Las Vegas Sun

July 27, 2015

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Sun Editorial:

More work to do

Improving mental health care has to become a priority for Nevada

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As the Sacramento Bee has diligently reported in a series of troubling articles, the state-run Rawson-Neal Psychiatric Hospital in Las Vegas discharged nearly 1,500 patients to the Greyhound bus station over the past five years — with one-way tickets out of state. The patients were sent with some snacks and a few days of medicine.

The allegations of patient dumping have led to ridicule — Stephen Colbert: “What happens in Vegas stays in Vegas unless what happens is psychosis” — and serious allegations of patient dumping that could result in lawsuits.

Nevada’s response to the Bee’s stories has been painfully slow and, by all appearances, incremental. State officials started a review and last month announced they were tightening procedures, including mandating that anyone sent out of state be accompanied by an escort. Then, in a statement last week, Gov. Brian Sandoval said the review showed the “vast majority of patient releases were done correctly.”

There were 10 cases in which policy was broken, and the state fired two hospital employees and disciplined three others.

Sandoval also said the state has “obtained proposals from national experts” to study the mental health system to make sure industry best practices were being put in place and followed.

All of that comes across like a formula response to embarrassing situations — change policies, fire a few workers and then pledge to study the issue.

That’s not enough. The discharge-to-Greyhound situation is just a part of a larger problem. The state has long short-changed mental health budgets, action that has been buoyed by a pervasive attitude that has downplayed or dismissed the seriousness of the situation.

The Bee’s stories have raised significant concerns that shouldn’t go away with the next news cycle. There are still many questions to be answered, including:

What role did budgets play? Were workers at Rawson-Neal sending patients out of state because a bus ticket is far cheaper than treating a psychiatric patient? Does the hospital not have the budget to handle the demand?

What was the policy? If the “vast majority” of cases were up to state policy, that doesn’t mean the policy was correct. So, was the policy in line with standard and appropriate treatment? Is it now?

What else is there? It’s no secret the mental health system is stressed. Within a few days of Sandoval’s announcement, the emergency room at UMC, Clark County’s public hospital, closed its doors for 12 hours, refusing to take new patients because it overflowed with mentally ill patients.

That was a reminder of previous crises over the past decade, particularly the one in 2004 when several Las Vegas emergency rooms had to stop taking patients because they were overcrowded with mentally ill patients. That was supposed to change with the Rawson-Neal hospital, but here we are 11 years later facing a similar situation.

The state just can’t shuffle patients off from one place to the next. Are there other parts of the health care system affected by the overburdened health care system? How will the state respond? As well, what are the effects of this crisis on society at large?

What did the state really find? So far, details of the investigation have been parsed out. We have yet to see a full briefing, much less a full report of the state’s findings. Why not? If the state wants to restore some sense of trust with the public, it should release its full findings. What does the state have to hide?

Now what? It’s great that the state has national experts interested in studying Nevada’s mental health system, but what does the state do in the meantime?

As we have noted before, there’s not a big political constituency behind the mentally ill, so will Sandoval continue to push on this issue? Will the Legislature? Or is the assumption that this will all go away and the state can deal with it again in a few years, as has happened in the past?

Over the years, the state has been willing to push patients around, but that’s not dealing with the problem. Nevada needs to change the way it runs its mental health system, and it needs people, starting with the governor, to aggressively push for the change. As we said last week, Nevada is better than this.

Isn’t it?

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