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June 2, 2015

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J. Patrick Coolican:

The jail shouldn’t be our community’s largest psychiatric facility

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J. Patrick Coolican

Metro officer shoots, kills suspect

KSNV coverage of Metro police shooting and killing a man outside a condominium complex in the northwest valley, Dec. 12, 2011.

Sheriff Holds News Conference After Shooting

Sheriff Doug Gillespie arrives for a news conference at Metro Police Headquarters Monday, December 12, 2011. Gillespie called the news conference after a Metro Police officer shot and killed a man early this morning at a condominium complex in the northwest valley.  . Launch slideshow »

Between 25 and 30 percent of inmates at the Clark County Detention Center are prescribed psychiatric medication.

The largest psychiatric facility in Clark County? The jail.

This should embarrass us, even if our community is by no means unique in this regard.

I was drawn to this subject late last year, when Metro Police shot and killed Stanley Gibson, an unarmed, disabled veteran who was apparently in the midst of a psychiatric episode.

While Metro’s role in the tragedy is important and deserves close examination, the incident also revealed a problem that is related and just as pressing: gaping holes in our mental health safety net.

I spoke to a number of experts from government and nonprofit groups, and they agreed that our mental health system, though filled with hardworking professionals, is fractured and underfunded, leaving thousands throughout the valley undiagnosed and untreated — or in jail when they should be in treatment.

“If government is supposed to be there to help people who can’t help themselves, I can’t imagine a more important issue than mental health,” said Randolph Townsend, a former Republican state senator who served on a federal mental health task force.

It’s not clear exactly what happened to Stanley Gibson in the last days of his life. But here’s what we can piece together:

Gibson ran out of anti-anxiety medication before the federal Department of Veterans Affairs canceled his appointment to see a doctor. The VA told him they wouldn’t refill his prescription without his seeing a doctor. (The VA didn’t return my call.)

Gibson was troubled and delusional, and police were called. He was arrested for “resisting arrest” and booked into the jail Saturday evening, a spokesman for the family said. Officers assured Gibson’s wife that he would receive a psychiatric evaluation and be held for his own safety.

Instead, he was released that same night. Gibson’s family called 9-1-1 Sunday, and he was taken to University Medical Center, but he walked away around 7 p.m.

Hours later he was dead.

Reading what we do know about Gibson’s final days after the fact is crushing because we see so many opportunities to stop the tragedy.

“I hear stories like this every day,” said state Sen. Sheila Leslie, who also administers the state’s specialty courts, including the mental health court.

Despite the Gibson debacle, experts I talked to said Metro is considered progressive in its treatment of the mentally ill. They also say Sheriff Doug Gillespie has worked hard to train his officers to deal with the mentally ill.

“Metro has an excellent mental health team. When they have time to process the information, they know exactly the intervention the person needs,” Ron Lawrence, executive director of Community Counseling Center of Southern Nevada, said.

Metro’s Crisis Intervention Team, which is modeled on a highly regarded program in Memphis, Tenn., specializes in defusing volatile situations, getting the mentally ill into treatment and keeping them out of the judicial system, when appropriate.

In an interview last month, Gillespie said he was moving toward giving all officers this kind of training. It could save money — we pay $138 per day to house inmates at the jail. Counseling and medication might sometimes be more appropriate and cheaper.

Ultimately, however, efforts by police to move patients into mental health services will be futile if there are no services, Gillespie said.

“Are we providing adequate services to that percentage of the community? I think you can make a compelling case that we’re not,” he said.

Gillespie, whose department’s use of force history and policies are being reviewed by a federal agency, also offered a subtle warning, saying U.S. Department of Justice officials have told him they aren’t just looking at police departments; they’re reviewing whether states and localities like ours are in compliance with federal law. In other words, if our mental health system is found to be so severely deficient that we are violating the civil rights of the mentally ill, we could wind up with a federal judge acting as a kind of viceroy of our social services.

Where are we deficient?

Nevada has the least number of psychiatric beds per capita — 5.1 beds per 100,000 people — of any state, according to the Treatment Advocacy Center.

In Clark County, we have 733 beds, but 127 are set aside for the elderly and 58 for children. We have 298 beds at Rawson-Neal Psychiatric Hospital, but the Legislature only budgeted staff to support 190.

We also suffer a severe shortage of outpatient services — ongoing psychiatric care after the crisis has abated, which means giving people the counseling and medication they need to remain independent and functional.

“They’re in the system. They’re out,” said Brian Patchett, CEO of Easter Seals Nevada, which offers services for the mentally ill and developmentally disabled.

In other words, we lose track of them. Gillespie echoed this thought, noting that jail inmates are given three days of medication on their way out the door, but no one knows what happens to them after that.

Richard Whitley, acting director of the Nevada Division of Mental Health and Developmental Services, said people often have to wait 30 or 40 days for outpatient services.

Lawrence said he has 150 people on his waiting list.

Last year, I spent time with a social worker who was trying to reunite foster children with their parents. She expressed frustration about lengthy wait times for psychiatric diagnosis and treatment and a severe shortage of drug and alcohol treatment, as well.

Navigating the system is another challenge. Where do I go and who do I talk to? These are tremendous challenges, even for patients who have strong support networks of family and friends, Townsend said. “How do you find your way through that labyrinth?”

Overall, our mental health spending is 43rd per capita in the nation, according to Kaiser Health Facts.

Whitley, who is relatively new to the job at the state health division, said he’s trying to use data to most effectively direct resources. “It’s too easy to say we need more money,” he said. “The questions I’m asking are, ‘Where is the system failing and where do you direct resources?’”

Whitley said he takes a public health approach to mental health. In other words, just as we use vaccines to prevent epidemics, we should try to intervene early before mental illness becomes tragic and costly.

Since Whitley doesn’t want to say it, I will: We need more money for mental health services. In the end, we wind up paying anyway — in money for the jail, and in a moral fabric tattered by apathy.

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