Las Vegas Review-Journal - News

Southern Nevada Adult Mental Health Services will hold public forums Tuesday and Dec. 4 to consider how best to transfer mentally ill patients out of emergency rooms and into psychiatric hospitals faster and to discuss whether the state's Department of Health and Human Services should privatize adult inpatient mental health services.

"Despite our best efforts to alleviate the problem, the best we've been able to do is reduce the wait times in emergency rooms," said Stuart Ghertner, director of Southern Nevada Adult Mental Health Services. "But we've only made moderate improvements on the number of mentally ill patients waiting to be transferred from a hospital to a psychiatric facility. That problem is continuous."

At any given time, Ghertner said, as many as 55 mentally ill patients are taking up emergency room beds within Southern Nevada's 22 hospitals.

While that might not seem like a large number, he said one has to consider that patients who need emergency medical care would ordinarily be using those beds.

"That is always a concern," he said.

Ghertner said Mike Willden, director of the state's Department of Health and Human Services, has asked him to help create a single behavioral emergency services plan for Southern Nevada.

"What we'd like to do is create a single, unified drop-off point," Ghertner said. "That drop-off point could be right here at the hospital (Rawson-Neal Psychiatric Hospital in Las Vegas)."

Ghertner said that would mean people who are in the throes of a psychotic episode and need to be placed on a Legal 2000 hold would be taken to a psychiatric hospital instead of directly to a regular hospital.

Similar ideas have been pitched in recent years by others, including state legislators and members of the medical community, about how best to "triage" the mentally ill outside the emergency room setting.

However, switching where mental health patients are taken would probably require a change in state law as it relates to Legal 2000 holds, said Assemblywoman Sheila Leslie, D-Reno.

Legal 2000 is a statewide system used to initiate involuntary commitment of severely mentally ill people into Nevada psychiatric hospitals. It is for people who appear to be in danger of harming themselves or others. Legal 2000 status can be initiated only by law enforcement, licensed mental clinicians and physicians.

And, under state law, a person given Legal 2000 status must be medically cleared before being involuntarily admitted into a state psychiatric facility.

In Southern Nevada, the only places capable of triage and medically clearing them are hospital emergency rooms.

Last year, Leslie and state Sen. Joe Heck, R-Henderson, came up with some short-term solutions.

Leslie's idea was to specify in the law where someone who is mentally ill can be medically cleared before being taken to a psychiatric facility so people detained on a Legal 2000 hold could receive medical clearance at a "community triage center."

Heck's idea was to combine the community triage and crisis centers, creating something of a one-stop shop for people with mental or substance abuse problems.

Although neither idea made it to this year's Legislature in bill form, Leslie said "medical clearance'' will be a focus of the Legislative Committee on Health Care's meeting that will be held in Southern Nevada in two weeks.

"I've already spoken with our legal division about this and have asked them to provide us with some direction," she said.

Ghertner said the goal of Tuesday's forum is to get feedback and ideas from the public to submit to the Legislative Committee on Health Care during its meeting.

He said the second public forum will be on privatization of the state's inpatient psychiatric services.

If privatization is approved, inpatient services would no longer be under state operation. The state would contract services out to private corporations for mental health patients who need inpatient care.

Carlos Brandenburg, director of the state's Mental Health and Development Services division, has said that under this system, the state would provide oversight of the services but state employees would no longer provide the services.

Privatizing mental health facilities is happening across the country, but not everyone has liked the concept.

"I think it is absolutely wrong to consider this idea," Leslie said Thursday. "Every state that has privatized their inpatient mental health services has considered the decision a virtual disaster. For one, there's always going to be a need for more money, and if we are going to put money into something, then it should be our own existing system."

Privatizing state inpatient mental health services also raises a quality of care concern, Leslie said.

Contact reporter Annette Wells at awells@reviewjournal.com or (702) 383-0283.