Nevada’s mental health system to get $2.1-million funding infusion

By Andrew Doughman

Published Tuesday, Aug. 6, 2013 | 1:32 p.m.

Updated Tuesday, Aug. 6, 2013 | 2:38 p.m.

The legislative Interim Finance Committee approved $2.1 million in emergency mental health funding on Tuesday after spending hours criticizing Nevada's inadequate treatment of mentally ill residents and visitors.

Legislators said the state of Nevada’s mental health system appears to have reached crisis levels. Failures in the system, they said, have led to overcrowding in emergency rooms, backlogs and delays in jails, loss of accreditation for one major state hospital, difficulties in recruiting quality staff because of pay that's not competitive, and inefficient, expensive practices of moving mentally-ill inmates between Southern and Northern Nevada.

The $2.1 million would allow the state to renovate and reopen a state facility in Southern Nevada, hire more staff, pay for a mental health “drop-in” center and provide for more patient beds.

Gov. Brian Sandoval’s chief of staff called the funding “urgent” in the wake of a dramatic spike in the numbers of mental health patients flooding Southern Nevada’s emergency rooms and a crisis at Rawson-Neal Psychiatric Hospital in Las Vegas.

“Circumstances have changed, and we believe expeditious action is required today,” said Gerald Gardner, Sandoval's chief of staff. Assemblyman William Horne, D-Las Vegas, called the funding transfer an example of “robbing Peter to pay Paul.”

In addition to backlogs at emergency rooms, the state is also facing a lawsuit from the Clark County Public Defender’s office, filed in June, alleging that the state has lagged in treating mentally ill criminal defendants so that court proceedings may move forward. The suit is related to a 2005 case in which the state agreed to treat patients within seven days.

The emergency room overcrowding problem is a repeat crisis for Southern Nevada. In 2004, the county had the same problem and declared a state of emergency.

“We tend to fix the problem and it goes away, and we cut or move dollars and it comes back, and it comes back with a vengeance,” said Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas. “That’s the problem.”

Given ongoing structural problems with Nevada's system, legislators also asked state officials to quantify costs for long-term fixes to the mental health system.

Following questioning, the officials noted problems in the state system:

• Metro Police currently fly mentally ill criminal inmates to Northern Nevada for treatment at the state’s Lake's Crossing center.

“That doesn’t make sense for me,” said Mike Willden, director of Nevada’s Department of Health and Human Services. “Flying 70 percent of our forensic patients from the south to the north for treatment really doesn’t make sense.”

As a solution, state officials said they want to reopen the Stein Hospital facility in Las Vegas to house the criminally mentally ill, but this will cost $3 million for renovations and millions more for furnishings and staffing.

• Paying the $3 million renovation cost would mean the state won’t pay for “life safety” renovations at Lake’s Crossing because state officials recommended shifting this money to pay for renovations at the old Stein Hospital.

The Lake’s Crossing facility lacks accreditation from the federal Centers for Medicare & Medicaid Services because the state can’t do these life safety repairs to make the building compliant with modern safety regulations, Willden said. Therefore the state loses money because it can’t collect federal dollars to help pay for the inmates at Lake’s Crossing.

Legislators took no action on this $3 million request.

• The state wants to hire mental health contractors because it can’t afford to pay full-time employees competitive salaries.

“We can recruit them; we can’t close the deal,” Willden said. “Hence you see more and more requests from us to approve contractors. ... Down the road compensation is going to be an issue.”

Sandoval has added about $16 million to the mental health system this year. Some of that money pays for a 24/7 urgent care center for the mentally ill and outpatient community services for mental health patients.

The money the Legislature approved Tuesday will also help pay for a drop-in center, which could alleviate overcrowding at emergency rooms.

“I believe our future is developing the community end of this: the drop-in center and the urgent care,” said Willden, noting that the state urgent care facility has only been running for 11 days.

In some ways, legislators and the governor planned for Tuesday’s special legislative meeting.

During the legislative session, legislators set aside $4 million for facility improvements, staffing and operating expenses for Southern Nevada Adult Mental Health Services in-patient facilities like Rawson-Neal Psychiatric Hospital. The $2.1 million approved on Tuesday is to pay for improvements and more services through the end of the fiscal year.

The Legislature budgeted those dollars at a time when the hospital had come under increased scrutiny after the Sacramento Bee published a series of stories detailing how the Las Vegas psychiatric hospital improperly bused patients out-of-state without plans for follow-up treatment or family support.

The Joint Commission, an oversight agency for hospitals, yanked Rawson-Neal’s accreditation last month following an inspection of the facility. The state chose not to appeal the decision.

State officials had earlier argued that they had made several policy changes following publication of newspaper stories critical of the busing practices. They plan to apply for reaccreditation this year.

Rawson-Neal retains certification from the Centers for Medicare & Medicaid Services, meaning federal dollars still flow to Rawson-Neal for reimbursement for services.

Adding beds in Southern Nevada would replace some beds removed during the recession. The Department of Health and Human Services’ request to add 22 beds for patients would restore the 22 beds that the department eliminated during 2011.

The Legislature also budgeted money this year to add 10 more beds in Southern Nevada, but the state government would still need to add 12 beds if it wanted to provide the same level of service it did in 2010, when it shed staff and another 22 patient beds.

Adding money during the state budgeting process this year and at Tuesday’s meeting means mental health budgets are climbing back toward pre-recession levels.

There’s $23 million more in mental health spending this year than there was last year, Willden said. “Is that enough? No, I’m here to tell you it’s not enough,” he said.

Legislators, who adjourned their legislative session in June, called for more funding for mental health. “We are at a crossroads and we had better darn well find some funding sources to take care of our buildings and our people,” said Sen. Debbie Smith, D-Reno.