Friday, June 10, 2005 | 11:01 a.m.
As the dust settles from the frantic ending of the legislative session, advocates for the mentally ill are cheering.
"I'm ecstatic about it," Assemblywoman Sheila Leslie, D-Reno, said of the dramatic increases approved in funding for mental health services.
Despite the furor over property taxes, tax rebates, education and other initiatives, the mental health boost "is probably the most important thing that came out of the session, in my mind," Leslie said.
Leslie's plan to relieve pressure on Clark County's emergency rooms beat out a different proposal in the Senate, sponsored by Sen. Joe Heck, R-Henderson.
In addition to Leslie's bill, which gives $15 million to various mental health initiatives, the Legislature approved intact Gov. Kenny Guinn's mammoth recommended increases in the mental health budget.
Of the $91 million in new funding in the budget, $64 million, or about 60 percent, goes to Southern Nevada, where an emergency was declared 11 months ago when one-third of the area's emergency room beds were filled with mentally ill patients waiting to be moved to the chronically full state mental hospital.
Guinn spokesman John Trent noted that there was bipartisan support for the outlay, and the need for it wasn't really disputed.
"This was something that needed to happen," Trent said. "We don't want to grow government in every area, but we need to keep up with the growth of the population. I think the governor's really happy about the way things played out."
The new funding represents an increase of nearly 48 percent over the previous budget for a total of $282 million. The mental health agency's staff will increase by 449, with 356 of the new positions in the Las Vegas Valley.
"The state has come through with their commitment," said County Manager Thom Reilly, who has fought an often frustrating battle for the resources since declaring the emergency last July. The situation, he said, "is still going to be precarious for certain reasons, but there's definitely some hope on the horizon."
People in the throes of a mental breakdown, thought to be a danger to themselves or others, are taken to emergency rooms by ambulance, where by law a doctor must check them to make sure their medical condition isn't precarious.
Then the patients are supposed to get checked in to the state psychiatric hospital on Charleston Boulevard for treatment. But that hospital, built in the early 1970s, is much too small. So the patients wait in the emergency rooms for days -- usually at least three and as many as nine -- until a spot opens up so they can be transferred.
With Las Vegas-area emergency rooms already strained by growth and tourism, the beds where the mentally ill lie waiting for transfer are beds that then can't be used to treat the sick, who may wait hours before being treated.
A new mental hospital currently under construction is scheduled to open next year. Until then, Leslie's bill will spend $7 million to create "crisis placements." Leslie described that as a facility, operated by contract, where patients could go after being cleared by an emergency room doctor but before being placed in the state hospital.
"The holdup at the hospitals hasn't been getting the tests done, it's been what do you do with them (the patients) afterward," Leslie said.
Heck's proposal, on the other hand, would have bypassed the emergency room entirely, taking those in mental crisis directly to a separate facility staffed with a physician, where they could be medically cleared, psychiatrically stabilized and then transferred to the psychiatric hospital if needed.
Heck, an emergency room physician, said his proposal would have been preferable, but the crisis facility would still take some pressure off emergency rooms.
"I think it'll help, but the answer is not to have (mentally ill) people going to the ER to begin with," he said. "The big clog is when they start out in the emergency department and we can't move them out."
Leslie said taking medical clearance out of the emergency rooms was too expensive.
Her bill also includes $1.7 million to double the number of residential placements contracted out by the state; $1.9 million for Clark County's year-old specialty court for the mentally ill who repeatedly commit nonviolent crimes; and $1.8 million to continue funding a mental health triage center, operated by WestCare.
Vic Davis, president of the Southern Nevada chapter of the National Alliance for the Mentally Ill, agreed with Heck that taking medical clearance out of the emergency rooms would have been preferable.
"But this will take some of the pressure off and reduce the wait time," Davis said.
He cautioned, however, that the new services available will quickly fill up, and the new mental hospital will be full as soon as it opens. More emphasis is needed on services such as housing and counseling that can keep people out of the emergency room altogether.
Leslie said other initiatives would also help the mentally ill, such as new funding for emotionally disturbed children and child welfare. Her only regret, she said, was the failure to pass a bill that would have devoted $4.5 million to services for families with autistic children.
Leslie, who works at Washoe County's mental health court, said the recognition of mental health needs was long overdue. "Policymakers across the state and the general public understood that we have to address this crisis because it affects everything," she said.
Carlos Brandenburg, in charge of the state Division of Mental Health and Developmental Services, noted that support for mental health came not only from Democrats such as Leslie and Assembly Majority Leader Barbara Buckley, D-Las Vegas, but also from conservative Republicans such as Heck, Senate Majority Leader Bill Raggio, R-Reno, and Sen. Randolph Townsend, R-Reno.
"It's been a great session for us, and the winners are all Nevadans who suffer from mental illness and their loved ones," Brandenburg said. "It's become a nonpartisan issue, a Nevada issue."
But he cautioned against complacency. "According to our prevalence study, we're serving only half of the severely mentally ill in Nevada," he said.
"Even with this (increase), 30 to 40 percent of the mentally ill are not going to be receiving services. We're not going to rest on our laurels."
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