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September 2, 2014

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J. Patrick Coolican:

The jail shouldn’t be our community’s largest psychiatric facility

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J. Patrick Coolican

Metro officer shoots, kills suspect

KSNV coverage of Metro police shooting and killing a man outside a condominium complex in the northwest valley, Dec. 12, 2011.

Sheriff Holds News Conference After Shooting

Sheriff Doug Gillespie arrives for a news conference at Metro Police Headquarters Monday, December 12, 2011. Gillespie called the news conference after a Metro Police officer shot and killed a man early this morning at a condominium complex in the northwest valley.  . Launch slideshow »

Between 25 and 30 percent of inmates at the Clark County Detention Center are prescribed psychiatric medication.

The largest psychiatric facility in Clark County? The jail.

This should embarrass us, even if our community is by no means unique in this regard.

I was drawn to this subject late last year, when Metro Police shot and killed Stanley Gibson, an unarmed, disabled veteran who was apparently in the midst of a psychiatric episode.

While Metro’s role in the tragedy is important and deserves close examination, the incident also revealed a problem that is related and just as pressing: gaping holes in our mental health safety net.

I spoke to a number of experts from government and nonprofit groups, and they agreed that our mental health system, though filled with hardworking professionals, is fractured and underfunded, leaving thousands throughout the valley undiagnosed and untreated — or in jail when they should be in treatment.

“If government is supposed to be there to help people who can’t help themselves, I can’t imagine a more important issue than mental health,” said Randolph Townsend, a former Republican state senator who served on a federal mental health task force.

It’s not clear exactly what happened to Stanley Gibson in the last days of his life. But here’s what we can piece together:

Gibson ran out of anti-anxiety medication before the federal Department of Veterans Affairs canceled his appointment to see a doctor. The VA told him they wouldn’t refill his prescription without his seeing a doctor. (The VA didn’t return my call.)

Gibson was troubled and delusional, and police were called. He was arrested for “resisting arrest” and booked into the jail Saturday evening, a spokesman for the family said. Officers assured Gibson’s wife that he would receive a psychiatric evaluation and be held for his own safety.

Instead, he was released that same night. Gibson’s family called 9-1-1 Sunday, and he was taken to University Medical Center, but he walked away around 7 p.m.

Hours later he was dead.

Reading what we do know about Gibson’s final days after the fact is crushing because we see so many opportunities to stop the tragedy.

“I hear stories like this every day,” said state Sen. Sheila Leslie, who also administers the state’s specialty courts, including the mental health court.

Despite the Gibson debacle, experts I talked to said Metro is considered progressive in its treatment of the mentally ill. They also say Sheriff Doug Gillespie has worked hard to train his officers to deal with the mentally ill.

“Metro has an excellent mental health team. When they have time to process the information, they know exactly the intervention the person needs,” Ron Lawrence, executive director of Community Counseling Center of Southern Nevada, said.

Metro’s Crisis Intervention Team, which is modeled on a highly regarded program in Memphis, Tenn., specializes in defusing volatile situations, getting the mentally ill into treatment and keeping them out of the judicial system, when appropriate.

In an interview last month, Gillespie said he was moving toward giving all officers this kind of training. It could save money — we pay $138 per day to house inmates at the jail. Counseling and medication might sometimes be more appropriate and cheaper.

Ultimately, however, efforts by police to move patients into mental health services will be futile if there are no services, Gillespie said.

“Are we providing adequate services to that percentage of the community? I think you can make a compelling case that we’re not,” he said.

Gillespie, whose department’s use of force history and policies are being reviewed by a federal agency, also offered a subtle warning, saying U.S. Department of Justice officials have told him they aren’t just looking at police departments; they’re reviewing whether states and localities like ours are in compliance with federal law. In other words, if our mental health system is found to be so severely deficient that we are violating the civil rights of the mentally ill, we could wind up with a federal judge acting as a kind of viceroy of our social services.

Where are we deficient?

Nevada has the least number of psychiatric beds per capita — 5.1 beds per 100,000 people — of any state, according to the Treatment Advocacy Center.

In Clark County, we have 733 beds, but 127 are set aside for the elderly and 58 for children. We have 298 beds at Rawson-Neal Psychiatric Hospital, but the Legislature only budgeted staff to support 190.

We also suffer a severe shortage of outpatient services — ongoing psychiatric care after the crisis has abated, which means giving people the counseling and medication they need to remain independent and functional.

