Tag Archives: Nevada mental health

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. 

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Filed under Mental Health, Nevada legislature, Nevada politics

We’re the worst? Nevada is the Least Safe State

We could be doing a little better than this:

“Among the things that led to Nevada’s dismal overall status were a 47th ranking for “murder and non-negligent manslaughter per capita,” 47th for “public hospital rankings,” 43rd for “percentage of population without health insurance coverage,” 31st for “employer health insurance coverage rates” and 47th for “assault per capita.”

Piled on these were poor financial rankings for Nevada: 49th for “annual consumer savings account averages” and 50th for “percentage of people who spend more than they make.”  [Full story RGJ]

So, in terms of overall financial safety, Nevada ranks 50th — only Mississippi ranks lower; and in the home and community safety column we’re ranked 49th, with only Tennessee ranked below us.  [WalletHub]

We didn’t make the infamous top ten rankings in “aggregate state rankings in gun violence outcomes,” but we are sitting at number 12. [CAP pdf] We were 9th in national rankings of firearm deaths (2010), and if we extend the time period to 2001-2010 Nevada climbs into 5th place. [CAP pdf]

In short, having relatively lax gun safety statutes and regulations, and being in proximity to other states with lax statutes and regulations isn’t going to produce happy outcomes in regard to overall firearm deaths by accident, suicide, negligence, or homicide.

Our recent example of gun violence in Las Vegas should be perceived as yet another reminder that radicalized gun enthusiasts with access to copious amounts of firearms and ammunition isn’t a recipe for reducing our crime rate and raising the level of public safety.

If we would reduce the level of gun violence, there are some things that work.  No, they aren’t going to stop ALL or each instance of it, but they do help bring down the unfortunate statistics.

#1. Enact universal background checks for all gun sales.  At the risk of redundancy, Nevada proscribes arms sales to felons, fugitives, juveniles without adult supervision, undocumented aliens, and the seriously mentally ill. Arms may also be proscribed for those who have been involved in domestic violence incidents.  It would help our law enforcement officials if we were more careful to insure that people in these classifications do not acquire their own arsenals.

#2. Limit the ammunition capacity.  Seriously, if a person hasn’t shot the home intruder with ten rounds, what makes anyone think the next 20 would do more than merely shoot up the house? In at least two highly publicized instances the shooter has been apprehended while trying to reload.

There’s another element which deserves some consideration — Nevada ranks in the upper half of national suicide statistics, with a 20.3 rate. And, we know that of the four categorized methods, firearms are used most often (50.5%). [AFSP] [CDC] To see firearms as strictly related to “crime” statistics is to miss a significant portion of the public health and safety issues associated with the profusion of firearms.

The risk factors for suicides are well documented: family history, child abuse, previous attempts, personal history of mental disorders or clinical depression, history of alcohol or substance abuse.. [CDC] However, while we’ve put a great deal of effort into studying suicide, rather less has been done to research protective measures. This is not to say we don’t have a grasp of what works to prevent suicides. Easy access to clinical care for physical, mental, and substance abuse disorders mitigates the problem, as does having a variety of clinical interventions and the provision of support for those seeking help.

Individuals with family/community support, access to medical care relationships, and those who have been provided with assistance or training in problem solving, conflict resolution, and non-violent means of dealing with disputes, also are less likely to commit suicide.

If we’re serious about reducing this element of insecurity in Nevada there are measures we could take ‘for starters’.

#1. Enhance and improve the capacity of Nevada’s Drug Courts.  We currently have 17 adult drug courts in the state [NVJud] among the specialty courts available.  Each and every specialty court should be able to function secure in the knowledge that the rehabilitation services it mandates are readily available for those those come through the system.

#2. Improve the level of staffing and support services in our mental health system.  Unfortunately, information regarding current levels of support and regional availability of services is difficult to access because the State Division of Public and Behavioral Health is still trying to get its website up and running — a project which it estimates will take three to six months. (The old links aren’t working today.)

Adopting any, or as could be hoped, of all four suggestions will take some political leadership, and a bit of readjustment in how we perceive and deal with our fellow citizens.

First, it would be helpful if we could expand the discussion of firearm safety beyond the tortured logic of “freedom” or other generic complaints about governance and see the proliferation of firearms as a public health issue. Secondly, once we can visualize aspects of firearm safety as an element of public health then we can begin to address subordinate issues such as keeping firearms out of the hands of those who are a danger to themselves and others, and of restraining the amount of damage a troubled person might be able to do.

