Tag Archives: Nevada Mental Health Services

Four Steps to a Safer Society

Assault RifleDon’t talk to me about “mass shootings are just rare manifestations of mental illness,” unless you intend to offer suggestions concerning how we cope with those suffering from mental illness, emotional problems, or behavioral issues.   I have in mind some notions which seem like sound judgment,  not necessarily founded in any specialized knowledge of the subject.

#1. Adequately fund mental health care services at the state and national level.

Nevada, currently being sued by San Francisco for its dubious practice of “transporting” mentally ill individuals beyond its jurisdiction, [NBC]  has been warned — this from a mental health professional back in April 2013:

“Dr. Dale Carrison, the chief of staff and head of emergency medicine at University Medical Center, is more blunt.  “The mental health system has been broken since I got to Las Vegas 22 years ago,” Carrison said. “There aren’t a lot of options for people. Every time they cut the budget they cut the mental health budget first. We do a very poor job of evaluating them and treating them. At some point, you’ve got to say the state just doesn’t care.” [LVRJ]

Nevada wasn’t (isn’t) alone in its refusal to enact budgets which competently address the problems associated with mental illness and substance abuse.  NAMI issued its 2011 Report (pdf)  citing cuts in California’s mental health services totaled $587.4 million, New York cut its budget by $132 million, Illinois cut $113.7 million, and Arizona cut its mental health care budget by $108.4 million.  Nevada made the list of the largest cuts as a percentage of its total mental health care budget:  (1) Alaska by 35%, (2) South Carolina by 23%, (3) Arizona 23%, (4) Washington, D.C. 19%, (5) Nevada 17%, (6) Kansas 16%, (7) California 16%, (8) Illinois 15%, (9) Mississippi 15%, (10) Hawaii 12.1%.   We ought not take pride in being on this “Top Ten List.”

The situation at the national level isn’t much better.  Already at a parsimonious level, the sequestration of federal funds for non-defense discretionary categories further stretches already strained mental health research and service budgets.  Mental Health America, formerly known as the National Mental Health Association, issued this warning about further cuts to mental health care funding:

“These cuts will be disastrous to communities and individuals living with mental health and substance use conditions. States have already cut mental health budgets by a combined $4 billion over the past three years-the largest single combined reduction to mental health spending since de-institutionalization in the 1970s. Cuts enacted by sequestration are estimated to reduce non-defense discretionary (NDD) funding anywhere from 7.5 to 12 percent across-the-board. Given one in every four Americans lives with a mental health or substance use condition, and more than 67 percent of adults and 80 percent of children who need services do not receive treatment, maintaining discretionary federal funding for mental health and substance abuse services is pivotal to ensure citizens have access to behavioral health care.”  (emphasis added)

What efficacy do we expect from a system in which we have reduced the allocation of resources by the largest amount in the past 3 decades?  There are about 316,000,000 Americans, and if approximately 25% need mental health care or substance abuse assistance then that’s nearly 79 million people in need of help and care.  If at present 67% of adults and 80% of children who need help aren’t getting it now, what makes us think that sequestering funds for services and further limiting the funds available for mental, behavioral, and substance abuse assistance will make the situation any better?

#2.  Improve the record keeping and coordination between mental health entities and law enforcement services.   SB 221 enacted by the Nevada state legislature would have helped, but the NRA beholden Governor vetoed it.   It’s going to take personnel to get this done.  People are going to have to be hired to do data entry, to coordinate information sharing, and to maintain the integrity of the records.  Again, if we’re serious about resolving the problems associated with mentally ill persons securing deadly weapons then this is an expenditure which makes sense.

#3. Implement the provisions of the Affordable Care Act which deal with health insurance coverage of mental health care services.    If we are serious about providing adequate mental health care services to individuals who might hurt themselves or others, then it’s fulsomely obvious that 41 votes to repeal, delay, or defund the provisions of the Affordable Care are patently silly.

