Las Vegas Sun

November 27, 2014

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Letter to the editor:

Nevada must act on mental health

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Readers of the articles by the Sacramento Bee, which appeared in the Sun, about the “patient dumping” of James F. Brown learned about the challenges a person with mental illness deals with in order to maintain stability. (The biographical movie “A Beautiful Mind” depicts a prominent math professor’s torment from schizophrenic hallucinations, which also antagonize Brown.)

Besides illustrating the recurring extraordinary challenges that a mental disorder can cause, the Sun’s Thursday article details California’s exemplary mental health integrated network, which restored Brown’s stability. The Sacramento Bee articles are instructive for our Nevada legislators. If legislators do not have a special session to address Nevada’s woefully inadequate mental health system, they should consider making an exception to their current “cutoff” date and work on reform now.

Nevada is at risk for lawsuits. J. Patrick Coolican’s recent column warned about some other false economy: “Our jails and prisons have become de facto mental health facilities. ... We end up paying anyway, through emergency room care or jail beds.”

Americans pay dearly when massacres result from the tiny fraction of the mentally ill — recently from males in their 20s — whom we have chosen to ignore. Besides improved treatment, national mental health reform should include a universal background check (which also lists felons). A background check is the most viable compromise for gun safety reform.

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  1. It's estimated that 20 percent of the American population suffer from mental and emotional illnesses and ailments. Of these about 12 percent seek and receive professional help. Those are scary stats. Look at the military population and the increasing numbers of PTSD cases and the resulting suicides attributed to the disorder among our returning troops.

    Carmine D

  2. Along with evidence of shoddy mental health treatment of "out of state patients" comes another question. Are Nevadans treated much differently?

  3. Can anyone actually define "mental illness?" The parameters change with the blowing wind. Self-inflicted actions suddenly become "mental illnesses" and why? Because today's modern day Witch Doctors: psychologists, psychiatrists and "counselors" say so. According to them, the USA is one giant "Snake Pit." By the way, these professional charlatans increase the size of their income with every "new" disease, defect, syndrome or ailment they can put on the books. Quite a cozy arrangement, wouldn't you say? I guess they learned well by watching the ambulance chasers at work!

  4. As a society, we should be very concerned with mental illness and the impact it has upon the lives of not only its victims, but upon those around those victims. There is a great need to be proactive in our approach to mental health, with early diagnosis and treatment. Both physical and mental health dysfunctions should be identified and have treatment plans early in life, to best serve the individual and society at large.

    To be proactive, we need to start early in life, not wait for an individual to have a crisis event or wait for adulthood, when then the general laws of the land take hold for accountability. IF there was a screening today of the children in our schools, we would be shocked to find the great need for mental health care, and the fact these children are growing up without it! And we wonder why the performance in schools is so pathetic. School Counselors are not equipped, nor adequately trained to deal with the complex mental health issues many of our school children possess.

    Why is this issue of childhood mental health being ignored?

    Blessings and Peace,
    Star

  5. Using the term mental health in the state of Nevada is an oxymoron. Gambling, prostitution, substance abuse are rampant in this state. Mental health services are almost nonexistent for all except the affluent.

    Nationally our health care dollars are spent on heart disease, cancer, obesity and diabetes. So much money goes to those four segments there is very little left for anything else.

  6. Nevada can't act on anything until we get our priorities straightened out. Sure education is important but NOT MORE IMPORTANT that life itself. Mental health, senior needs, individual ability to work and save towards a modest retirement are much more essential than endless worthless degrees and maximum "education" that makes you unemployable.

  7. There has to be a mechanism to compel help on the mentally ill that need it. The standard of they have to be a danger to themselves or others the way it is interpreted today is crazy. There are plenty of families that want to help their family members but can't because the family member doesn't want help. The ACLU makes like it is a life choice to be mentally ill and stands in the way of compelling help on those that need it. Now the person has to hurt themselves or another person to be compelled help. That standard is literally crazy.

    Of course we just watched our whole legislature watch one of their own spiral down and did nothing. They stood by and watched up until the point where he almost got himself shot by police. Is that really the way we should be handling people like him? Waiting until they put themselves in danger like that? Does that make a scintilla of sense? Yet our legislature still does nothing. Bunch of cowards and do-nothings.

