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Shame of the state

When weighed against Nevada’s larger failings in mental health care, allegations of patient dumping are small potatoes.

That certainly doesn’t excuse what happened to James F. Brown in February, when the homeless, mentally ill man was discharged from the state’s Rawson-Neal Psychiatric Hospital in Las Vegas and put on a bus to Sacramento, Calif., a city he had no ties to and had never even visited. His plight was reported by The Sacramento Bee. Nevada officials owned up to what happened, disclosing that Mr. Brown’s discharge violated procedures. The Bee subsequently reported that other hundreds of other Nevada patients had been bused all over the country in recent years.

California officials announced investigations and have threatened to sue Nevada. The Los Angeles city attorney compared the practice to human trafficking. And the Nevada Democratic Party has all but accused Republican Gov. Brian Sandoval, who’s been in office for all of 28 months, of not only ignoring the issue, but condoning it.

Yes, Gov. Sandoval waited far too long to make a public statement about the Bee’s reports, finally commenting Tuesday. Per his style, the former judge took a deliberate approach to the allegations in ordering investigations — without calling a news conference. Those involved in the discharges have been disciplined (or so we’re assured — state personnel records are confidential), and the state is examining each of the more than 1,500 out-of-state psychiatric patient transports since July 1, 2008. Health and Human Services Director Mike Willden says a preliminary review shows “the bulk” of those patients were sent home, where they had some sort of support through family, friends or prior treatment, with a discharge plan. Two other February discharges, in addition to Mr. Brown’s, violated policies and were deemed unsafe.

To prevent more inhumane ejections of the mentally ill, new state rules require a second doctor to sign discharge orders, and the hospital administrator must authorize all out-of-state transports to verify that someone or some program can assume responsibility for the patient upon arrival. A federal investigation will be carried out by the U.S. Centers for Medicare and Medicaid Services, at Nevada’s request. There are signs of accountability.

Mentally ill people from all across the country find their way to Las Vegas amid millions of visitors — no doubt, some of them dumped by other states — and the state provides many of them with limited treatment. If those patients wish to return home, the state helps them get there. It’s ridiculous to suggest that every single mentally ill person who is put on a bus is being “dumped” on another state.

We don’t yet know how many patients have been discharged in as cruel a fashion as Mr. Brown. We don’t know whether any of these people were at risk of instability. But it’s a symptom of much bigger problems with mental health treatment. It’s incredibly expensive. It’s not a winning issue for politicians. And Nevada, still reeling from the Great Recession, lacks the resources to restore the bare-bones services it offered when the economy was strong.

We can blame the failures of society as well, if we want, and complain that families who used to take care of their own now want government — the taxpayers — to carry their burden. But the reality in Nevada is there are scores of families who have tried mightily to get mentally ill loved ones the help they need, only to find such limited services that they eventually give up and walk away. If we can’t take care of our own, there’s no way we can help the troubled people who make their way here from somewhere else.

Including federal funding, the state spends about $90 million less on mental health care than it did before the recession, and it has about 360 fewer positions to do the job. Rawson-Neal has nine psychologists for 190 budgeted beds.

Gov. Sandoval has added almost $5 million in mental health funding to the 2013-15 budget, including $800,000 for a much-needed 24-hour urgent care center at Rawson-Neal. It’s a start. It will take many years and big money to rebuild the state’s mental health system — if the public supports it.

With so many interests competing for scarce resources in Carson City, and so many businesses and individuals struggling to get by, would taxpayers support higher taxes to pour $50 million to $100 million into services that are used by a tiny portion of the population? When hundreds of them cycle through the system again and again, won’t take their medication and wind up in jail? And how would parents and teachers unions react if tens of millions of new dollars flowed into psychiatric hospitals instead of schools?

It’s easy to score political points on the mistreatment of a single mental health patient. Achieving a political solution is a far different, far more complicated matter.

Mental health is a bipartisan failure in Nevada. And patient dumping is the least of our worries.

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