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Nevada Considers Community-Based Psychiatric Emergency Response Center

LAS VEGAS, Nev.– Two weeks ago, Stuart Ghertner, director of the Southern Nevada Mental Health Services, was told to find a way to fix what ails the state s mental health system.

His idea was to create a community-based psychiatric emergency response center that would be the designated facility to provide medical clearance for the mentally ill, thus alleviating the crowding of emergency room beds.

The concept is being used in several other states including Arizona, where Ghertner worked before coming to Clark County.

It was one of several ideas about how to safely divert people from ERs that was presented Tuesday to the Legislative Committee on Health Care.

But Ghertner s proposal is merely an idea at this point, one that s being pitched by a division facing significant cuts in funding. And since no one knows the costs associated with such a system, officials are hard pressed to say whether it will ever become a reality.

Carlos Brandenburg, director of the state s Division of Mental Health and Developmental Services, told the committee his department will lose $51 million in state funding should Gov. Jim Gibbons maximum proposed budget cut of 8 percent become reality. That figure includes about $13 million in federal matching dollars, Brandenburg told the committee during a lengthy meeting dedicated almost entirely to mental health care.

Brandenburg couldn t say what services within the division are possibly on the chopping block. But, he said, I d be remiss if I didn t say all options are on the table.

One option worrying committee members, as well as Southern Nevada mental health officials, is the loss of 22 beds scheduled to open Jan. 1 at the old psychiatric facility along West Charleston Boulevard. Southern Nevada is already set on Dec. 31 to lose 20 to 25 psychiatric beds from West Care, a nonprofit entity that serves indigent and low-income Nevadans and is providing the mental health agency with beds.

West Care, like Ghertner, proposed a system that would create facilities where mentally ill patients can receive medical clearance outside a hospital setting.

Brandenburg s news, in addition to a report by Dr. Leslie Dickson, professor of psychiatry at University of Nevada School of Medicine on shortages of psychiatrists, problems with recruitment and the overall emergency room problem, was unwelcome news to committee members.

It is completely unacceptable to cut $51 million from mental health, said Assemblywoman Sheila Leslie, D-Reno, I m really, really afraid mental health is going to suffer as it did in 1991, she said. We re not happy about this. … Our most vulnerable are going to be the ones to suffer.

Dickson and Sen. Joe Heck, R-Henderson, said Las Vegas Valley emergency rooms are on pace to see between 11,000 and 13,000 mental health patients this year. Only about 20 to 30 percent of them will ultimately be transferred to Southern Nevada Adult Mental Health Services, Dickson said.

Under Ghertner s plan for medical clearance, the psychiatric emergency response center would include crisis intervention, time limited interdisciplinary evaluation and treatment, on-site resources to support continued recovery, discharge with treatment recommendations and referrals to outside resources.

The goals of the center are to provide structure and support to stabilize the person in crisis, assess the individual s psychiatric needs and to provide a full range of safe psychiatric emergency services, Ghertner said. More importantly though, the psychiatric emergency response center would shore up acute care beds now being taken by Legal 2000 patients. Legal 2000 is a statewide system used to initiate involuntary commitment of someone who is considered a danger to himself or others.

Heck, who was in support of this plan, called it an idea that has floated around for years but which has never come to fruition. He said providing medical clearance outside of an emergency room setting is crucial to solving the mental health crisis in Southern Nevada.

The impact on the hospitals is tremendous, he said while showing the committee a Web-based tracking system used to monitor patients being admitted into area emergency rooms. Around noon Tuesday, roughly 46 patients were at area hospitals on Legal 2000 holds, Heck showed. The most, 10, were being held at UMC.

If you take 30 percent off the top, you already have made a big impact, Heck said, referring to the number of patients who need to be placed in a psychiatric facility.

Ghertner s proposal also received support from Bill Welch, president and chief executive officer of the Nevada Hospital Association, and Gary Milliken, representing American Medical Response and Medic West.

Milliken said between November 2006 and Oct. 31, 2007, AMR and MedicWest ambulances transported 4,477 people who were on a Legal 2000 hold to an area emergency room or a psychiatric facility. Of those, 788 calls were initiated by Las Vegas police and 2,600 were initiated by hospitals.

He said AMR and Medic West, which are the same company now, billed $1.8 million for those transfers but collected only $400,000.

We wrote off $1.4 million, he said. We basically pay for that loss.

Leslie, who, toward the end of the meeting stopped Ghertner from speaking because the information he was providing was too unsettling, asked the committee whether a letter should be sent to the governor about sparing mental health from budget cuts.

Sen. Maurice Washington, R-Sparks, vice chairman, recommended the letter contain language about keeping the 22 psychiatric beds scheduled to open Jan. 1.

Contact reporter Annette Wells at [email protected] or (702) 383-0283.