  8. Realistically what can you do for these people? Build more institutions and put them on drug diets? How about a community farm experience where they toil in the field and learn a trade and produce something? No, can't make anyone do that. Many seem to rather hang on street corners begging for money. Dumping money into "programs" is not the answer, a real idea of how to house and teach and oversee is needed in some form of somewhat self sustaining environment.

  9. There has been no discussion of the effect of background check law to prevent persons with mental and emotional disorders from seeking it. Why? For concern that they can't purchase a gun and/or if they owned one already it would be taken away. A consequence of such a background check law, if it passed, or passes, would be to force the mentally/emotionally ill not to seek help. In greater numbers than we already have who don't.

    Carmine D

  10. Please click on the link, "the Sun's Thursday article details...." in the letter to the editor above to see my online comment (mainly referenced information). Thank you.

  11. In my comment above I asked readers to open a link. Here is my copied comment from that link:

    The information below gives validity to my concerns that Nevada, along with other states, has serious room for improvement concerning its mental health system (and not JUST regarding releasing patients by bus to other states). The newspaper excerpt shows that services have been slashed. However, legislators have proposed improvements. After this important Review-Journal excerpt, I reference information from yesterday's Jon Ralston's 7:30 PM Channel 3 "Ralston Reports." You will see that writer Joan Patterson's excerpt continues to my next comment.

    "Won't somebody please help?" by Joan Patterson on 4/8/13 was part of the Review-Journal's "mental illness" multi-day coverage. It reported, "In 2009 the National Alliance on Mental Illness gave the country an overall "D" grade for delivery of mental health care. Since then states have cut their mental health budgets further because of the recession.

    "Nevada cut 28 percent of its general fund mental health budget from 2009 to 2012, placing it among the handful of states that have made the most 'devastating' cutbacks, an alliance report shows.

    "State Sen. Justin Jones, chairman of the Senate Health and Human Services Committee, noted that the reductions have meant, for example, a 19 percent drop in mental health staffing and a loss of 100 beds at the Rawson-Neal Psychiatric Hospital in Las Vegas. All of this during tough economic times, when the need for services usually rises, he said.

  12. "Despite the cuts, there have been rumblings about proposed changes in Nevada's mental health services. One proposal is for a 24-hour urgent care center in Las Vegas for the mentally ill, many of whom now have to seek health during a crisis at hospital emergency rooms. There's also discussion of an outpatient commitment law that would help keep the mentally ill from continually revolving in and out of community jails by requiring them to receive treatment."

    Last night Jon Ralston interviewed Mike Willden, director of the state Health and Human Services Department. Jon mentioned that $80 million dollars has been cut from the mental health budget. Mike Willden echoed the "NV message" that money is not the problem. He said that there was
    about $2 million unspent in their budget last year, and this year will probably be the same. I hope Mr. Willden gives us details about this unfathomable statement.

    Jon Ralston also mentioned that TODAY is the day that is SUPPOSED TO be the deadline for mental health bills. However, Jon hinted that there is an option called an emergency bill.

    My editorial comment is that it is too bad that the reason we have arrived at this emergency/"REVIEW" stage is only because of a caregiver who cared enough to get James F. Brown to sign a patient release of information form (before he "disappeared" for a while), the Sacramento Bee's investigation, bad publicity, and threats of lawsuits/judgments against Nevada. (Some "officials" mentioned over a week ago that not many of their constituents had expressed concern for mental health care reform--as opposed to concern for other Nevada needs, such as education.)

    Another very PERTINENT article is "Jail detains, doesn't treat," by Laura Myers, in the Review-Journal, 4/15/13.

  13. On April 10th the Las Vegas Sun published an "Other Voices" editorial by Anne Michaud (interactive editor for Newsday Opinion) entitled "Treat these young men before they kill." It was the source in my letter to the editor when I referred to massacres resulting from males in their 20s. I wrote that letter before the Boston Marathon bombings. I recommend that editorial.

  14. Currently investigators, as well as government officials who have legally requested records, are examining 1500 Rawson-Neal Psychiatric Hospital bus ticket receipts from 7/1/08-3/31/13. Total admissions during that period equaled 31,043. About half of those patients were discharged after being observed for 72 hours or less. It would be helpful if someone separates the readmissions. Make a list of patient names with the number of each one's total readmissions. Perhaps, these names could be matched with names on police records. If recidivism is a significant problem, it could be targeted, which would reduce admissions. (One reason given for the busing of patients was that the hospital had such an overwhelming number of admissions. The bused number was argued to be a small percentage of the total admissions.)

