Monday, April 8, 2013

From Brooks to Brown, a Sordid Tale of a Broken Mental Health Care System

We've known for some time that this is the case. Yet since the Steven Brooks scandal broke, his plight has shed light on the state of mental health care here in Nevada. So what's the state of mental health care here in Nevada? It can easily be described in one word: Awful.

The [Nevada Division of Mental Health & Developmental Services] suffered a 12.5 percent cut in its budget over the past two years and a 13.9 percent decrease in general fund revenue, resulting in a loss of 150 positions. The lost jobs included those in inpatient and outpatient treatment centers. Like other state agencies, those employees who kept their jobs also endured 2.5 percent salary reductions and mandatory unpaid furloughs.

From fiscal 2009 through fiscal 2012, Nevada saw its mental health budget decline by 28.1 percent, the nation's fifth highest drop during that time.

"The cuts have raised concerns regarding meeting client needs," the report stated. "Budget cuts and elimination of positions and services has been a trend since the last comprehensive Needs Assessment in 2008."

One hurdle facing the division is that Nevada already ranks poorly in mental health spending per resident in comparison to most other states. Nevada also was dead last in Medicaid spending per resident from fiscal 2004 through fiscal 2009 and was 49th in 2010. That year, Medicaid spending averaged $1,224 per U.S. resident but only $505 per Nevadan.

Any wonder why Governor Brian Sandoval (R) suddenly found an extra $25 million for mental health services?

Well, here's another reason. The Sacramento Bee has been investigating the story of James Flavy Coy Brown since March. And the Northern California paper has since uncovered the terrifying truth of the mental health system here in Nevada.

It was 6:30 a.m., 15 hours and 11 stops after a taxi had scooped him up in front of Rawson-Neal Psychiatric Hospital in Las Vegas, where he had spent the previous 72 hours, and deposited him at a bus station.

During the long ride to Northern California, Brown had rationed the peanut butter crackers and Ensure nutritional supplements that a staff member at the mental hospital had given him, along with his discharge papers and a bus ticket to Sacramento. His food was gone, and he was nearly out of the medication to treat his array of mood disorders, including schizophrenia, depression and anxiety.

As the bus door opened in Sacramento, Brown, 48, stepped out into the pre-dawn gloom. It was 30 degrees, and his windbreaker was no match for the chill.

Brown, a native of the American South with a distinct accent and a healthy head of salt-and-pepper hair, had arrived in the capital city with no concrete plan for survival. He had no friends or relatives in Sacramento. He had lost his ID, Social Security and insurance cards somewhere in Las Vegas. He had no idea how to fill the prescriptions that helped tame the voices and anxiety that clouded his mind.

Brown was discharged from Rawson-Neal... And thrown onto a Greyhound bus. And 15 hours later, he was in California. And he was clearly still suffering from severe mental illness. James Flavy Coy Brown needed more treatment, yet Nevada just decided to dump him into California.

Obviously, several officials in California are furious. And the Nevada Division of Mental Health & Developmental Services is now facing state and federal investigations. So far, it's already been discovered that Brown was not the only dumped out of state. Far from it, there were many more cases of patient dumping to California and other states.

In February alone, at least three other mental patients were discharged from Rawson-Neal Psychiatric Hospital in Las Vegas to far-flung destinations, including California, with a small supply of medications and a few cans of Ensure for nourishment, according to a report issued Monday by the Nevada State Health Division.

Those four represent just more than 10 percent of the 30 sample files reviewed by state investigators in response to concerns about Brown's care. [...]

Nevada recently has made a practice of busing mental patients out of state. The state sent 99 psychiatric patients to California between July 1, 2012, and the end of February, Nevada health officer Tracey Green told state lawmakers during last month's hearing. She said 81 percent were California residents who wanted to go home.

By contrast, an official with Arizona State Hospital told The Bee that facility has not sent a patient out of state by bus in recent memory. Oregon State Hospital discharged one patient to family in California between July 2012 and January, according to a hospital spokeswoman.

The federal Center for Medicare and Medicaid Services is working with Nevada authorities to investigate the state's treatment of mental health patients.

Some patients have been sent as far away as Oklahoma and Massachusetts (??!!). And of course, many were simply packed into Greyhounds and dumped into California. And they were done so despite needed further treatment. And they were only given a few cans of Ensure and a tiny supply of medicine.

So is this what Nevada considers to be "proper mental health treatment"? No wonder why Steven Brooks was allowed to wither on the vine for so long. And no wonder why Governor Sandoval suddenly found another $25 million for mental health care. (Yet that still doesn't completely erase the previous 4 years worth of budget cut, let alone help the state catch up with 2 decades worth of growing case loads.)

So what will it take for Nevada to fully fund the kind of mental health care that our state needs? How many more embarrassing scandals must emerge before the state fully funds mental health care?

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