The high cost of apathy

This time, it really is about the money. But then, it always has been.

After all, we live in a state where you’re expected to solve your own problems or go back to where you came from.

The National Alliance on Mental Illness gave Nevada a D grade in its most recent report card, citing the state’s 28 percent reduction in mental health spending between 2009 and 2012. The NAMI report also found that “Nevada has one of the lowest per capita rates of mental health funding in the nation while the suicide rate is among the nation’s highest, as is the percentage of adults reporting poor mental health.”

Last week, the Interim Finance Committee approved Gov. Sandoval’s emergency request to add $2.1 million to the state’s mental health budget to address critical issues at the Rawson-Neal inpatient hospital in Las Vegas. The facility recently was recommended for “Preliminary Denial of Accreditation” by the Joint Commission after serious problems were identified with its discharge practices and level of services. The inspection was in response to complaints stemming from widely publicized newspaper stories of “Greyhound Bus therapy” whereby patients were discharged to the bus station for transportation anywhere out-of-state and out-of-sight.

The new funds will add beds and staffing, but it’s more like putting a proverbial finger in the dike than solving the problem. Patients are stabilized and released from the hospital quicker than you think, discharged back to the street with nowhere to live, no transportation, no income and no future. An appointment six-to-eight weeks away won’t ensure they stay on their medications or remember to do a “walk-in” to the clinic when the side effects from the stronger medications kick in.

The truth is the solutions to the new crisis are the same as the answers to the old ones, such as the public health emergency in 2004 when mentally ill people were taking up so many beds in hospital emergency rooms, there was little room for people with medical emergencies.

Sandoval should do more than acknowledge the problem, decades in the making, with an emergency request, hoping it’s enough to keep the lid on the bubbling volcano waiting to explode. Instead, he should create a blue ribbon commission to make short-term and longer-term recommendations for systemic change. The commission’s membership should be small but mighty, with respected professional and political leaders in Nevada who know the problem and potential solutions well. We don’t need outsiders or a two-year study to tell us where we’re failing. It’s painfully obvious.

Make no mistake, the commission’s recommendations would certainly involve spending more money since over half of the psychiatric holds in our emergency rooms don’t require hospitalization. They do require services, however, such as supported living arrangements to provide stable, safe housing with staff to make sure appointments are kept and medications are taken.

We need drop-in centers, vocational rehabilitation programs, supported work opportunities, individual and group counseling, mobile outreach teams, triage centers, mental health courts, teams for the most seriously ill, and a co-occurring disorder inpatient program for those with serious addiction issues along with their mental illness. We need rural mental health clinics that are staffed at a reasonable level. All of these programs have been slashed or eliminated during the recession, and they were never adequately funded. Some don’t even exist in Nevada’s mental health system.

The bottom line is people can learn to manage a life-long mental illness with some timely and effective help. But without sustained local and state leadership, and substantially more resources, one crisis rolls into another.

If we don’t spend the money now, we’ll surely continue to pay for our foolishness through increased jail and prison costs, hospital and health care bills, and most importantly, human tragedy.