Lawmakers facing tough decisions on mentally ill

Art Nadler

Friday, Jan. 30, 1998 | 10:13 a.m.

The Senate Committee on Commerce and Labor has established an interim study committee to examine whether the state needs to be more involved in the treatment of mentally ill patients.

Presently, a broad interpretation of mental illness applies to any person who poses a clear and present danger of harm to himself or others. The person must also lack the ability to exercise self-control, judgment and discretion in the conduct of his affairs and relationships with others.

Consequently, when individuals who have been committed to mental institutions show that they no longer pose a danger to themselves or others, they are usually released back into society.

This has become the crux of a fiery disagreement between relatives and concerned citizens who feel former mentally ill patients need ongoing care, and proponents of Americans' inalienable right to refuse treatment.

Ed Clements, a retired Air Force colonel, is spearheading a grass-roots movement to revise Nevada's law on mental illness. He says the law, as written, goes further than the above definition, but mental health facilities, hospitals and law enforcement agencies aren't enforcing it. He wants the law revised to be more clear.

Clements says the law also allows for individuals to be committed to mental facilities, if they are unable to care for themselves.

He refers to Subsection A of NRS 433A.115 which states that a person who: "Acted in a manner from which it may reasonably be inferred that without the care, supervision or continued assistance of others, he will be unable to satisfy his need for nourishment, personal or medical care, shelter, self-protection or safety, and there exists a reasonable probability that his death, serious bodily injury or physical debilitation will occur..." can be committed.

Clements is driven by a deeply rooted personal experience. His 29-year-old daughter is mentally ill. Last January, he said, after being released from a mental hospital, she was shortly thereafter found pregnant and living in the streets.

"We tried to get her to (Adult) Mental Health (and Retardation)," Clements said of his involvement with the state mental health facility. "They said she was not a danger to herself or others. They had nothing to offer, except to transport her to the Salvation Army."

Clements said his daughter ended up at a local hospital emergency room, where she was diagnosed as being dehydrated. A week later, she was discovered to be pregnant.

Besides clarifying the mental illness law, Clements and others want the state to adopt an involuntary outpatient civil commitment program. An IOC would force people with mental illness, who require treatment, to submit to treatment on an outpatient basis.

"How can this possibly work?" H. Jill Smith, a rights attorney with the Nevada Disability Advocacy & Law Center, asked. "How would you monitor it? They'd have to have the mental health police do the monitoring. It would be like being on parole. What happens to people who don't show up (for medication)? Do you arrest them?"

Sen. Randolph Townsend, R-Reno, chairman of the Committee on Commerce and Labor, sees good arguments on both sides of the issue. He stresses that the interim committee has no agenda at this point, and is purely on a fact-finding mission.

"It's a very delicate area of individual rights and public rights," Townsend said. "This is just one tough issue, but we have to have a program in place."

Sen. Jack Regan, D-Las Vegas, a member of the interim committee, agrees with Townsend that an outpatient civil commitment program walks a "very tight line regarding one's civil rights."

He said something has to be done because mentally ill people are eventually picked up and end up in the judicial system.

"We deal with a lot of symptoms of mental illness, but we don't deal with the disease," Regan said. "We have to define above danger to yourself or others."

But, Regan added, he wasn't sure how to do that at this point.

Carlos Brandenburg, administrator for the Division of Adult Mental Health/ Mental Retardation, feels forced IOC would be counter productive. He said many mentally ill people are already apprehensive about dealing with mental health facilities.

"When you take away someone's rights, you see the stress and alienation in their faces," Brandenburg said. "The time would be best spent on not changing the law, but supporting a client-based community system. Give me the resources for housing, care management and outreach workers. That's how you help the person, when you make contact in the community."

Brandenburg also felt that it would be difficult to administer medication and monitor mentally ill people. Doctors, he said, are reluctant to give medications outside of a hospital setting.

Clements insists the mentally ill can't be helped unless the state becomes involved.

"In fact, if private individuals or organizations do force individuals to do the right things to keep mentally ill individuals under control," Clements said, "they can be held liable by the same system of laws that incarcerates these individuals, because they demonstrated they were a danger to themselves or others...

"The only agency with the authority to do that is the state. In the case of the mentally ill, the individual cannot make a life-threatening decision for them -- they have a brain disorder that prevents them from doing that. Who is left. The state."

The interim committee will meet again in Carson City Feb. 26. The meeting will be teleconferenced at 9 a.m. to Las Vegas in the Grant Sawyer State Office Building, 555 E. Washington Ave., Room 4100.