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November 22, 2014

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j. patrick coolican:

Brooks case can be impetus for improving mental health services in Nevada

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Sam Morris / Las Vegas Sun

Assemblyman Steven Brooks talks to Majority Leader Marcus Conklin on the third day of the 2011 legislative session Wednesday, Feb. 9, 2011, in Carson City.

J. Patrick Coolican

J. Patrick Coolican

For thousands of Southern Nevadans who have dealt with a family member in crisis, watching the Steven Brooks story unfold must feel surreal and all too familiar.

Brooks, a Democratic assemblyman, was hospitalized Friday after his family called Metro police because of his increasingly erratic behavior, which indicates he is unwell and needs help.

The safety of Brooks and his family and other legislators is paramount. The situation came to light when he was arrested Jan. 19 with a loaded gun. Police allege he had been making threatening remarks about Assembly Speaker Marilyn Kirkpatrick after he had been passed over for an important committee assignment.

Once there’s some stability, I hope that his situation might spur a conversation about mental health services in Nevada. Specifically, the lack thereof.

Unfortunately, this is the second time I’ve had to write this column, so forgive my plagiarism. Last year, I wrote about this issue because of the late-2011 death of Stanley Gibson, a mentally ill veteran who was shot and killed by Metro police.

“In general, there’s a shortage; a shortage of providers and not a great system to get services to people who need it,” Barbara Buckley, former speaker of the Nevada Assembly and the head of Legal Aid of Southern Nevada, said Saturday.

Buckley said there’s wide acknowledgement in state government of the need for more mental health services, but the needs are just as great in K-12 and higher education, for instance.

My fear, however, is that mental health gets short shrift because, unlike suburban parents, the mentally ill and their families are not a political constituency with much of a megaphone.

According to the Treatment Advocacy Center, Nevada has the fewest psychiatric beds — 5.1 per 100,000 residents — of any state in the union. Our mental health spending is 43rd per capita, according to Kaiser Health Facts. During the ongoing budget crisis of the past five years, $80 million was cut, according to former legislator Sheila Leslie, who was chairwoman of health and human services committees and watched those budgets deteriorate.

As I noted last year, 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 staffing to support 190 this biennium.

As I write this, Brooks is still hospitalized.

Once he’s released, however, the wait for outpatient services can be 30 to 40 days, according to the state’s Division of Mental Health and Developmental Services.

“We only serve the sickest of the sick,” Leslie said.

In the end, we wind up using our jails and prisons as psychiatric facilities. Sheriff Doug Gillespie has said between 25 and 30 percent of inmates are in need of psychiatric medication at any one time. Once released, they often have no access to the medication they need.

Metro prides itself on its crisis intervention team and progressive policies for dealing with the mentally ill, modeled after a successful program in Memphis, Tenn. But in a better system, police would be able to focus more on policing and less on this population.

Leslie notes the strong stigma attached to mental illness, though of course that’s true everywhere and not just here.

She said people may be reluctant to seek care for themselves or family members, and then once they do, navigating the system is difficult, if not impossible.

I wrote a different column Friday, one that asked why Nevada seems to attract its share of eccentrics and incompetents and occasional criminals into its elite echelons of politics, business and even nonprofit groups. I avoided openly mocking Brooks but didn’t spare other notables.

As news broke late Friday about Brooks’ hospitalization, even ambient, light-hearted mockery seemed tone-deaf.

I was especially struck Friday by a wise piece written by Kristy Totten on the website of CityLife titled, “Why we should not ridicule Assemblyman Steven Brooks.”

“Through snarky tweets, nasty reader comments and newsroom jokes, we’ve dismissed Brooks’ behavior as comical, deserving of ridicule because nothing came of his delusions, no one was hurt. But what if something had happened? Would it still be funny then? The answer is no.”

I’ll come clean on some snarky tweeting about the situation as late as Friday morning.

In defense of colleagues, this is an important and fascinating story, so I fully understand the need to aggressively report it. And, so far as I know, none of us is qualified to understand what is going through Brooks’ mind or has much experience confronting a situation like this. Throw all these factors together, and we wind up with Brooks shirtless on the front page of the Las Vegas Review-Journal, which, in retrospect, seems imprudent and exploitative.

Totten has it right when she concludes:

“We have the opportunity here to help someone, and to prevent people from getting hurt. In many ways, this presents a test case for Nevada. If we can’t figure out how to help a guy who is imploding so spectacularly in full public view, how can we create a system that will help quieter, less visible cases? It’s human nature to laugh off tragedy that doesn’t happen, just as it’s human nature to wonder, when it does happen, why we didn’t see it coming. Regardless of how we ultimately address this, one thing is for certain. We should not laugh, and we should not simply move on.”

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  1. It's estimated that 20 percent of the population suffer from mental and emotional illnesses. Maybe more in bad economic times like these. Of these, about 12 percent seek medical assistance/counseling for their conditions. Society can't force them to do so except under rare and unusual conditions like the Congressman. The majority go about their lives suffering and untreated.

    CarmineD

  2. We'll see if a State Legislator has more success getting help with a mental health issue than your average citizen.

    Too often, mental health treatment is not much more than a prescription to alter brain chemistry and often cause other side effects. Some of these help if the patient makes the rational decision to use them. But then, rational decision making is not exactly the forte of people with mental health problems, is it?

  3. "...none of us is qualified to understand what is going through Brooks' mind or has much experience confronting a situation like this."

