Youth mental health facility suffers from staff shortage

Stacy J. Willis

Saturday, Nov. 25, 2000 | 3:02 a.m.

This is where the lucky kids go.

Inside this teenager's tiny room at a psychiatric facility on Charleston Boulevard is a single bed, a locked window and a desk. The linoleum floor is squeaky clean, the walls bare.

His only apparent personal items are a pair of Nikes in the corner and, taped to the back of the secured door, a picture of NBA star Shaquille O'Neal.

This adolescent is one of few who have been admitted to the only state-operated, youth psychiatric hospital in Southern Nevada, Desert Willow Treatment Center.

Many other under insured or uninsured mentally ill children and adolescents are on a three-month waiting list to gain admission -- some are stuck in Las Vegas hospital emergency rooms, some wait in group homes and others have been sent to out-of-state facilities.

But Desert Willow's beds are not all full. In fact, 20 of the 56 beds in this 2-year-old, $8 million facility are empty. The problem, says Desert Willow Administrator Barbara Qualls, is that the state hasn't funded enough staff for the operation.

"We decided in July that in order to keep the quality of care at a high enough standard, we had to increase the staff-to-patient ratio," Qualls said. "We have beds sitting empty, but we can't admit because we don't have enough staff to watch the kids who would be in those beds."

Desert Willow opened in 1998 with funding to employ 65 direct-care staff -- 54 mental health technicians and 11 nurses. But within two years it became apparent that the acute and nonacute patients needed more thorough care, said Vicki Miller, director of nursing. The staff-to-patient ratio was raised to 3-to-1 for nonacute care and 4-to-1 for acute care. "These are kids with all sorts of problems. It runs the gamut," Qualls said. "We've got kids who suffer a serious depression and tried suicide, we've got kids who are sexually abused, kids who are schizophrenic.

Nowhere to go

"A lot of them are in the custody of the state -- kids who have been in and out of the system, kids from foster care, kids from group homes, kids who really need quality care and attention. There is nowhere else to go from here," Qualls said.

Qualls estimates that Desert Willow needs 20 additional employees to open the 20 unused beds. Her proposal to the state Division of Child and Family Services requests roughly $550,000 in additional staff funding, she said.

But the division is uncertain about exactly where that money would come from -- or whether it is entirely necessary.

"Basically right now the request for additional funding is being studied," Dr. Christa Peterson, deputy administrator of the division, said. "But I don't think the intent is for nothing to happen."

To parents of emotionally disturbed children, the state's uncertain answer to the problem at Desert Willow is insufficient.

"I've spent a lot of time talking to division officials and going around and around," said T.J. Ingebretson, community outreach coordinator for Nevada Parents Educating Parents, a federally funded resource organization. Ingebretson has worked with more than a dozen parents whose children have either been in Desert Willow or await admittance.

"It is very difficult for parents -- especially when you're having a crisis with your child -- to be told to wait," Ingebretson said.

The most immediate source of funding for the state institution would be the Legislative Interim Finance Committee. In order to secure emergency state funds, the division would need to submit a proposal through the state Department of Human Resources to the committee, which will meet on Dec. 4.

Otherwise, the next chance to receive an appropriation would be during the spring legislative session -- which means funds might not be available until next summer.

"But we need this now -- we really can't wait until the legislative session," Qualls said. "The population is growing here, and the pot is boiling over."

In addition to affecting families, Desert Willow's staff shortage is affecting other health care facilities. Local hospitals that are struggling with their own overcrowded emergency rooms and nurse shortages are forced to absorb the overflow of the state's mentally ill children.

University Medical Center Pediatric Emergency Room Director Dr. Larry Satkowiak said an average of four mentally ill children per week are brought into his emergency room.

"I get a child who just took 7,000 pills and says he wants to kill himself, and I call Desert Willow and they say, 'We don't have a bed for him. Sorry,' " Satkowiak said.

"So we have to admit children to UMC even though we don't have the psychiatric care they need. Sometimes we just keep them in the emergency room until the acute episode has subsided, or sometimes we admit them to the hospital.

"Sometimes it's better to just hold them in ER because if they are admitted, they have to have a sitter -- a nurse who can watch them around the clock. That's another staff person for us," Satkowiak said.

"But if we're promised a bed at Desert Willow the next day, we just hold them here in ER overnight because we have nurses on duty," he said.

Parents, health care officials and social workers say that Desert Willow's problems are indicative of a state that has continually failed to adequately serve mentally ill children.

"We need more programs, more help for these kids," said Kathy Love, who runs Reaching Our Community's Kids, a behavioral day-treatment program. "This has become a waiting game more than anything else. We're seeing kids shifted around and held in a holding pattern until someone else gets discharged because there aren't enough programs."

Nevada has been notoriously low in mental health funding since the 1970s, according to the National Association of State Mental Health Program Divisions in Arlington, Va. The state has ranked at the bottom in state dollars appropriated per capita for mental health for years, despite having the highest suicide rate in the nation and a population with high substance abuse and addiction issues.

State officials say mental health program funding is increasing, but still lags well behind the population growth. Between 1991 and 1999, the state saw a 23 percent increase in mental health funding, and in 1999, Gov. Kenny Guinn's budget included increases for a variety of mental health programs, Peterson said.

"We've had increases every year in some aspect of the children's mental health system," Peterson, who has worked for the state more than 20 years, said.

Still, Nevada's youth mental health system -- which includes everything from out-patient counseling to residential treatment -- served only 1,049 children last year. Of those only 243 were served in one of the two on-campus acute facilities, Desert Willow and Willow Springs in Reno. The average stay in Desert Willow for acute care is 30 days. Length of stays for nonacute patients varies widely.

State Assemblywoman Barbara Buckley, D-Las Vegas, said a bipartisan committee of lawmakers has been working this winter on proposals to reform the foster care system in the state -- including a request for appropriations for youth mental health programs.

"The question is always 'Where will we get the money?' " Buckley said.

"For some reason some legislators don't consider this a priority," Buckley said. "But the longer a child languishes without getting treatment, the greater is the likelihood that they will spend the rest of their life in our mental health system or prison system."

Peterson said the division was committed to getting additional funding for Desert Willow, "but there are many different funding sources."

Recruiting providers

In addition to courting federal or private dollars, she said the division is trying to recruit more private providers to the state.

Southern Nevada lost one of its private psychiatric care providers when Charter Hospital closed earlier this year. Another private psychiatric facility, Montevista Hospital, has 28 beds for children in Las Vegas and works with Desert Willow to hold underinsured patients until a bed at Desert Willow is open, Qualls said.

Other states, such as Florida, are looking toward privatizing state facilities as a solution to the high demand for mental health care.

But as the state continues to grow, so does the population of underinsured or uninsured children who rely on state care.

"If you look at the population growth and the number of children we're serving, we're probably not keeping up," Peterson said. "What's the solution? That's not an easy question to answer."