Southern Nevada’s only state-run psychiatric hospital for adults has lost 15 psychiatrists, 40 nurses and 74 mental health techs over the last decade, records show.
None of those positions were replaced, despite the state’s notorious lack of mental health care services.
According to the data obtained through an open-records request, the overall staffing at Rawson-Neal Psychiatric Hospital has dropped 44 percent in 10 years. In 2007, the hospital had 21 doctors, 114 nurses and 160 mental health technicians. That number has shrunk to six doctors, 74 nurses and 86 mental health technicians.
By comparison, the patient count has dropped by about 30 percent to 142 patients in the civil and forensic units, down from 204 patients a decade ago.
“I’m extremely concerned,” said Robin Reedy, executive director of Nevada’s National Alliance on Mental Illness. “You cut down the doctors to a third and the patients have only gone down 25 percent. And I would suspect the patients that are left are the harder cases that need more intense services.”
Jo Malay, the hospital administrator, said the drop in staffing is linked to Nevada’s expansion of Medicaid, which allowed mentally ill patients to be treated at private clinics and hospitals. Malay said more than 200 new beds opened up for behavioral health patients in Southern Nevada.
“With those beds opening up, the need for our beds decreased so we could really focus on the clients that fall within our safety net — those who are uninsured or out of medical bed days,” Malay said. “I think we’re doing very well. The quality of the care is what we look at, and that remains high.”
But a Rawson-Neal nurse, who spoke on condition of anonymity for fear of retaliation, said the decline in staff has impacted quality of care — patients are being rushed out before they’re ready.
“When I first got here 10 years ago, we were staffed very well and if there was an empty bed, it was filled up immediately,” the nurse said. “Now we’ve shut down units. There are lots of empty beds.”
The nurse said a decade ago each there were seven to eight patients to one nurse and now it’s 12 to 13 patients per nurse.
The staff reductions come after nearly a decade of budget cuts to mental health services in Nevada. The Southern Nevada Adult Mental Health Services’ actual funding was $103 million in the state’s 2007-08 biennial budget, but it was slashed to $74 million by the 2015-16 biennium budget. Positions in the agency dropped from 848 to 759 during the same period.
While the state budget for mental health services decreased, Medicaid spending on behavioral health soared from $172 million in 2012 — before the Affordable Care Act expansion — to $466 million last year.
“People are going to other places to get their mental health services,” said Julie Kotchevar, deputy director at the Nevada Department of Health and Human Services. “They don’t have to go to Rawson-Neal anymore.”
Nevada health officials said the state last year decreased inpatient beds at Rawson-Neal from 160 to 88. And although the hospital reports performance measures such as patient length of stays and re-admission rates, there are no benchmarks for staff-to-patient ratios.
Nevada ranks last in Mental Health America’s 2017 rankings, and the state has faced scandals for dumping patients in California and overlooking filthy conditions at state-funded group homes. The crisis is amplified by the state’s shortage of psychiatrists, psychologists and other mental health professionals.
“I think if you ask the doctors directly, they would say it’s the hourly pay,” Malay said.
Reedy said the Medicaid expansion is not an excuse for Nevada to cut positions or mental health funding.
“We are consistently number 51 on the scale. We’re behind,” she said. “They can argue they’ve expanded Medicaid and things will look better, but so has every other state and they’re still putting more dollars into mental health.”