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July 22, 2014

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Mental health budget gets a shot in the arm

Ginger Maline believes her 37-year-old son, who suffers from schizophrenia, is better off staying in Milwaukee than moving to Las Vegas.

As a volunteer for the Southern Nevada Alliance For the Mentally Ill, Maline hasn't been happy with the state's funding of mental health care.

"That's why our son is in Wisconsin," she said. "I don't want him here unless there are good programs. In Wisconsin they have good community support programs. There's a lot more understanding about mental illness in Wisconsin than here."

That said, Maline is ecstatic over the Nevada Legislature's decision to spend $177.5 million over the next two years on mental health care. That's a 48 percent increase over the previous biennium, and even $10 million more than proposed by Gov. Bob Miller.

Maline isn't alone in her enthusiasm. She's joined by mental health care advocates and professionals throughout Las Vegas. James Northrop, director of state-run Southern Nevada Adult Mental Health Services in Las Vegas, called it "Christmas in July."

They're excited because the additional funds will be used to purchase newer and safer medications, and start treatment programs that have been successful in other states.

"We should see a reduced rate of hospitalization and crisis contact, and longer stays in the community," Northrop said. "We should see fewer (negative) side effects and better functioning in the community."

Mental health advocates traditionally have been among the weakest and least successful lobbies in Carson City. Throughout the 1990s, Nevada has ranked near the bottom in the amount of money it spent per person on mental health.

A historical perspective by the Mental Health Legislative Task Force, a group of Nevada advocates and professionals, noted the state's mental health services were at an all-time high when they underwent drastic cuts in 1992. Miller made the cuts in response to the nation's economic recession, but mental health advocates never forgave him.

"Closings included four mental health clinics in Clark County, one clinic, a halfway house and the geriatrics unit in Washoe County, and seven out of 15 rural clinics," the task force noted. "Case management was cut, hundreds of staff positions were discontinued and residential rehabilitation programs were closed. With one stroke of the pen, Nevada's mental health system lost over a decade of progress."

It therefore was no surprise when mental health advocates lined up behind Las Vegas Mayor Jan Laverty Jones in her unsuccessful 1994 gubernatorial bid against Miller.

Bob Wolfe, a peer counselor at the state-run clinic at 6161 W. Charleston Blvd., is no fan of the governor.

"He really doesn't know mental health," Wolfe said. "He's more into school funding."

That mental health advocates succeeded with the 1997 Legislature represents a textbook example of how an underachieving special-interest group can acquire political clout. They did it by ridding themselves of infighting, and agreeing to work together on common goals.

They also were more cordial with lawmakers. Morty Eber, vice president of the Southern Nevada Alliance for the Mentally Ill, said that allowed advocates to do a better job explaining their agenda to legislators.

"There was no question it was less adversarial," said Eber, father of a mentally ill son. "We had a lot of people in the community who were mental health advocates who were so disillusioned with how we were treated that they used to get in the face of elected officials and the people who ran the agencies."

Unlike mental retardation, which can result in developmental disorders and less-than-average intelligence, mental illness is a brain disorder than can afflict even the most intelligent individuals. The most common forms of mental illness include schizophrenia, whose sufferers may have strong fears or hallucinations, and mood disorders, such as depression.

Wolfe, who suffers from deep depression, once ran a successful commercial property management company in Montana. He also had a drinking problem.

After his mother died, he fell into a deep funk. Initially, he was misdiagnosed as an individual who wasn't motivated to work or do anything.

Once he received proper medication and counseling, however, Wolfe's condition improved. He now helps mental health professionals do a better job treating patients in his role as a consumer advocate. He's also about to begin a $10-an-hour job at a local resort.

"We're human beings," he said. "We can get out there and work. We just need the chance to get care. (The misconception is) that we all have to be in the hospital, and that all we want to do is sit around and smoke cigarettes and drink coffee."

One reason mental health advocates are elated is that there will be more money available for such new-age drugs as Clozapine, Olanzepine and Risperdone. The state also will be able to serve more patients.

That's important because in Clark County, the average monthly caseload in state-run medication clinics rose from 2,428 in fiscal 1995 to 3,324 through May. The total patient caseload in local state-run clinics also rose from 8,343 in fiscal 1995 to 10,140 through May.

"The new medications are an awakening," said Ann Marie Smith, president of Americans For Mental Health in Las Vegas. "They'll enable a person to be possibly a wage-earning person. You'll actually see less people that will be perceived as mentally ill."

Smith, also the parent of a mentally ill son, is equally enthusiastic over the new leadership provided by Northrop, who was elevated to his current post last fall.

"Jim is a true advocate," Smith said. "He cares about the person. He's not so lost with bureaucratic stuff that he's focusing on programs to the detriment of the person he's serving."

Northrop's agency, part of the Nevada Division of Mental Hygiene and Mental Retardation, operates two clinics in Las Vegas, one in Henderson and another in North Las Vegas. The Legislature agreed to open another clinic in Pahrump in July 1998 and one in Mesquite in January 1999.

Under Northrop's guidance, some of the increased state funding will be used beginning in January to launch a Program for Assertive Community Treatment. Hailed by advocates, this team care approach has been deemed a success in states such as Wisconsin and Michigan.

In Las Vegas, the program will involve 72 severely mentally ill individuals served by a team of six professionals. The professionals, including doctors, nurses and social workers, will each make house calls to 12 clients on a regular basis.

The visits will include help taking medication or learning how to shop or ride a bus. Team members will also meet to discuss the progress of the clients. If clients have special needs, they may get visits from team members other than the ones they've been regularly assigned.

"We hope to target the individuals who show (hospital) recidivism," Northrop said. "We will scrutinize carefully the usefulness of this program and others. If we demonstrate success, we'll ask for more teams."

The added funding also will enable local clinics to beef up their counseling and case worker staffs. The benefits are expected to affect not only those individuals with housing but those without. An estimated 30 to 40 percent of all homeless individuals have a mental illness.

The Salvation Army is attempting to get federal money through Clark County and the city of Las Vegas for a temporary shelter for the homeless mentally ill. Current shelters are usually filled on a first-come, first-served basis.

"The whole homeless community realizes that mental health care is the biggest need," Smith said.

Smith also said she'd like to see future funding for a factory that could be used to give mentally ill individuals job skills.

"The end result is we want them to be as independent as they can be," she said.

The increased state funding is appreciated by private sector health care providers. One is Michael Adams, president of Behavioral Health Care Options, a subsidiary of Sierra Health Services Inc.

HMO consumers can get short-term coverage for mental illness but it's more difficult to get insurance for long-term care. That's one reason state-funded services are important, Adams said.

"The typical HMO benefits are for the short term and for crisis intervention, whereas a lot of problems we see are chronic and very long term," he said. "Better funding in the public sector lets us do our job better because it means more clinical resources are available."

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