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September 30, 2014

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Sun Editorial:

More work to do

Improving mental health care has to become a priority for Nevada

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As the Sacramento Bee has diligently reported in a series of troubling articles, the state-run Rawson-Neal Psychiatric Hospital in Las Vegas discharged nearly 1,500 patients to the Greyhound bus station over the past five years — with one-way tickets out of state. The patients were sent with some snacks and a few days of medicine.

The allegations of patient dumping have led to ridicule — Stephen Colbert: “What happens in Vegas stays in Vegas unless what happens is psychosis” — and serious allegations of patient dumping that could result in lawsuits.

Nevada’s response to the Bee’s stories has been painfully slow and, by all appearances, incremental. State officials started a review and last month announced they were tightening procedures, including mandating that anyone sent out of state be accompanied by an escort. Then, in a statement last week, Gov. Brian Sandoval said the review showed the “vast majority of patient releases were done correctly.”

There were 10 cases in which policy was broken, and the state fired two hospital employees and disciplined three others.

Sandoval also said the state has “obtained proposals from national experts” to study the mental health system to make sure industry best practices were being put in place and followed.

All of that comes across like a formula response to embarrassing situations — change policies, fire a few workers and then pledge to study the issue.

That’s not enough. The discharge-to-Greyhound situation is just a part of a larger problem. The state has long short-changed mental health budgets, action that has been buoyed by a pervasive attitude that has downplayed or dismissed the seriousness of the situation.

The Bee’s stories have raised significant concerns that shouldn’t go away with the next news cycle. There are still many questions to be answered, including:

What role did budgets play? Were workers at Rawson-Neal sending patients out of state because a bus ticket is far cheaper than treating a psychiatric patient? Does the hospital not have the budget to handle the demand?

What was the policy? If the “vast majority” of cases were up to state policy, that doesn’t mean the policy was correct. So, was the policy in line with standard and appropriate treatment? Is it now?

What else is there? It’s no secret the mental health system is stressed. Within a few days of Sandoval’s announcement, the emergency room at UMC, Clark County’s public hospital, closed its doors for 12 hours, refusing to take new patients because it overflowed with mentally ill patients.

That was a reminder of previous crises over the past decade, particularly the one in 2004 when several Las Vegas emergency rooms had to stop taking patients because they were overcrowded with mentally ill patients. That was supposed to change with the Rawson-Neal hospital, but here we are 11 years later facing a similar situation.

The state just can’t shuffle patients off from one place to the next. Are there other parts of the health care system affected by the overburdened health care system? How will the state respond? As well, what are the effects of this crisis on society at large?

What did the state really find? So far, details of the investigation have been parsed out. We have yet to see a full briefing, much less a full report of the state’s findings. Why not? If the state wants to restore some sense of trust with the public, it should release its full findings. What does the state have to hide?

Now what? It’s great that the state has national experts interested in studying Nevada’s mental health system, but what does the state do in the meantime?

As we have noted before, there’s not a big political constituency behind the mentally ill, so will Sandoval continue to push on this issue? Will the Legislature? Or is the assumption that this will all go away and the state can deal with it again in a few years, as has happened in the past?

Over the years, the state has been willing to push patients around, but that’s not dealing with the problem. Nevada needs to change the way it runs its mental health system, and it needs people, starting with the governor, to aggressively push for the change. As we said last week, Nevada is better than this.

Isn’t it?

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  1. Mental illness is a highly charged, powerful image that no one wants to be associated with. Nevada tends to picks its winners and losers, when it comes to causes. It is driven by politics, with Nevada's key players being the entertainment industry (who desires a fine balance between unbridled spending frenzy, illusion, ideations, and madness), mining (who is solely focused on pushing their own interests alone, exploiting the laws, taxing system, and ultimately the People of Nevada who rely on a functional infrastructure and suffer due to the lack of funding it), and Nevada's infrastructure (always trying to put on a good face to the public to cover the lack in their organizations).

    Being truthful, authentic, and real just doesn't play well in a land of razzle-dazzle, religion, and players. Who are you going to trust? If a person felt they needed help, and approached a family member, fellow worker, or even attempted to seek help at a public organization as their local school, church, police, fire, offices, they would be met with people who DO NOT want to handle their mental health problem directly.

    All of the sudden, the reaction to the person seeking help having a mental issue, turns into a chain of referral protocols that are far away from immediate help. Even the 800 number hotlines will try to deescalate the affected individual, and then refer them (which again, will allow time to lapse and follow through is improbable).In other words, "Go away, we don't deal with people with your kind of problems."

    In a world where folks will spend their time and money to involve their lives with television shows riddled with endless drama and not give a fellow human being affected with a mental illness condition the time of day, we have to question the values in our society, extending to our societal overreach in our government. Those suffering with mental illness/disease are avoided, that seems to be our solution.

    As Americans are finding out, the people with chronic mental conditions are not going away any time soon. Most quietly suffer amongst us, resigned to a life of isolation and a personal hell lived out to the grave. But as we are discovering, the outlyers, the anomolies, the true outcasts, are finding their way into our view through deranged violence visited upon innocent victims, causing an upheavel and garnering sudden national attention.
    Part 1 of 2
    Blessings and Peace,
    Star

  2. Part 2 of 2
    Is this the way we Americans want to handle mental illness/mental disease in our country, state, or homes?

    The foundation for our mental health wellness begins at birth. It is a life-long process which we develop our senses of right and wrong, from cradle to grave. Incidents involving shades of mental disease are manifesting at our public schools, and we are finding that many parents avoid taking responsibility for their parts in shaping their child(ren)'s developing psyche, and continue that path throughout their offspring's life/lives during formative years while their child(ren) are in school.