Further, if we can reform and improve our delivery of social and mental health services we might see the reduction in the kinds of behaviors which augment our unfortunate statistics.  Social and mental health services are labor intensive, and there are no convenient technological answers to issues involving human beings and their behavior.  Money doesn’t solve mental health problems, but it does build and staff those facilities which can alleviate the suffering which accompanies disorders and substance abuse problems.

In short, we will get what we are willing to pay for.

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Filed under Gun Issues, Nevada, Nevada economy, Nevada legislature, Nevada politics, Politics

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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Filed under Gun Issues

Bits and Interesting Pieces

Jig Saw Puzzle** That stalwart champion of free enterprise, Las Vegas’s own Sheldon Adelson, is complaining about his competitors offering lower room rates, and diminishing his profits. [LVinc]  Perhaps if he’d saved a bit of that moolah he pitched at GOP candidates in the last election…?

** If an endorsement from Governor Sandoval is supposed to be an effective repellant to ward off pesky intra-party competition — it’s not working, at least not in the run for 2016, in the Lt. Governor’s Office department.  Ray Hagar has more in the RGJ.  Muth complains here.  More from Ralston here.

** Governor Sandoval had an opportunity to help prevent the possibility of private guns sales to ineligible persons, and he blew it.

“Nobody — least of all Sandoval, a former attorney general and federal judge — wants felons or the mentally ill to get guns. But the fact remains, the governor had a chance to make it more difficult for that to happen, and he chose not to take it. And while this incident was resolved without tragedy or bloodshed, the next one may not be.”  [Sebelius]

Amen.

** There was the “transportation” of James F. Brown, and now Nevada’s Rawson-Neal Psychiatric Center is losing its accreditation.  [LVRJ] The Nevada Progressive has more + video.

** Talking Point Memo lists the “8 biggest losers”  should Congress fail to pass a comprehensive immigration policy reform bill.  And, might we add radical right wing Nevada politicians in a state in which the Hispanic population is projected to increase from about 687,166 in 2010 to approximately 802,432 by 2016? [StateDemographer pdf]

** Oh, my goodness and glory… Senator Harry Reid spoke about the effects of climate change and its association with wildland fire danger, and predictably the right wing goes off the rails.  From the Damned Pundit:

“Reid was stating the obvious. For decades scientists have been pointing at factors like warmer spring temperatures, lighter winter snowpacks and earlier growth creating an abundance of dryer fuel, and linking those factors to more — and more intense — Western wildfires.”

Here’s the predictable piece from the Elko Daily Freepers, a portion of the litany of “fact checking” provided in an attempt to advance the deniers’ fantasies: “Pay no attention to the fact there has been no appreciable global warming in 15 years despite a dramatic increase in carbon output from all sources — a phenomenon none of the global warming models can explain.”  Thus we are supposed to ignore this data from the Arctic studies?  Or, the Cambridge University study projecting that Arctic methane release could cost the global economy about $60 trillion over the next decades?

By the way, the old “prescribed burn” system which the EDFP writer would prefer to see restored — it’s not necessarily a thing of the past, witness the 2008 Prescribed Fire Guide (download) for forest and wildland management. [SJEl.org]

** So, why is Representative Steve King (R-IA Xenophobia) still on the House Subcommittee on Immigration?  NRDC would like to know.   Oh, wait — Rep. Michele Bachmann (R-MN6) is still on the House Permanent Select Committee on Intelligence.   There’s more on Representative Cantaloupe Calves here.

**  It’s really hard to gin up any sympathy for the Bankers when they do stuff like mistake a foreclosed home for the one across the street and remove all a person’s belongings — then they trashed or sold all her stuff, and the bank is now refusing to pay for  replacements. [Crooks & Liars] Original story from Channel 10 here.   The First National Bank of Wellston is “disputing” the lady’s $18,000 claim for replacing lost personal property.  Her response: “I’m not running a yard sale here. I did not tell them to come in my house and make me an offer,” she said. “They took my stuff, and I want it back.” [ColumbusDispatch]  The FNB of Wellston has $94,813,000 in assets, and $56,598,000 in outstanding loans, it has reserves of $590,000. [BankTracker]   This story has hit other  national blogs, such as Think Progress.

** Members of the Senate who are drafting taxation reform legislation have promised their colleagues they’ll keep their suggestions secret for the next 50 years.   Transparency? Accountability? Anyone? The story, if not the suggestions, have leaked already — into Politico and The Hill.

** Jobs, Jobs, Jobs — and by CBO lights, the GOP is on the hook for killing about 1.6 million of them.   [Politicususa]  Just think of how many more they can kill if they make good on their pledge to Shut Down The Government unless President Obama agrees to repeal Obamacare?

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Filed under Adelson, banking, ecology, Gun Issues, Immigration, Nevada politics, Taxation