

Cook said there are plans to have staff drive to outlying areas to provide services to the division's clients on a scheduled basis. The division is also looking into providing transportation to get clients in rural areas to other facilities. However, lawmakers questioned how that plan would save the division money.

"I don't think you've thought out the miles of having these people travel,'' said Assemblyman Tom Grady, R-Yerington. "In some of these areas, it is ludicrous to think these people can travel these distances."

Cook said Northern Nevada services, which operates a 40-bed in-patient psychiatric hospital, would also lose staff. Thirty-six positions will be eliminated within the agency; 13 positions will be lost at Dini-Townsend Hospital.

In addition, Cook said the division would eliminate one medical director position. He said the director of Southern Nevada services would handle that position in Northern Nevada services.

"It is beyond depressing to think where we might be in two years. It took us 10 years to go from 50 to 40," Leslie said, referring to Nevada's ranking in the United States in providing mental health services.

Contact reporter Annette Wells at awells@ reviewjournal.com or 702-383-0283.