    Furthermore, the current system supports such negligence of accountability. The time has come to face mental illness/disease and actively address it, even if some are insisting a stance of denial of the problem or their experiencing personal "discomfort" regarding the subject. Our neighborhood public schools have countless children manifesting behavioral issues which only receive a cursory addressment. Behavior impacts learning!!! The latest "Anti-bullying," "Flip the Script," and "Be Kind" programs simply place a bandaid on the problem of UNtreated mental illness/disease. The root problem never really gets attention and is addressed. Sure, let's just keep on covering up. That is the solution, right?

    Mental health is the bastard child in the healthcare industry. Here in the United States, we all can secure vision, dental, hearing, and overall physical health care far easier than mental health. Why? Because of the stigma. Because of denial. Because of how it threatens our lives: home, job, and relationships. Because of inadequate access. Adequate and sustainable funding will help, but there needs to be greater awareness and support for those afflicted with mental health illness/disease within the public's attitude and government policy maker's decisions.

    Our society and world is only as strong as its weakest link. Let's start caring and doing something meaningful and actually productive about mental health with us and around us!

    Blessings and Peace,
    Star

  3. Vegas attracts many who are "unusual" or turned out by their families whether they/we be individuals or just living close to the edge. Soooo, we get more than our share or more than the national norm. Yet, we do essentially nothing for people who are facing challenges--unless they have kids in K-12. Mental illness can hit the best of us but certainly visits the challenged (financially, emotionally, physically, orphaned/divorced) more often. I've tossed in a few posts that Nevada needs to negotiate a serious federal grant to run several dormitories for homeless singles--those with mental illness, Vets, long-term unemployed, disabled or semi-disabled. DHHS could oversea or contract "half way" houses were clients could get free or near-free rent on dorm rooms to maintain a residence, seek health care, seek employment, receive counseling, receive "life skills" training. Yet we just ignore it and dump all available funding into "education."

  4. The idea is assistance before intervention is needed. Options for people before they become so sick that they are candidates for institutionalization or prison.

  5. Admissions, Discharges, and Maintenance Are the Keys to Success

    The first essential of a productive network of psychiatric facilities and social services is being able to give treatment to a patient as soon as possible. That saves the patient and the system. Generally, the earlier in, the earlier out. Also, the sicker a patient gets, the more likely he is to self-medicate with drugs and/or alcohol.

    Schizophrenic, bipolar and severely depressed patients who delay getting help can cross a threshold, whereby they are so unstable or delusional that they do not realize they are ill. Then it requires a legal rigmarole for involuntary hospitalization.

    The second essential of a productive system concerns something that doctors rarely acknowledge that they violate: prevention of a too-early discharge. To decrease recidivism, a hospital needs to keep a patient long enough to get him stabilized. An EXTRA one or two days often makes the difference. Hospitals face intense pressure from insurance companies and the "administration" (regarding operating expenses) to release patients. Lack of insurance, inadequate insurance, and a waiting list of patients are factors.

    The third essential is a comprehensive network. That includes 24-7 crisis/intervention centers, psychiatric units in multiple hospitals and "nursing care" facilities, group homes, and boarding houses. Maintenance/continuing care includes routine appointments with case managers and doctors, as well as home-visit nurses.

  6. Continued:

    It's been reported that the Las Vegas commissioners are seeking funding for UMC, which has recently accepted overflow patients from Rawson-Neal psychiatric hospital. If UMC can offer psychiatric treatment for less than the $850.00/day per patient,* it could be an integral part of a reformed system. The increasing funding for UMC; the new tobacco-settlement and general-fund money proposed by Governor Sandoval for the whole system; and the ongoing, best-practices improvements have started the reform.

    Another aid in the search for hospital cost containment is the new comparative database of 2011 hospital charges by The U.S. Centers for Medicare & Medicaid Services: http:/www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html.

    *The source for the $850/day figure is: "BROKEN LIVES, BROKEN SYSTEM," by Laura Myers, Las Vegas Review-Journal, 4/14/13. This figure was given as testimony before the 2011 Nevada legislature.

  7. The Las Vegas ad is correct: Whatever happens in Las Vegas, stays in Las Vegas.

    But there's a caveat to that.

    Except if your perceived to be a mental patient.

    Then Governor Sandoval says you gotta go.

    Don't matter if it's Sacramento, Los Angeles or San Francisco.

    You gotta go.

    Don't matter where. In Tea/Republican Party politics, you need to go somewhere else. It's the policy of YOYO (You're On Your Own). Here's twenty dollars. Here's three days worth of medicine. Here's a one way bus pass. Get the hell outta Nevada. Sandoval don't want you here.

    Over 16 years of Tea/Republican Party Governors, this don't surprise me.

    Time to crush the Tea/Republican stranglehold on the Nevada State Government here in Nevada.

    C'mon, Nevada. We gotta get a strong Democrat to run against this predator Sandoval.

  8. The solution to 'Improving Mental Health Care' in America begins with identifying the money to pay for the services.

    Many of America's mental health patients are being housed in State Prisons because the State Health System has been cut back year after year since Reagan. States don't have empty facilities waiting to be utilized.

    The patient-prisoners can't just be released because they have been given prison terms for criminal behavior - they misbehaved when lack of mental health care budgets and facilities put out on the street.

    Will they be released, pardoned or treated inside the prison by the criminal justice system?

    Will this be a Government program or will contracts be given to the lowest bidders, no matter what the bid?

    And before that begins, who is going to pay for the war in Iraq? The medical and health bills are still piling up from that great act of conservative diplomacy. The job creators can't be bothered, so whose next Kimasabe?