    Coolican -- this is the best part of your article. I'm surprised you didn't include the balancing factor of Barlow's denial of his part in the NLV police report behind all this.

    "It's estimated that 20 percent of the population suffer from mental and emotional illnesses. . .Society can't force them to do so except under rare and unusual conditions like the Congressman."

    CarmineD -- who do you mean by "the Congressman"?

    "We'll see if a State Legislator has more success getting help with a mental health issue than your average citizen."

    pisces -- you're assuming of course anything we're reading and seeing about Brooks is true. I'd like to see the rest of the story when the dust settles.

    "Sounds like the old Soviet union. Blacks, women and "deviants" usually are the victims of a run away mental health system."

    mred -- your post raised good points. The Nazi drive to exterminate all undesirables from the world seems to never be far from becoming public policy again. Too many forget our own nation's experiments with electroshock and other barbaric "therapies," lobotomies and eugenics.

    I've yet to see anything here from someone even claiming to know Brooks personally and what he's going through. This could very well be gossip amok.

    "Great minds discuss ideas, average minds discuss events, small minds discuss people." -- Admiral Hyman G. Rickover

  4. "CarmineD -- who do you mean by "the Congressman"?" @ KillerB

    I meant Mr. Brooks. Mea Culpa. Hovever, if I were referring to the US Congress, I would have used the plural form: Congressmen. ;-)

    CarmineD

  5. "I meant Mr. Brooks."

    CarmineD -- he's a Nevada Assemblyman, not a Congressman.

  6. He's a D. You hope he gets better. Were he an R, you would be busting him.

  7. Compliments to his FAMILY for dealing with it. I would argue with Ms. Buckley that the needs in K-12 and higher ed are NOT as great. We dump way too much of our resources into broken K-12 and higher ed. So much so that we have extremely limited resources remaining for ESSENTIAL public services. Follow this: We could confiscate 90% of EVERYBODY'S INCOME and K-12 would still cry for more without producing graduates who can read and write. Sure teachers would be paid more but we'd get nothing for it. As is, we're TAXING TOO MUCH and getting TOO LITTLE. Let us refocus our funding to reasonable levels: cutting gov-employee compensation to reasonable levels at the City, County, SD level, cutting K-12 to comparable levels in Arizona, cutting higher ed so we offer college ONLY to Americans who have made Nevada their home, cutting non-essential programs and LIMITING welfare (including city welfare) housing benefits, Child Care credits via DHHS.... limiting to the 2 years President Clinton signed into law. Government funding to food banks is dumped onto illegals who drive up in their Cadillac Escalades and use their iphones to network on which food bank is giving the most today. Let's take a look at how we fund assistance for Autism--be subsidizing single-family houses when group housing would be more appropriate for those above age 16 or 14--encouraging them to learn how to live in a group setting or on their own. Ditto on increasing payments to grandparents and step-parents to "foster" their relatives. Let's look at Medicaid and the people who've been USING US year after year. We NEED that funding for essential programs that would include trauma situations of the mentally ill. p.s. Those adjudicated and/or diagnosed with long-term mental illness might also do well in group living situations, perhaps even maintaining employment. Group living is much more cost effective than long-term commitment to a hospital or incarceration--and much more quality of life for the residents.

  8. Bradley, they do have to "sell newspapers." I realize you have experience dealing with the incarcerated sick and would have a perspective on how we deal with SOME of the more violent with mental health issues. (And whether you agree or not, many with MH issues must be incarcerated since there is no way we can fund 24/7 commitment for all needing it.) As I've maintained re Sandy Hook, "we" forced that Perp into what he did. What individual can withstand abandonment by much of the family--bad quotes from brother. Father absent and "distant" from son. Mom left to deal with it but she was more concerned with volunteering her time to others. Sure she home schooled the Perp RATHER THAN deal with the public schools that magnified the Perp's issues. Rather obvious he was bullied and in pain all the time. In consideration, Mr. Brooks may have been behaving quit well: hearsay, then more hearsay, like the tin can telephone relay where the end "message" isn't even similar to what was first said. I haven't seen or heard anything definitive on the gun possession. Brooks had it in the car driving when alleged victims were miles away? I'm not trying to work all sides of this. It's just NEVER black or white. We all have "weak" moments and many deal with outright MH issues at various times. So let's all behave as if the next guy MIGHT be having a bad day and treat each other with reasonable respect. When we see another who is not or cannot do the same, let's call upon services including law enforcement for PRECAUTIONARY action with the funding for diversion to MH crisis services. So let's DIVERT SOME FUNDING from K-12 into ESSENTIAL public services. It is just a shame that we spend upwards of $12,000 a kid per year when the same kids and the rest of us can't cover adequate shelter, heat, food, health care.

  9. "Metro prides itself on its crisis intervention team and progressive policies for dealing with the mentally ill..." - from the column

    Tell that to Gibson's family.

  10. "Tell that to Gibson's family."

    boftx -- good one.

    "If the exercise of constitutional rights will thwart the effectiveness of a system of law enforcement, then there is something very wrong with that system." -- Escobedo v. State of Illinois, 378 U.S. 478, 490 (1964)

  11. "CarmineD -- he's a Nevada Assemblyman, not a Congressman." @ KillerB

    Yes, I know. And realized my mistake when I reread my post. I was thinking assemblyman but typed Congressman. By then it's too late to correct. You were right to question me and set the record straight. Thank you.

    CarmineD