Wednesday, Aug. 11, 2004 | 8:25 a.m.
Editor's note: In August the Where I Stand column is turned over to guest writers. Today's columnist is Kenny Guinn, governor of Nevada.
AS GOVERNOR of the state of Nevada, one of my primary concerns has been health care. A fundamental part of any health care system revolves around the ability of people to have timely access to needed services when they have medical emergencies.
Last month this issue came to a head when Clark County Manager Thom Reilly proclaimed a state of emergency due to mental health patients overcrowding hospital emergency rooms. This issue, however, did not become a crisis overnight.
In my budget presented to the 2003 Legislature, there were several initiatives to address the growing mental health needs in the Las Vegas area. They included: a new 150-bed psychiatric hospital scheduled to open in spring 2006, a second program for an assertive community treatment team, a mobile crisis team to visit local hospitals and help triage mental patients, expanded medication clinic services, residential supports and service coordination.
Overall, the mental health budget was increased 35 percent in Southern Nevada for the 2004-2005 biennial budget, as compared to the 2002-2003 budget. Most of the budget expansion was targeted to provide community-based services and to keep people out of hospitals.
That said, we all know there are times when hospitalization is the only way to stabilize patients and provide the care and services they need. When this occurs, the current process is to take the seriously mentally ill to a local hospital to ensure these individuals do not have medical problems before their mental health care needs can be assessed.
Today there are only about 140 psychiatric hospital beds that are available to provide care to the adult population in the Las Vegas area, of which the state operates 103 beds. These psychiatric beds serve a seriously mentally ill population estimated to be 5 percent to 6 percent of Nevada's population (between 75,000 to 90,000 people in the Las Vegas area).
Four years ago the number of psychiatric beds in the Las Vegas area was double this number (260 beds). Three local hospitals have closed 133 psychiatric beds since 2000, severely limiting Southern Nevada's ability to handle the needs of the seriously mentally ill.
Clearly, the closure of private psychiatric beds and population growth alone have put extreme pressure on Nevada's public health care system. In December 2003 an average of 24 mentally ill patients were in local hospital emergency rooms waiting for admission to the state hospital.
For some reason, 2004 has seen a tremendous increase, with the average growing to 57 per day in June 2004 and peaking on July 9 of this year to more than 100. The state responded through the Division of Mental Health and Developmental Services by contracting Westcare, a local nonprofit organization, to provide relief to hospital emergency rooms. Using emergency funding, Westcare, senior staff and hospital emergency room staff were able to transition about 100 patients out of the emergency rooms.
Unfortunately, due to the limited nature of emergency funding, this resource is not available on an ongoing basis. Therefore, the state also used emergency funding to rehabilitate 28 beds on the Southern Nevada mental health campus to help with overcrowding conditions. The Nevada Legislature has been asked to provide funding to operate these beds and will make this decision on Thursday. I have urged them to provide the ongoing funding necessary.
The events of the past month are illustrative of the fact that Nevada is not just in the midst of a mental health crisis -- our state is in the midst of a public health crisis. There are days when emergency rooms in Southern Nevada are full, and individuals with medical emergencies cannot be admitted without waiting for long periods. At the same time, mentally ill patients are not getting the treatment they need from these same emergency rooms. Compounding matters even further: hospitals have very limited capacity if there is any type of major event that requires a medical response.
We all must plan for future needs, including staffing more hospital beds at the state facility, providing more community-based resources and encouraging the private sector to provide mental health care in the community and in hospitals.
If we do this, our state will move from "crisis" mode into a "solutions" mode regarding the public health of our citizens.