Nevada’s Mental Health Care Gift Basket?

Catch of the Day Catch of the Day: To Nevada Progressive for digging up the 2013 Arizona (ABC Phoenix) story about more patient dumping by Nevada mental health services, into both California and Arizona.   And, what services did Nevada mental health professionals offer?

“They had been provided a bus ticket, a small amount of cash, a print out of a Mapquest that showed them how to get to CASS. And written on it was, ‘ask for Howie,'” he said. Holleran says these cases often end in chronic homelessness. He says that stretches resources in other states, like Arizona. And it passes along the problem, instead of fixing it.” [ABC15]

Now, Nevada’s mental health services added a chaperone to the  list? So, in 2014 the mentally ill will get a bus ticket, a small amount of cash, a map, a note to find “Howie,” and a chaperone.  A regular Gift Basket?

So, by April 1014, after a year of really embarrassing news,  the Rawson-Neal facility could announce it had passed muster with the Federal authorities:

“After a year, federal officials’ ongoing probes of Rawson-Neal Psychiatric Hospital may have come to an end as the state facility was found to be largely compliant with regulations and will continue to be reimbursed by the Centers for Medicare and Medicaid Services.

The clearance and certification won’t do anything to alleviate the crisis Clark County emergency rooms face in dealing with large numbers of the mentally ill, but the accomplishment pleases at least one local hospital official.

“It makes a huge difference,” Dr. Dale Carrison, chief of staff and head of emergency services at University Medical Center said Thursday. “It’s a certified facility now. It’s good for everybody associated.” [LVRJ]

First, what on Earth does “largely compliant” mean? Does it mean there are still problems with screenings and transfers? Does it mean that the closure of the walk in clinic meant more log jams and more problems for emergency facilities?

Secondly, the administrator may have been happy back in April with a resolution which allows reimbursement from Medicare and Medicaid, but what’s happening in Clark County emergency rooms?  Yes, it’s good for everyone there’s a certified facility – it’s just not good that we don’t have enough such facilities to address the problems.

Have we solved the bed space and treatment problem described by the Las Vegas Review Journal back in February, 2014?

“At least six mental health patients have been held in the Clark County jail — some for as long as three months — when they should have been placed in mental health group homes.

Southern Nevada Adult Mental Health Services has blocked their release at least since December because it could no longer afford to pay for inpatient beds and treatment for new patients.

But state mental health officials never informed District Judge Linda Bell or the defendants’ lawyers, which left the patients lingering in jail for months where they receive little, if any, mental health treatment.”

There were two issues raised in the February report. First, was the obvious funding problem.  Could it be that the reimbursement from Medicare and Medicaid was sufficient to resolve the problem of warehousing the mentally ill in correctional facilities?  However, the second issue is almost more alarming – Why didn’t the Adult Mental Health Services inform the District Judge or the defendant’s lawyers about the problem? 

Even the funding solutions offered  in June 2014 were temporary and patchwork.  On June 19, 2014 Governor Sandoval presented a plan to the Interim Finance Committee to take $3.5 million from the tobacco settlement money to fund Mobile Outreach Safety Teams, and Mental Health Court facilities in southern Nevada. [Sandoval] {Minutes of the 6/19/14 IFC mtg are not yet available online}

Here’s a challenge for the next session of our Assembled Wisdom.  First, allocate sufficient funding for mental health care facilities and services in Nevada so that we don’t have to have another dismal year like 2013, during which we read about dumping patients off on neighboring – and other – states.  Secondly, allocate funding for implementing the current  recommendations for health care facilities for both adults and children.  We have a Governor’s Behavioral Health and Wellness Council, and it provided a report (pdf) in May 2014, and its recommendations are relatively specific.  This is as good a place to start as any.

The third leg of the stool requires some action on the part of the U.S. Congress.  The licensing issues surrounding facilities with more than 16 beds needs to be addressed.  Without diving too far down into the weeds, suffice it to say that Congress needs to review the definition of an “Institution for Mental Disease.”   Granted there were reasons back in the day to crack down on the institutionalization of too many people for periods of time which were altogether too long.  However, there are individuals suffering from conditions which periodically require intensive care.  Sixteen  bed hospitals, as the Council pointed out, aren’t logistically or financially feasible – but they can provide the kind of intensive treatment some patients need on a temporary basis.  Should the U.S. Congress be able to get beyond “Benghazi” long enough to take a serious look at the redefinition of IMD’s then we might make more progress in the treatment of mentally ill individuals in local settings.  Small facilities, staffed and equipped to meet short but intensive individual treatment, could offer care intermediate between long term hospitalization and group home treatment.

In the mean time, Nevada could do a better job of addressing the issues of mental health care – such as implementing the recommendations of the Behavioral Health and Wellness Council, and it should do so during the next Legislative session. 

Comments Off on Nevada’s Mental Health Care Gift Basket?

Filed under Mental Health, Nevada legislature, Nevada politics

Comments are closed.