The Affordable Care Act requires health insurance corporations to issue policies which cover depression screening for adults and behavioral assessments for children at no extra cost.  Further, coverage for mental health and substance abuse is expanded and given the federal parity protections.  Going a step further, an insurance corporation may not decline coverage for pre-existing conditions, including mental illness.

#4. Enact common sense restrictions on the possession of firearms.   (a) Require background checks for all gun sales.  Legitimate, honest gun dealers already do this. The illegitimate, and dishonest ones need to be put out of business.  There is nothing “onerous” about a background check — it takes a matter of minutes, and if our record keeping systems are functional, then some people who should not possess firearms can be weeded out before they cause injury to themselves or others.  (b) Enact limits on the ammunition capacity.   If I haven’t shot “the burglar” after 15 rounds, the chances are I’m not going to.  The only thing I’m going to accomplish is to do more damage to my property than the erstwhile hypothetical burglar ever dreamed of doing.  (c) Crack down on gun trafficking.  There’s an unhealthy level of profit for people who traffic in stolen guns, and who transport guns both stolen and purchased in states with lax gun sale requirements.  New York City police recently arrested two gun smugglers from North and South Carolina who tried to offload 254 guns into the NYC market. [CNN] (d) Ban the sale of “assault weapons.”  Yes, a person can be killed by a bullet from a single shot .22 caliber gun; BUT weapons which are designed to, or can be easily modified for, rapid fire merely serve to increase the carnage.

A few common sense steps might reverse the trends in this chart from GunPolicy.Org.

Gun Death Chart 2*Alpers, Philip and Marcus Wilson. 2013. Guns in the United States: Facts, Figures and Firearm Law. Sydney School of Public Health, The University of Sydney. GunPolicy.org, 27 August. Accessed 18 September 2013.

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Nevada’s Short Term Memory Loss

Budget Cut Scissors** Nevada’s not-very-neighborly exportation solution to mental health care case loads continues to raise hackles in California — this time from northern Nevada health care facilities. [full story RGJ] On the sunny side of this story — the state board of examiners has approved additional funding for mental health care services, and the legislature has fast tracked $2.1 million for upgrades. [NewsObs]  It’s not like we weren’t warned in November, 2011:

“States such as California, Illinois, Nevada and South Carolina, which made devastating cuts to mental health services previously, have made further cuts for fiscal year (FY) 2012, putting tens of thousands of citizens at great risk. States have cut more than $1.6 billion in general funds from their state mental health agency budgets for mental health services since FY2009, a period during which demand for such services increased significantly. These cuts translate into loss of vital services such as housing, Assertive Community Treatment, access to psychiatric medications and crisis services.”  [NAMI]

** And, when a Nevada Congressman (Joe Heck R-NV3) is confronted by a very real Nevada small business owner who finds that the provisions of the Affordable Care Act and Patients Bill of Rights are helping his small business, what happens?  The Nevada Progressive documents his fumbling “GOP didn’t have a chance to offer alternatives” — They did offer an alternative! In November 2009 the Republicans offered a 219 page health care bill:

“The bill’s general approach expands state-based high-risk insurance pools for Americans with pre-existing health problems, permits trade associations to organize to purchase group insurance, imposes caps on medical liability lawsuits and allows health insurance companies to sell policies across state lines.” [Kaiser News]

The bill didn’t gather enough support to pass.  Next question.

** While we’re on the topic — the provisions of the ACA (Obamacare) will extend health insurance coverage for treating mental illness:

“The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act of 2008 to extend federal parity protections to 62 million Americans. The parity law aims to ensure that when coverage for mental health and substance use conditions is provided, it is generally comparable to coverage for medical and surgical care. The Affordable Care Act builds on the parity law by requiring coverage of mental health and substance use disorder benefits for millions of Americans in the individual and small group markets who currently lack these benefits, and expanding parity requirements to apply to millions of Americans whose coverage did not previously comply with those requirements.”  [ASPE]

This must have been in one of those pages Representative Heck didn’t get around to reading?


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Filed under Health Care, Nevada politics, Politics

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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Filed under Nevada legislature, Nevada politics

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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