Jails, hospitals on frontline of mental health, panel says

On any given day, about 140 people are taken to hospital emergency rooms in Nevada for a mental evaluation. Only about half of them have problems — psychiatric or physical — requiring inpatient care, but they often linger for days, clogging access to vital services for others in need, a state panel was told Wednesday.

That and other statistics provided a sobering snapshot of Nevada’s mental health system that has come under criticism in recent months amid allegations that patients from a state psychiatric hospital in Las Vegas were bused out of state.

Gov. Brian Sandoval created the 18-member Behavioral Health and Wellness Council by executive order in December. The council, led by forensic psychologist Dr. Joel Dvoskin, includes members of law enforcement, judges, legislators, mental health and budget experts. They are tasked with assessing Nevada’s mental health system and recommending improvements.

Problems are especially acute in southern Nevada, where the Clark County jail is where most people are identified as having mental illness.

“We have a huge population in our jails,” said Dr. Tracey Green, state health officer.

The Clark County Detention Center is the state’s largest mental health unit, with 300 beds.

Three times as many people with serious mental illness are incarcerated than receiving hospital-based treatment, Green said, and over the last 30 years the number of inmates with serious mental health problems has tripled.

In 2011, more than 55,000 inmates at the Clark County Detention Center had a history of mental illness. The panel was also told that of those with multiple mental health admissions and detentions, 87 percent were charged with trespass.

Gaps identified in the system are many: not enough of doctors, nurses, social workers and others on the front lines; insufficient coordination; not enough psychiatric beds; lack of housing; hassles with Medicaid reimbursements; and above all, funding.

“It’s about money. It’s about money in multiple ways,” said Mike Willden, director of the Department of Health and Human Services.

Lawmakers last year approved $342 million for behavioral health in the current two-year budget cycle, $21 million more than actual expenditures in the last biennium.

But the state’s spending on mental health suffered big cuts during the recession, when $15 million was slashed from a budget of $116 million in 2009 for Southern Nevada Mental Health Services alone.

In 2013, the southern Nevada agency had an approved budget of $87.5 million.

Willden said state spending does not take into account behavioral health costs paid for by Medicaid.

Those expenditures totaled $259 million in 2013, more than double the $105 million in 2007.