More mental health funding is sought

By Steve Kanigher

Friday, Oct. 10, 2003 | 11:22 a.m.

Emergency room physicians and Metro Police plan to again press Nevada legislators for state funds that they say are desperately needed to tackle pressing mental health care issues in Southern Nevada.

For the physicians, the issue is relieving hospital emergency rooms that are overflowing with mentally ill individuals, preventing others from getting immediate care. Clark County set a local record last month for the number of mentally ill patients involuntarily sent to emergency rooms under a state law that allows them to be temporarily committed by police, nurses and other social service professionals.

For Metro, the issue is beefing up a new program that diverts mentally ill individuals from jails to a local treatment facility.

Based on testimony Thursday from both the physicians and Metro representatives at a mental health hearing in Las Vegas, state lawmakers can expect an earful when a subcommittee of the Legislature's Interim Finance Committee meets on Oct. 20 to consider the funding requests.

The concerns from physicians and police were aired at a meeting of the Nevada Mental Health Plan Implementation Commission at the Sawyer State Office Building. The commission is considering whether to implement proposals in Nevada that were recommended in July by a national mental health panel that was formed by President Bush.

Dr. Dale Carrison, University Medical Center's emergency center director, said he complained to state officials three years ago about the strain placed on local emergency rooms by the "involuntary holds" of mentally ill individuals. But he said that he got no response and that the problem is getting worse.

"The system is completely overwhelmed," Carrison said. "The system is still broken and we're in crisis."

What Carrison and fellow emergency room physicians want is for the state to provide funding for mobile teams that specialize in emergency mental health care. Such teams, which would include a psychiatrist, would relieve the pressure placed on emergency room physicians who do not specialize in mental illness.

Without the teams, emergency rooms will continue to get backed up with mental health patients, causing delays in care for other emergency patients, such as those with chest pains, doctors told lawmakers. The problem spills over to ambulance services, which are often delayed when trying to unload patients at emergency rooms. The ripple effect includes delays in ambulance response time.

Dr. Rick Henderson, emergency department director at St. Rose Dominican Hospital, said entertainer Roy Horn, who remains in critical condition after being mauled last Friday by a tiger during a performance at The Mirage, was lucky that an ambulance arrived at the scene in under five minutes. Often people who call for an ambulance in the valley wait far longer than they should have to. That's largely because ambulance crews frequently get tied up while trying to turn patients over to hospitals, Henderson said.

"It's the equivalent of closing down two hospitals to take these (mental health) patients," he said.

During a hearing recess, Jonna Triggs, clinic director of the state's Southern Nevada Adult Mental Health Services, said that county emergency rooms had a record 71 involuntary mental health patients on both Sept. 1 and Sept. 2, and averaged 55 a day for all of September.

"It's a mess," she said.

The reason these patients wind up in emergency rooms is due to the lack of hospital beds for the mentally ill. Lawmakers were told that Nevada has only 4.5 publicly funded beds for such patients per 100,000 residents, compared to a national average of 33 beds per 100,000 residents.

A new state psychiatric hospital planned for Las Vegas won't open until 2006, at the earliest. Even then, Triggs said the state would have only eight publicly funded beds per 100,000 residents.

The commission was told that mentally ill patients are involuntarily held in emergency rooms anywhere from 36 hours to nine days. They are often strapped to gurneys, hooked to catheters and left in hallways.

"We are depriving them of their rights and they're not getting the care that they deserve," Dr. Gary Goldberg, assistant medical director of the Sunrise Hospital and Medical Center emergency department, said. "It's actually a tragedy. This is a problem that needs to be dealt with now."

Commission member Charles Duarte, chief of Nevada's Health Care Financing and Policy Division, suggested that hospitals help pay for the mobile mental health units since most Southern Nevada hospitals remain profitable. But Carrison said that UMC has suffered from millions of dollars in losses and cannot afford to pay for such help.

"This is truly a state responsibility," Carrison said.

State Sen. Ray Rawson, R-Las Vegas, a commission member and dentist by profession, expressed support for the physicians.

"I'm concerned about an automobile accident or a heart attack," Rawson said. "I want you to be around if I show up. I don't want to wait."

Metro representatives also weighed in with a request for an additional $677,333 in state funds to help support a triage center at WestCare that helps police divert individuals with mental illness from incarceration to treatment. The commission was told that the cost to taxpayers for triage is only $250 a day, compared with $1,500 a day if sent to an emergency room.

The commission, convinced by Metro's arguments, voted to recommend that the state provide the additional funding. The triage center, which has served 3,000 patients so far this year, was counting on a budget this fiscal year of $3.8 million, with funding equally split among local governments, hospitals and the state.

The state has already agreed to partial funding but Metro is seeking the additional money to avoid cutbacks to the program.

Some members of the Interim Finance Committee initially balked at Metro's request last month before agreeing to form a subcommittee to study the request further.

"I've been surprised by the opposition to this," Rawson said. "Who wouldn't want to solve this problem?"

Janelle Kraft, Metro's budget director, said some of the opposition may be based on the fact that the program is located at WestCare, a Las Vegas facility that has alcohol and drug abuse treatment programs.

"WestCare is the only game in town in terms of detox," Kraft said. "That wasn't our first choice but they came forward and graciously offered their facility."

Metro Officer Frank Pascoe, one of the first local police officers to be trained in crisis intervention to deal with mentally ill individuals, talked about one person who was arrested 736 times in the county and another who was detained 503 times, all for petty offenses.

Both individuals were mentally ill but no triage services were available to help them so they were repeatedly transported to jail, Pascoe said. He said Metro's goal is to train 20 percent of its patrol officers in crisis intervention.

"We want to de-escalate the whole situation and move it away from a potential deadly outcome," Pascoe said.

The commission also received an update on suicide prevention programs in Nevada from Dr. Rena Nora, clinical professor of psychiatry at the University of Nevada School of Medicine.

Nora said that a new state suicide prevention program that was approved by lawmakers this year should get off the ground by January 2005.

Nevada for years led the nation in the number of suicides per capita, but dropped to third in 2001, according to the latest statistics. There were 452 suicides in Nevada last year, including 273 involving Clark County residents and 39 involving visitors from elsewhere.

Nora said she would like to see more state attention diverted toward early intervention programs. She also said it would be helpful if more insurance plans covered treatment for addictions.

The commission is planning four more hearings and then will issue recommendations to Gov. Kenny Guinn and the Legislature early next year.