AB 287: One Facet of Nevada’s Mental Health Services Problems

Nevada’s unfortunate tendency to ship psychiatric patients from the Rawson-Neal facility to parts unknown has drawn appropriate scrutiny from all manner of powers that be.  [full story Las Vegas Sun] By political lights it appears we can move toward solving the problem by adding 19 beds? No word yet on the 20 consultants recommended to resolve staffing problems.

It will probably take more than that. The 2009 grading of Nevada’s overall level of psychiatric services by the NAMI earned us a “D.” (pdf)  And, that “D” was a a ‘grading on the curve’ gift.  Nevada earned an “F” in category I which includes Health Promotion and Measurement.  We got a “D” in category II, financing and core treatment or recovery services.  The state received another “D” in consumer and family empowerment, category III.   Nevada flunked category IV, community integration and social inclusion.  As well we might have given the transportation policy?

One thing failing states are not doing in terms of category IV criteria is allocating resources for long term care and housing of mentally ill individuals.  Failing states also have difficulty extracting the mentally ill from the criminal justice system.  Nevada has mental health courts — which were in serious jeopardy under funding proposals in 2011. [LVSun]  By April 2013 not much had changed. The mental health courts are still not “up to speed,” still in makeshift accommodations, still overloaded. [LVRJ]

The Nevada Legislature has taken up one significant piece of legislation concerning the treatment of those individuals, often well known to local law enforcement, who are dangerous to themselves or to others when not taking their prescribed medication.

AB 287, a bill that “Authorizes the involuntary court-ordered admission of certain persons with mental illness to programs of community-based or outpatient services under certain circumstances,” passed the Nevada Assembly on May 24, 2013.  It has been referred to the Senate Committee on Health and Human Services.  Testimony in favor of AB 287 held in April noted:

“Currently in the state of Nevada, a person with severe mental illness is ten times more likely to be in one of your jails or prisons versus one of your psychiatric hospitals. This is a less restrictive alternative to hospitalization. While it will not solve all the issues with the mental health system in Nevada, it is a critical tool that the state is missing.” [Ragosta, TAC pdf]

One of the more insightful statements in opposition to AB 287 came from an individual who questioned the cost effectiveness of emergency treatment while the remainder of the mental health system in Nevada struggles with serious underfunding and consequent understaffing.

AB 287 will be heard in the Senate Health and Human Services Committee today. (May 28th)

Meanwhile, the funding issue continues for a state which has cut some $80 million for mental health services since 2007, and which has cut 19 staff positions by attrition.  There was some savings from pharmaceutical policy changes, but perhaps not quite enough to account for the total decrease in federal funding which dropped from $721.2 million for nationwide services in 2007-2009 to $631.2 million in 2011-2013.  [LVRJ]

Nevada’s own version of self-delusion includes visions of making a broken system work — without adequate personnel and staffing — in the interest of “saving money.”  This seems a classic case of penny wisdom and pound foolishness.

The well intentioned objections of the ACLU notwithstanding, there is a need for AB 287 to protect both the individuals who refuse treatment and  the communities in which they reside.  While we debate the finer points of civil liberties and the stigma attached to mental illness, there are still individuals who are experiencing auditory hallucinations, or who display other serious  symptoms, who “loop” through the mental health system, and who are in urgent need of assistance in some other location than a holding cell.

Nevada ranks 39th among the nation’s states in its funding for mental health care services. We can, and should do better.

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