Mind matters

Newly approved psychiatric hospital will be full the day it opens

By Larry Wills

Twelve years ago, Nevada's minuscule mental health services took a massive hit. Services were cut back and clinics closed amid a state budget crisis. Only one clinic remained open for the fast-growing community of 800,000, leaving many in need of help on their own. Horror stories abounded. A woman reportedly appeared naked at the clinic and was told to come back for an appointment the following month. A stricken man went into the desert and took his own life. Nevada became something of a snake pit in terms of mental health care.

In the ensuing years, the services received more money, but never caught up with the population as the community moved past the 1 million mark.

"This has been neglected for many years," says JoAnn Lujan, executive director of the triage crisis center at WestCare. "After those cuts were made in '92, we'll be cleaning up that mess for years to come. The same things are happening now, but at an alarming rate."

Lujan should know. Her unit has been treating mental health and substance abuse cases at a frantic pace in a facility that has only 50 beds.

"We have 500 admissions a month. In March, 61 percent of those received mental health services," she says. "We're taking the very worst cases--those with substance abuse, mental health problems and who are homeless."

And WestCare is only the tip of the iceberg, since it deals only with patients voluntarily seeking treatment. The others go to the hospitals.

Every night, the mentally ill clog emergency rooms across the valley. On one night alone last week, 60 such patients were waiting in local ERs. "These patients are taking up a substantial portion of the ER capacity," says Bill Welch, executive director of the Nevada Hospital Association. "We see 30 percent or greater taken up by mental health patients. We've had days where we exceeded 100 patients."

Welch says the already overloaded emergency rooms then have to send patients elsewhere. "It's contributed to the divert situation, the ERs are backed up and patients are redirected to other hospitals," he says.

Dr. Dale Carrison, University Medical Center's emergency room director, says the patient backlog threatens quality of care for other patients. "The resource is so overwhelmed. They can't check a blood sugar. It's horrible. With over 60 patients, that shuts down two 30-bed departments in the valley."

Hospital emergency rooms must accept all patients regardless of need or financial condition. Mental health patients are given physical examinations before they are referred to other programs such as WestCare. But that takes time and uses up limited manpower and resources. "Some have medical problems and obviously we need to have that capacity. But we are not a psychiatric hospital," Carrison insists. UMC has only 20 beds in its psychiatric observation unit. And he says that affects treatment for patients in need of regular health care. "If you're there for treatment, they keep your bed."

Dr. Jonna Triggs, director of Southern Nevada Adult Mental Health Services, agrees. "You should care about those 60 people in the hospital. If you're in an accident, you're going to wait."

Lujan says the hospital backlog results in less-than-humane treatment. "They're handcuffed to a gurney for three days in the ER," she says.

That bad news was tempered somewhat last week when Gov. Kenny Guinn approved a $32.5 million psychiatric hospital on state land at Oakey and Jones boulevards. The facility will have 150 beds and is expected to be finished in two years. The hospital will augment the state's Adult Inpatient Psychiatric Unit, a locked facility that provides 77 beds, and a crisis unit with 26 beds.

Triggs says the new hospital will go a long way toward improving care. "I'm excited about it. Today, we have 60 people who can't be transferred because we're full." She says the crisis unit also is at capacity. "We receive about 10 ambulance deliveries a day."

But whether the existing units will continue to treat the same population hasn't been decided. Triggs says the 77-bed facility may be converted for Alzheimer's patients now being cared for out of state.

Lujan believes the growing number of patients will glut the new and existing facilities within two years. "This new hospital is already full."

Welch concurs, insisting that Nevada is too far behind the curve in mental health care to catch up with just one hospital. "By the time the hospital opens up, unfortunately, growth will bring us back to where we are today."

He also blames onerous Medicaid rules that preclude privately owned institutions from providing similar care. "Federal guidelines do not allow them to reimburse for these patients unless the facility provides a full-service emergency room. And the reimbursement rates are low, so low to drive private companies out of the mental health business."

Charter Hospital on Spring Mountain Road closed in the mid-1990s and Lake Mead Hospital shut its 22-bed facility in February. Monte Vista Hospital still survives, providing 36 beds. State officials have supplemented hospital beds with outreach programs and group homes. Triggs says about 600 people are in that program. Of her $51 million budget, about 70 percent is spent to keep people out of hospitals. Triggs received a 26 percent boost in her budget to better deal with the patients. She also received nearly $1 million to form a special team to help the estimated 8,000 homeless in Southern Nevada, nearly a third of whom are believed to suffer mental problems. The team, which will consist of medical experts, will try to treat patients before they have to go to emergency rooms.

But that's a tall order when inmates now have to wait two weeks after being released from jail to get their medications and end up at a hospital that doesn't have beds. The average number of psychiatric beds nationwide by population is eight times higher than Nevada. And Lujan believes hospital backlogs won't be alleviated until the state finds a better way to evaluate the patients without going to emergency rooms. WestCare lost its bid for $600,00 in state funds this month, which Lujan says would have created a intake center to bypass hospitals.

"The state doesn't want to do medical clearances," she says. "Hospitals will continue to have these individuals in their ERs." WestCare, instead of expanding, is facing a budget crunch, and is forced to hire a less qualified staff. "We're doing some innovative things with limited resources."

Welch agrees that bypassing emergency rooms is a priority. "We have supported those evaluations being done at psychiatric hospitals," he says. Otherwise, Southern Nevada hospitals will never catch up with the population growth. "We have five new hospitals, five or six expanding and three that have broken ground. We need a serious re-evaluation of the entire health care system."

Lujan calls the new psychiatric hospital just the beginning. "We believe this is just one step of many that needs to be taken. If you don't have the money, you will always have people who are marginally functioning."

Carrison sees much of the problem as a matter of public attitude. "We have a huge percentage of the homeless who are mentally ill," and treating them depends on public support. "This community has to grow up in some ways."