Clogged with the mentally ill: What it means for health care

If you think the patient dumping scandal at the state’s Rawson-Neal Psychiatric Hospital has no effect on your health care, guess again.

The valley’s lack of mental health resources has always left hospital emergency rooms as the treatment centers of last resort for patients in distress. For a time, it appeared state and local government agencies had managed the problem well enough to keep it from reaching the crisis levels of years ago.

But on Monday, University Medical Center declared an “internal disaster” because nearly half of its 45 emergency room beds were occupied by the mentally ill — patients the public hospital is obliged to admit but has no ability to treat. That action shut down the emergency room to arriving ambulances for 12 hours.

Across the valley, 183 psychiatric patients — including 28 at Valley Hospital Medical Center and 22 at Desert Springs Hospital Medical Center — were being held at hospitals, taking up space and diverting attention from sick and injured people who could actually be treated.

The attention focused on Rawson-Neal for its improper discharge practices — which included a series of Sacramento Bee stories on a mentally ill man who was bused there despite having no support and no ties to the city — has forced the Las Vegas facility to clamp down and more carefully adhere to revised policies. Two psychiatrists were fired and two more doctors were expected to resign.

“We have noticed that Southern Nevada Mental Health Services has slowed down the number of patients it is now taking in a 24-hour period since the problems arose” at Rawson-Neal, said Dr. Dale Carrison, UMC’s chief of staff and head of emergency services.

On Thursday, state officials placed a full-time psychologist at UMC to help manage the overflow of mentally ill people coming through the emergency room. At best, it’s a Band-Aid for a problem that won’t get better anytime soon.

“The emergency department is not the appropriate place for mentally ill patients to receive long-term care,” said Sunrise Hospital and Medical Center spokeswoman Amanda Powell. “Therefore, our community needs a lasting solution to a much larger problem.”

This influx of mentally ill patients increases wait times in emergency rooms for people whose ailments do not require immediate attention, but are suffering nonetheless. Mentally ill patients also pose security risks for staff and patients.

Addressing Nevada’s mental health system is more than a matter of doing the right thing, of providing passable care to the valley’s most vulnerable people. It’s a threat to the health care system as a whole. Sen. Harry Reid was right when he told the Review-Journal Friday that the mentally ill have no lobbyists, “just a few lefties out there screaming in the wilderness,” and therefore it’s easy for elected officials to cut costs there. But that forces us to pay in different ways, and the crowding of our emergency rooms is one early example of it.