“They’re in the system. They’re out,” said Brian Patchett, CEO of Easter Seals Nevada, which offers services for the mentally ill and developmentally disabled.

In other words, we lose track of them. Gillespie echoed this thought, noting that jail inmates are given three days of medication on their way out the door, but no one knows what happens to them after that.

Richard Whitley, acting director of the Nevada Division of Mental Health and Developmental Services, said people often have to wait 30 or 40 days for outpatient services.

Lawrence said he has 150 people on his waiting list.

Last year, I spent time with a social worker who was trying to reunite foster children with their parents. She expressed frustration about lengthy wait times for psychiatric diagnosis and treatment and a severe shortage of drug and alcohol treatment, as well.

Navigating the system is another challenge. Where do I go and who do I talk to? These are tremendous challenges, even for patients who have strong support networks of family and friends, Townsend said. “How do you find your way through that labyrinth?”

Overall, our mental health spending is 43rd per capita in the nation, according to Kaiser Health Facts.

Whitley, who is relatively new to the job at the state health division, said he’s trying to use data to most effectively direct resources. “It’s too easy to say we need more money,” he said. “The questions I’m asking are, ‘Where is the system failing and where do you direct resources?’”

Whitley said he takes a public health approach to mental health. In other words, just as we use vaccines to prevent epidemics, we should try to intervene early before mental illness becomes tragic and costly.

Since Whitley doesn’t want to say it, I will: We need more money for mental health services. In the end, we wind up paying anyway — in money for the jail, and in a moral fabric tattered by apathy.

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  1. Nice article. Apathy has been a huge problem in this city for over 40 years as I've been here that long and have seen it. There has never been adequate mental health facilities and no matter who you put into leadership roles, there never will be. Just another reason to leave this declining city. Some, not all of course, of the mental health problems can be helped with the proper rearing of our children. Morals, values, ethics...can not be taught in the school system, that begins at home with the parents. These mental patients just don't suddenly one day "become" mental, it begins in childhood with a lack of nurturing, a lack of direction, a lack of ambition, common sense training, and a lack of knowledge of the consequences of that persons actions. Some mental problems are genetic yet most are environmental, and again, begin with the upbringing in the family or lack thereof. Where did we as a society stop caring about one another??? I keep trying to remember and believe that, "people are still good at heart", but it keeps getting harder and harder each and every day. Wake up America, put the cell phone down, stop caring about the 'jones' and let's try to get back to what made this country the best on this planet.....doing the right thing, making progress towards a better world, taking pride in our products, our accomplishments, and our hearts and souls.

  2. oh please, if your so concerned open your home up for some of them. Or move them in your neighborhood. More liberal nonsense

  3. The healthcare system of the United States has been on a downward spiral to my memory for decades. Even back in the 1970s, you waited on appointments for care. With the advent of "Free Clinics" in neighborhoods, you got more immediate care. PBS had an expose' on successful healthcare models in our country, where EVERYONE received optimal care, as they found that by being proactive rather than reactive, costs of healthcare can be driven down. Our WHOLE country needs to adopt this stance.

    We need to set medical care free of bureaucratic red tape. Severely limit the juridiction of the FDA. Allow citizens to make choices about their healthcare, rather than the INSURANCE COMPANIES being the driving force of what you can and cannot have.

    The trend has been for lawmakers to CUT healthcare and mental health funding rather than rewarding successful models. THis must end. Bring back the family doctor that can do house calls and can have more than a 5-10 minute appointment with you. UNtie the hands of our country's doctors! Release or loosen the medication trials and restrictions so that the people have access with the knowledge of possible side effects. Limit lawsuits on liability---the consumer should beware and be educated given all the information online these days.

    The good people who work in the social service sector need support to do their jobs, their calling, their mission. Empower them with the ability to extend prescriptions if doctor appointments are delayed. Provide the tools they need to better serve clients, people who require needed services to live and survive.

    The poor and infirm are with us always, and our society would do best to show compassion and provide immediate relief to such, rather than further torment them. Mercy is almost a forgotten word in our vocabulary these days. Unmerited favor.

