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October 30, 2014

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j. patrick coolican:

Mother finds a way to build hope for mentally ill out of son’s tragic death

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Leila Navidi

Marilyn Rogan-Smith, seen on Tuesday, May 28, 2013, is the co-founder of Adam’s House, a residential treatment facility for the mentally ill located in the Owens Avenue Salvation Army campus in Las Vegas.

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J. Patrick Coolican

No one is more intimately aware of the gaping holes in our mental health safety net than Marilyn Rogan-Smith.

She retired as a captain at the Clark County Detention Center, where she oversaw medical and psychiatric treatment in what is Southern Nevada’s largest de facto mental health facility.

Her son Adam was born with a birth defect in 1985 and had skull surgery when he was 4 months old. Unbeknown to the family until years later, the surgery left Adam with brain damage that seems to have manifested itself as mental illness, including schizophrenia, obsessive-compulsive disorder and attention deficit disorder.

“Because my son needed services so badly, I was driven to be an advocate and find the best mental health services out in the community. Unfortunately, in Nevada, that’s a struggle,” she said this week.

Adam got caught in a common cycle beginning around age 13 — when he was faithful about taking his medication, he was healthy and productive. Then he would consider himself cured — wanting to free himself from the stigma of mental illness — and stop taking meds. When problems quickly arose, he self-medicated with drugs and alcohol. Jail, emergency rooms, institutions.

In April 2012, Adam died of cardiac arrest, though his untreated mental illness was the real cause, Rogan-Smith said.

“The death of my son nearly killed me,” she said. She isolated herself and began raising Adam’s 4-year-old daughter Alayna, whom she and her husband have adopted. Alayna’s mother, who also suffered from mental illness, took her own life after Adam died.

Then Rogan-Smith got a call from Jeff Iverson, a local business executive who also runs sober living facilities.

His proposal: Take over a recently shuttered facility for the homeless and mentally ill on the Owens Avenue Salvation Army campus and start their own program of housing and treatment.

Today, Adam’s House has its grand opening.

“It’s like Adam’s life has meaning,” Rogan-Smith said.

“I couldn’t help him, but maybe another parent doesn’t have to go through the pain of losing a child to this disease,” she said. “And hopefully we can help them live with dignity and self-respect, and they’ll be productive members of society.”

The facility has room for 42 people, with an additional nine separate studio apartments for residents who gain independence.

The goal is a family environment and immersion in all the necessary services in one place, including a consistent team of caregivers who will provide continuity of treatment.

The need is so great in the Las Vegas Valley that nearly all the spots are already taken, with more referrals coming every day.

While I was interviewing Richard Holligan, another co-founder and a psychiatric nurse, he received a call from a doctor at a hospital looking to place a patient. She is no longer a threat to herself or others, but where does she go now?

“There’s no place to discharge her to, so the cycle starts again,” Holligan told me.

Luckily, with the opening of Adam’s House, he could head to the hospital and evaluate her to see if she’s a good candidate. Turns out, she was, and now she’s at Adam’s House.

But Adam’s House is a drop in the bucket. There are scattered group homes in the valley, mostly full and some better than others, but for the most part, a lack of transitional housing with services is a big problem and a key reason our mental health system operates in perpetual crisis. Patients bounce around from emergency room to the state-run Rawson-Neal Psychiatric Hospital, to the jail and back to the streets, in a never-ending vortex.

“Nevada waits until the person is in crisis,” Holligan said.

In 2010, our per-capita mental health spending was 57 percent of the national average, and we’ve cut around $80 million from mental health since the start of the recession.

Of Adam’s House, Rogan-Smith said, “It’s a start.”

Indeed it is. And kudos to this plucky team for its efforts.

But I find the timing of the opening of Adam’s House bitterly ironic, coming as it does in the closing days of a legislative session that will once again be known for its inaction when it comes to protecting the state’s most vulnerable citizens.

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  1. Deinstitutionalization of the mentally ill began in the late 1950's with the advent of the drug thorazine. The vision was that they would be released into the care of a vast network of community treatment centers. Well, the mentally ill were released, but as BChap notes, funding for community treatment was eliminated. Instead of being housed in state mental hospitals, those with mental illness now live on the streets or are incarcerated. Our treatment of the mentally ill now is mostly non-existent. "The 'least restrictive setting' frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies." http://www.pbs.org/wgbh/pages/frontline/...

  2. We need to re-prioritize how we spend our tax revenue. We blindly dump billions into K-12 and higher ed with a negative ROI. Let's get back to reality and deal with survival. American citizens should have a temporary safety net that includes reasonable relevant services for the handicapped, ill, and TRAINABLE. If you can but won't manage it yourself after once or twice through K-12, government training, detention/boot camp, you don't get more helpful services. If you can't manage it, we should be there to assist your family and you to become self sufficient even if that means living off SSI/SSDI with food stamps and Medicare. Recent media more-than-suggests that many of those drugs (for the "mentally ill") just aren't as helpful as once thought. Some put you into a near-coma or zombi state--which may be needed if you are uncontrollably violent. I still say we must provide dormitory living options w/deadbolt locks on individual rooms--so the resident can lock out the world and feel safe. Sure "management" will have keys in case monitoring indicates violence--monitor via daily conversation with the case workers on staff. Further, we NEED LEGISLATION to allow DHHS et al search for and/or contact relatives--as in the case of JPC's recent article on woman looking for brother after 25 years--with good chance the bro may have needed triage services or police involvement. Perhaps a database of who's looking for whom so when someone "checks in" the case worker can search--how would he know his sister has a new name, moved out of the home state, wants to hear from him? The case workers should also be authorized and encouraged to make a client entry identifying name(s), dob, SSN, place of birth, parents, siblings, military record, and some info on self sufficiency--ability to care for self.
    I recall a New York program where they found it "kinder" and less expensive to provide repeat ER patients who were homeless--provide them with free apartments and utilities. Most already qualify for EBT SNAP. So dorm rooms with varying degrees of freedom. Say one complex as a half-way house after hospitalization. Another complex for those who have less severe needs. Mix in Veterans with PTSD. GO WITH THIS JPC. The subject woman, Ms. Rogan-Smith is trying to do this but clearly is limited in how many she can serve. We need to step up. DHHS needs to pursue a federal grant and get a program going. Enough of the related and socializing managers and administrators mixing in the big brass meetings in Carson City, Reno, and Las Vegas. GET SOMETHING DONE.