Confounded by poor care for the mentally ill, the Arizona Supreme Court in 1989 not only affirmed their right to receive treatment but compelled lawmakers to fund subsequent programs.
Here in Las Vegas, our city's lone psychiatric treatment facility may need some high-court help of its own.
Years of legislative indifference to and financial stress on Westcare's 9,000-client triage center for the mentally ill reached a zenith over the weekend, as the county declared a public-health crisis that forced the state to spend $100,000 for temporary shelter. Psychiatric patients tied up nearly one-third of the Valley's hospital emergency-room beds, limiting the number of physicians available for acute trauma cases like heart attacks and accident victims. Last-minute cash infusions from local municipalities spared the 56-bed Westcare facility from closing last week. It'll now be open through August.
After that, it's anyone's guess.
Maybe the state will pay its third of the $3.8 million agreed upon when the center was created in 2001 (hospitals and municipalities cover the remaining two thirds; the state isn't compelled to pay). Or maybe the 18 other funding sources will cover the shortfall.(Unlikely. The city of Las Vegas and Clark County have, but Henderson is concerned about paying more than its proportional share.) Or the center, which saves taxpayers millions, could close shop.
Here are five reasons that shouldn't occur:
The numbers justify its existence: Close the center and prepare for even more clogged jails and congested emergency rooms and more cash grabs from your wallet. Mental-health officials say it costs nearly five times as much to jail a psychiatric patient as to treat one. Last year, the center saved taxpayers $11 million by diverting patients from jails.
Westcare also saves hospitals money. In 1999, local emergency rooms spent $3.3 million treating 3,253 psychiatric patients; those numbers jumped to 6,864 treated and $9.3 million spent in 2001. Add to this the chronic public inebriates—4,119 emergency-room visits in 1999, leading to $3 million in emergency-room costs; and 5,858 visits in 2001, at a cost of $7 million. Treatment at Westcare is a financially prudent course.
State has responsibility for care: Psychiatric care is a state mandate, but you wouldn't know it by recent history. Appeals to the Task Force for a Healthy Nevada (which annually distributes between $39 million and $51 million in tobacco-settlement money, most of it to the Millennium Scholarship college program) and the Legislative Interim Finance Committee (which shifts funds to cover projects) went nowhere. During the same 2003 Legislative session in which lawmakers killed a $1.3 million grant request from Westcare, causing a 30-percent reduction in center staff, lawmakers approved a contentious $32 million, 150-bed mental hospital, one of whose sales pitches was that it wouldn't look like a psychiatric ward.
Mental-health beds are at a premium: Clark County lags behind the national average of state-run psychiatric beds to residents, 4.5 per 100,000, compared to the median of 33 per; and last year, 80 percent of the 25,000 psychiatric patients served statewide were in the county. Even with the advent of state-funded temporary shelter, as many as 30 psychiatric patients occupy emergency-room beds, where they wait an average of 55 hours (but as long as 10 days) for diagnosis and treatment.
"Because of this," says Nancy Goth, special projects officer for Westcare, "if you or I or someone else needs emergency-room treatment, we might not get it in a prompt fashion."
City needs more psychiatric infrastructure: Of the psychiatric patients "warehoused" in general-care hospitals—remember, our mental-health capacity is sparse, and we're years away from the state's planned facility—Landreth says half end up back on the streets untreated. Meant to fill in the gap, Westcare's triage center has become the infrastructure.
"Emergency-room doctors can't just discharge them [the mentally ill and public inebriates]," Goth adds. "They must assess them and then discharge them to an appropriate facility. If there is no appropriate facility, then what?"
Triage Center is last line of defense: Long clamored for and woefully needed, the city's first mental-health court unfortunately adds little in the way of after-care. Piloted with $150,000, the court focuses on helping about three dozen nonviolent mentally ill offenders stay out of trouble and out of jail; Westcare treats nearly 9,000 clients with immediate needs.
"Mental-health court helps people who've been incarcerated and released to turn their lives around—it doesn't deal with people who are experiencing a mental-health crisis and need immediate attention ... If [the triage center] closed, you're talking about creating a huge revolving door [for the mentally ill] between emergency rooms and jails," Metro counsel Kathy Landreth says. "Las Vegas is the only large metropolitan city without a walk-in/drop-off emergency mental-health facility, and one of few whose hospitals lack psychiatric emergency departments. Every community of any size should have a place where people can go when they are experiencing a mental-health crisis."
Goth says at least one lawmaker (Sheila Leslie, D-Reno) is willing to sponsor a new grant request in the next session, and the Southern Nevada Regional Planning Coalition, which helped create the program, is exploring funding mechanisms. The group hopes to present a plan by July 26.
"This program is in financial crisis, and the one-thirds formula isn't working ... on one hand, it's a testament to the community's commitment that the center has 19 different funding soures, but it makes it complicated," Goth says. "It's funny. We have a dearth of mental-health facilities, but are still being looked at as a model program."