    Commenter Kellen summed up the roots of our current mental health crisis, "Some, not all of course, of the mental health problems can be helped with the proper rearing of our children. Morals, values, ethics...can not be taught in the school system, that begins at home with the parents. These mental patients just don't suddenly one day "become" mental, it begins in childhood with a lack of nurturing, a lack of direction, a lack of ambition, common sense training, and a lack of knowledge of the consequences of that persons actions. Some mental problems are genetic yet most are environmental, and again, begin with the upbringing in the family or lack thereof. Where did we as a society stop caring about one another??? I keep trying to remember and believe that, "people are still good at heart", but it keeps getting harder and harder each and every day."

    The cheapest form of mental health care is to BE THERE for someone.

    Blessings and Peace,
    Star

  4. National Healthcare needs to be of concern to all of us. Access to basic healthcare to all would provide benefits to everyone long term when we do not have to pay the exorbitant price of providing that care when the problem becomes one that requires huge expenditures like those in the story or cancer that could have been prevented if treated early or diabetes that could have been managed if found early, etc. You get the idea.

  5. I second Juan Sanchez :)

  6. The VA here in Las Vegas seems to be poorly managed from the bottom up. It's amazing how competency in low employees can improve an organization.

  7. More liberal nonsense, indeed. How dare you suggest that taxpayers could save long term money by addressing an issue with a relatively modest (compared to the cost to us and private business) investment in addressing mental health issues ! It's bleeding heart liberals like you Mr. Coolican who want to "save the world", but you know what -- the free market will take care of mental illness (if that's even a real thing). We all bought our ticket, we all take our ride. If some mentally ill guy, for instance, stabs me in the heart and actually causes it to bleed, well that's my fault - I should have been busy monetizing his mental illness instead of walking down the street. As a dyed-in-the-wool conservative, I feel that we should never spend taxpayer money on anything except roads and prisons - even if it completely destroys our ordered civilization. It's 2012, Mr. Coolican. Welcome to Thunderdome!

  8. Dayvid F.,

    Why waste money on roads? BTW, I think "bleeding heart liberals" has been replaced with "lame stream media" or "tax and spend crowd." you should invest in the Fox News Dictionary of Conservative terms, available at foxnews.com. Well worth the money and the updated terms will help you crush those Social Security payin', Veteran benefit spending socialist.

  9. Back in the early 1980's, a counselor of alcoholics named "Sundance" sued the City of LA and State of California, claiming that the "criminialization" of public drunkenness was a violation of the rights of homeless people who suffered mental illness. In 1985 an LA Superior Court judge issued a sweeping order, forbidding law enforcement agencies with jurisdiction over LA's skid row from arresting intoxicated individuals. The order was very broad, in that it also forbade law enforcement from arresting other people who appeared to be mentally ill. As the Sundance case took its long trip to the California Supreme Court, the LAPD implemented to court's order "decriminalizing mental illness". Ultimately, in 1987 the California Supreme Court issued a mixed opinion, which upheld the anti-public intoxication law. See: http://articles.latimes.com/1987-01-01/n.... However, as a matter of policy the Sundance decision pushed California and its law enforcement agencies towards removing mentally ill people from jails and prisons and moving them into state-funded out-patient treatment programs. For years and years afterwards, the State of California funded treatment programs, and law enforcement generally implemented a hands-off policy with respect to mentally ill people "out in public" as long as they did not commit crimes against third parties. However, as California's economic fortunes have fallen over the last several years, funding for public mental health programs has been drastically cut...while at the same time law enforcement still tends to leave mentally ill people acting out in public alone.

    For Nevadans, the history of criminal vs. clinical treatment of mentally ill people in California shows us that unless there is a way to shift the mentally ill out of jails, and into long term treatment, and PERMANENTLY fund that treatment in a way which cannot be cut when state funds are short, shifting the mentally ill from one state institution (jail) to another (hospital/clinic) will ultimately accomplish very little in the long run.

    Based on what happened in California it's likely that if the mentally ill are removed from the Clark County jail, state officials wielding the budget ax in Nevada inevitably would limit, cut-back or eliminate mental health treatment funds without realizing the consequences on the surrounding mentally healthy community.

    If there is to be any benefit in Clark County and the State of Nevada moving mentally ill people from the County jail into out-patient treatment, the County and the State are going to have to PERMANENTLY commit to funding those treatment programs. Short of the State signing a court-supervised consent decree binding the State to permanently fund those much needed out-patient mental health programs, a change in the sentiment of the Legislature or a new Governor will always put incarceration-alternative mental health programs at risk of being shut down.