    Jail costs for a mentally ill person is $140/day, plus medication (if he can obtain it). I think that Rawson-Neal costs about $800/day. Those staggering costs are limiting factors. That said, it's hard to imagine that 1) over $80 million was cut from the mental health care budget in the time period being examined, and 2) I understood Mike Willden to say on "Ralston Reports" that mental health care has been $2 million UNDER budget. Why wasn't the money used to add beds, restaff, etc.?

  15. The main reason for my ongoing online comments is that I want to share informative, pertinent articles/sources that will ASSIST readers who are curious AND those who will be able to aid in reforming our mental health care system. That includes many people--from legislators to communicators like you and me.

    Previously, I mentioned that Rawson-Neal costs about $800/day. The source is "BROKEN LIVES, BROKEN SYSTEM," by Laura Myers, Review-Journal, 4/14/13. Here's a quote: "More than 8,000 patients go through Rawson-Neal each year, according to the Nevada State Health Division. The average stay at the acute care facility is about a week but can range from a few days to a few months. It costs an average of about $850 per day per patient, according to 2011 testimony before the Nevada Legislature. If insurance doesn't cover the cost, state and federal programs for indigents will likely pay the tab." My note: One problem is that Rawson-Neal's funding has been slashed. This state hospital does not have enough beds for everyone (only 200).

    The Thursday, 4/11/13 Sacramento Bee article that I reference below mentioned that James F. Brown, who was indeed "patient dumped," had insurance and Social Security, but his benefits had not been transferred from Nevada to California at that time.

    Obviously, the Nevada mental health care system needs to build a network, like the California one detailed in the Sacramento Bee article which the Sun printed on Thursday, 4/11/13, by Cynthia Hubert, entitled "Patient dumping in California casts pall on Nevada." (This was the THURSDAY article I referenced in my letter to the editor.) Supplemental facilities will not require $850/day.

    Laura Myers wrote "Kindness from Catholic Charities helps those on the street," (Review-Journal, 4/15/13). She interviewed Jodie Goldberg, shelter operations manager in Las Vegas.
    "The shelter has a maximum of 400 beds, but Goldberg said she never leaves anyone on the streets." Our "reform" could surely benefit from her experience!

  16. Update:
    I just read the Sacramento Bee online article,"Federal officials cite Nevada Mental hospital for deficiencies," (Cynthia Hubert and Phillip Reese). It reported that the federal Centers for Medicare and Medicaid Services alerted Nevada officials yesterday that Nevada has 10 days to correct "serious deficiencies" in the Rawson-Neal Psychiatric Hospital's mental health discharge policies, or the Centers will initiate action to terminate its federal Medicare provider funds.

    Rawson-Neal has already issued policy changes to safeguard patients during out-of-state transport. On April 2nd Gov. Brian Sandoval authorized $4 million for jail and prison "prisoner" transition. (Some of them need mental health care.)

    Can Nevadans assume that these targeted remedies for patient transportation, transition, etc. are just the start of a belated overall examination, which will lead to a productive integrated network of mental health services like the ones in California that started this whole comparison in the first place? (The Sacramento Bee gets a lot of credit, too.)

  17. Who said, "We do the best we can with the limited resources we have"? Odds are you think it is a Nevada official, talking about our mental health care system. Actually, it is a quote from Joan Burke, advocacy director at Loaves and Fishes in Sacramento, California. The staffers there got James F. Brown's written permission to disseminate his story. Before James' reunion with his daughter, he received help from seven different California "caregivers" from officers to hospitals to assisted living to a boarding house.

    The question for Nevada is now: where do we go? Some offficials have said the problem is solved. With Rawson-Neal's patient transportation policy changes, a proposed 24-hour crisis intervention center, and a little new money to help the 28% general fund budget slash, the psychiatric hospital will certainly be in compliance with federal requirements.

    However, the real answer is that we need to get in line with the system referenced in the first sentence above, that apologizes for its "limited resources" and won't be satisfied until every person who asks for help can get it.