Privatization of psychiatric care debated

Dave Wiglesworth suffers from depression and has been in and out of psychiatric facilities much of his adult life.

Based on that experience, the 36-year-old doesn't believe it would be advantageous to Nevada's mentally ill if the state's inpatient psychiatric services were run by a private company.

David Johnson's 24-year-old son spends weeks at a time in the state's Rawson Neal Psychiatric Hospital because of behavioral health problems. Johnson also disagrees with privatization.

The men were among 50 consumers, state workers and others at a public forum Tuesday on privatizing state psychiatric facilities. It was the second of two such forums, and the consensus coming from it was undoubtedly anti-privatization.

"I don't want to see a drop in services; I want to see an increase," Johnson said after the hour-long meeting. "My son may never get the kind of care that he needs and deserves; that's why I disagree with privatization. It is always the bottom of the barrel that gets left out."

Wiglesworth said he was concerned not only with the quality of care a private company would provide but the possibility of funding being wasted. He said his experience with private mental health providers is that they are concerned only about the "bottom line," not the consumer.

State employees worried that their jobs might be lost and indigent patients would be left out in the cold. Some questioned the timing of the forum, with Gov. Jim Gibbons recently telling state department heads to find ways to trim 8 percent from budgets to offset lower-than-expected tax revenues.

The Division of Mental Health and Developmental Services could face a $51 million cut, including federal matching dollars.

"I think 8 percent is egregious, and instead of talking about privatizing, why doesn't the governor just save mental health from the cuts," said James Osti, administrative analyst for the Southern Nevada Health District.

Sen. Joe Heck, R-Henderson, who attended Tuesday's forum, said the decision to explore privatization was made before the grim economic forecasts.

Stuart Ghertner, director of Southern Nevada Adult Mental Health Services who moderated the discussion, said Gibbons had asked state health officials in September to review operations at each of the four state-run psychiatric hospitals, including Rawson Neal. The idea was to see whether it "might make sense to privatize one or more of the hospitals,'' Ghertner said.

Administrators were also asked to hold staff meetings to come up with a "pro and con statement" about privatization, and to conduct a public forum. A forum was held in Northern Nevada last week.

A small committee, which includes Heck, also was formed to look into the issue.

Mike Willden, director of the state's Health and Human Services department, said feedback from the two forums and staff will be delivered to Carlos Brandenburg, administrator of the Division of Mental Health and Developmental Services.

Brandenburg will develop a "high-level white paper" detailing what the benefits of privatizing inpatient services in Nevada would be. This report probably will include the experiences of Florida, Pennsylvania and Arizona, which have privatized certain state mental health services, Willden said.

Ghertner said if inpatient services were privatized, the current $50 million budget to operate Rawson Neal would be put up for bid. The private or nonprofit company that won the bid would operate the hospital, he said. And because those services no longer would be operated by Nevada, state workers might be out of a job.

Launce Rake, representing the Progressive Leadership Alliance of Nevada, said the group was concerned about the public not having access to "written" information or plans on privatization of mental health services.

Last week PLAN sent a letter to Gibbons requesting that information be made available. State health officials say there are no written plans available because the discussion hasn't reached that level.

Though the majority in attendance Tuesday were against privatization, some said they just disagreed with dividing the current system. "I'm not against" privatization, said Michael Adams, vice president of clinical operations for Solutions Recovery in Las Vegas. "I just think when you don't have coordination between inpatient and outpatient services, it is an invitation for disaster."

Harold Cook, director of Northern Nevada Adult Mental Health Services, who led last week's meeting in Northern Nevada, said the majority of the 20 people who attended that forum were "overwhelmingly anti-privatization."

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