No Comment: Nevada’s Mental Patient Dumping

Question Mark 1The April 17th edition of the Sacramento Bee carried this article by writer Dan Morain: “Nevada’s Shame: Patient Dumping.” The report concerns a policy under the terms of which mentally ill patients are sent to various parts of the country — and out of this state, without sufficient concern for what happens when the transported patients reach their destinations.

One fact:  “Nevada buses many of its psych patients to those areas, 240 to the Los Angeles-Orange County area, 48 to the Bay Area and 71 to the Phoenix-Mesa-Tucson area since mid-2008.”

Another fact: “Sandoval has presided over cuts in mental health funding, as Nevada expanded its out-of-state busing program, from 290 people in 2010, the year before he took office, to 361 people in 2011, his first year in office, to 388 in 2012.  Another 81 patients were bused out of Nevada in the first 10 weeks of this year. At that rate, Nevada will have bused more than 400 people in 2013, though the rate might slow now that it is being exposed.”

In light of the Sacramento Bee’s reporting the story of a mentally ill individual shipped to Sacramento, a city in which the person had NO friends or relatives, without obvious concern for his — or the recipient community’s interests — raises some important questions.

1.  What processes are in place to insure that family members are aware of, and ready to assist, patients transported to other communities?  It’s one thing if the family of a patient is willing and capable of supporting a mentally ill person; it’s another if the family — although willing — doesn’t have sufficient means to support the care and treatment of a mentally ill family member.  How does the State of Nevada determine if the placement of the mentally ill person is the most appropriate for the health of the patient and the resources of the family?  Even if the family has the financial means to care for a mentally ill individual, does it have the space, and do family members have the time and expertise/support needed to insure proper care?

2.  What protocols are in place to notify cities and communities who are receiving Nevada’s mental health patients?  Surely, at some point the recipient families are going to contact local mental health and social services for assistance with mentally ill family members, so it would stand to reason that the State of Nevada would take some care to notify those local resources of the patient’s transportation to their community.  It doesn’t sound as though this has been a priority for the State of Nevada, from the article: “I have not received any communication from anyone in Nevada,” Orange County behavioral health director Mary Hale said, echoed by many other officials outside Nevada.”   The rejoinder from Nevada, that other states don’t inform us of transported mental patients, rings hollow.  Because other states aren’t making notifications doesn’t justify cavalier treatment.

3. What are the criteria by which transportation destinations are selected.  The response from Mike Willden, Nevada’s Director of Health and Human Services, isn’t encouraging:

“That said, our policies are pretty clear. We want to get that person back in the community,” Willden said. “We’re going to attempt to get you connected with your family, your friends and your resources in your community. So if you look at most of the bus transports we’ve done, that’s what we’ve done. We’ve connected them to their community.”

We’re going to “attempt to get you connected…?”  What does this mean?  Does “connected” mean that a determination has been made which answers previous questions raised about the capacity of the family or friends to provide proper and appropriate care have been considered and judged to be adequate?  Or, does it mean that the family or friends have merely said that the person would have “a place to stay?”

In the case of the Sacramento incident described in the article the “attempt” obviously failed.  What happens to an individual who arrives at his or her destination and there is no support previously arranged?

So, if you look at most of the bus transports we’ve done…”  Most?  In “most” cases the State of Nevada has “connected patients with families, friends, resources… What does “most” mean?  Does it mean that a bit over half the time the State has pre-arranged resources for the mental patient?  Or, 90%?  Does the use of the term “most” imply that a judgment has been made by the Department of Health and Human Services that a little bit of “error” is acceptable?  What is an acceptable rate of error for which a mentally ill person is transported to another community in which no family, friends, or local resources are predetermined?  If there were ever a rationale for Zero Tolerance in a mental health policy the concept would certainly be applicable to the dismissal of a patient to a locale in which no support was set up initially.

We can, and should, demand better answers concerning the transportation policies for mentally ill patients in this State. To do less is unconscionable.  Nevada’s Governor has “no comment,” perhaps we should be considering one?

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