Mentally ill still lack care

About a year ago, Southern Nevada's emergency medical services manager, Rory Chetelat, made a prediction.

He said the new Rawson-Neal Psychiatric Hospital would not be large enough to handle the patient load and, unless a solution were found, people with serious mental health problems would continue to inundate area emergency rooms.

Chetelat's crystal ball seems to be working well.

Just about daily, 70 to 80 people with mental health problems are held in emergency rooms because the 242 psychiatric beds between Southern Nevada Adult Mental Health Services and WestCare are taken, he said.

The numbers of mental health patients in emergency rooms are similar to what they were a year ago, before the Rawson-Neal facility started admitting patients.

And, though the mental health agency has secured state funding to open 22 beds at its campus along West Charleston Boulevard, that plan is on hold because staffing isn't in place, said Stuart Ghertner, director of outpatient services.

To buy more time for the mental health agency to hire more staff, the state has extended until Dec. 31 its contract with WestCare. The nonprofit entity serves indigent and low-income Nevadans and is providing the mental health agency with 25 psychiatric beds.

Beyond Dec. 31, WestCare faces the termination of the contract.

But if the staffing issue at the mental health agency is not resolved, "we will again look to extend WestCare with the available funds,'' state Sen. Joe Heck, R-Las Vegas, wrote last week in an e-mail.

"At this point, the 22 beds is not an issue of funding, but an issue of adequate staffing," he said.

Even if the mental health agency is able to use the additional 22 beds, there's still a question of whether the Las Vegas Valley will ever have enough psychiatric beds or, at the very least, reach the national average for psychiatric beds per capita.

"We will be adding 22 more beds but losing them at WestCare, so we're just trading off,'' Ghertner said. "At the end of the day, there's a lot of people with mental illness in emergency rooms, and the problem is due to the lack of bed space.''

From an emergency services standpoint, Chetelat said this compromises the medical care of people needing emergency treatment.

Hospitals are required to hold mental health patients, regardless of whether they have a medical problem, until they can go to an inpatient psychiatric facility. Sometimes such patients remain in emergency rooms up to five days.

"Twenty to 25 percent of our total emergency beds are occupied by mental health patients or individuals who really need to be somewhere else,'' said Chetelat, who along with other state and local health officials receives daily reports on emergency room patients and wait times. "I think things have gotten better. Some hospitals are setting aside separate areas to hold mental health patients and our patient wait times are going down, but this is a burden on emergency room staff.''

What's frustrating, Ghertner said, is mental health officials know what the solution is -- more beds -- but can't fix the problem. On top of that, there's staffing issues, both on the clinical and administrative side, in the mental health arena.

Hired less than a year ago, Ghertner is also running the inpatient side of the mental health agency because of the recent resignation of K.C.R. Nair and David Rosin. Nair was director of inpatient services at Rawson-Neal, and Rosin was the medical director for the state's Division of Mental Health and Development Services and was overseeing the psychiatric hospital.

Then there's the area's growth, said Mike Willden, director of the state's Department of Health and Human Services, which oversees the Division of Mental Health and Developmental Services.

"We're always going to be working at full capacity. Comfortably meeting the needs of the community is going to be an issue,'' he said. "All of the surveys (national) about psychiatric beds indicate that for a community the size of Las Vegas, we should have 533 inpatient psychiatric beds available to the public.''

Kirby Burgess, vice president of WestCare, said, "We're essentially just treading water'' in Southern Nevada with respect to resolving mental health issues.

In 2005, the Legislature allocated $7 million for the use of 50 psychiatric beds at WestCare's facility along Martin Luther King Boulevard. That funding was to expire last year but was extended to June 30, but only for 25 beds.

That extension was scheduled to end on Sept. 30 but again was extended until Dec. 31 because of the need by the mental health agency to fill positions.

Willden said WestCare's pricing structure also changed, so the extension to the end of 2007 only funds 20 beds.

Burgess says it costs WestCare a little less than $500 a day per mental health patient. The average stay is five days, he said.

Though Nevada has made some headway in hiring physicians, psychologists, social workers and nurses, psychiatrists are a different story.

Nevada doesn't offer competitive salaries for psychiatrists comparable to other Southwestern states, Ghertner said.

"We're hopeful that in the next legislative session we can see an increase in the base salaries for psychiatrists,'' he said. "Our proposal is to increase the salaries of psychiatrists by 10 percent. ... From my perspective, that's a high priority.''

The mental health agency has 29 psychiatrists. It is budgeted for 45.

In the meantime, Ghertner and Willden said there are ideas to revamp outpatient services that might help improve the flow of mental health patients.

One of those ideas is to work with WestCare on bringing together a triage, medical clearance and a possible psychiatric observation unit, Willden said.

Burgess said WestCare is in talks with the state about providing more mental health services, especially triage services.

WestCare operates a 50-bed community triage center at its Fourth Street location for individuals with behavioral health or substance abuse problems. This is a partnership between Clark County and the cities of Las Vegas, North Las Vegas and Henderson.

Ghertner said he also hopes to hire a psychiatrist to work night shifts so that incoming mental health patients either at area emergency rooms or Rawson-Neal can get processed into the system faster. As it stands now, patients who come in after hours aren't processed until the next day.