Nevada Received Poor Grades on Mental Illness Report Cards

LAS VEGAS -- The nation's largest nonprofit mental health advocacy organization gave Nevada a D- in 2006 and a D in 2009 on report cards that graded states on how well they cared for individuals with mental illness.

The National Alliance on Mental Illness of Arlington, Va., didn't issue an A grade for any state in either of those years. Nevada happened to be one of 27 states that received a D or F in 2006, and also one of 27 that got poor grades in 2009.

At the time of the 2006 report card, Nevada had the nation's fourth highest suicide rate but ranked only 36th in mental health spending at $62.78 per resident.

That report praised Nevada for establishing state-funded mental health courts, providing transparency in the reporting of mental health data on a website, reducing restraints and seclusion in hospitals, and funding increases for emergency room and jail diversion. But the state was criticized for allowing overflowing emergency rooms, particularly in Las Vegas. The organization also encouraged Nevada to improve community treatment programs and provide supportive housing options, particularly in rural areas.

The organization said of Las Vegas at the time: "The city, commonly associated with high rollers, wealthy real estate magnates and fun times, has become overwhelmed by growing numbers of mentally ill people in need of treatment, and lacks adequate infrastructure or funding to address those treatment needs.

"In 2004, Clark County formally declared a ‘public health disaster' because large numbers of people with serious mental illnesses -- and nowhere else to go -- were occupying hospital emergency rooms in Las Vegas. Even the population centers have been ill-equipped and ill-prepared to provide high-quality treatment and services to people with serious mental illnesses."

It was noted that the overall lack of housing and community-based mental health services in Las Vegas and elsewhere in Nevada "contributes significantly to the growing numbers of people in emergency rooms, jails and other crisis environments." The organization called for Nevada to increase from three statewide -- two in Las Vegas and one in Reno -- the number of teams specializing in assertive community treatment programs to help reduce hospitalization.

"This is not nearly enough to address the needs of people with schizophrenia and other serious mental illnesses who reside in dense urban centers," the organization stated. "Those groups must have access to intensive and multiple around-the-clock services."

Higher-than-average homelessness also was singled out as a problem for Nevada. The organization said that while services were concentrated on those who were already homeless, the same wasn't true of individuals who were at risk of homelessness if they didn't receive the services they needed.

Not all the news was bad. Nevada was praised for increasing its mental health budget 33 percent from 2003 through 2006, creating 98 new positions to help provide services. In addition to establishment of mental health courts, the state in 2004 completed a plan to implement a more effective mental health system.

But the 2009 report card, with the accompanying D grade, wasn't much kinder. The overall grade consisted of D grades for these shortcomings: financing; core treatment and recovery services; consumer and family access to information; promotion of consumer-run programs; and family and peer education and support.

The state received failing grades for these shortcomings: health promotion and measurement, including measures of emergency room wait-times and the quality of psychiatric beds by setting; and community integration and social inclusion, including collaboration among state mental health agencies and other state departments.

The organization also estimated that Nevada had 88,540 residents with serious mental illness as of 2009.

That report card praised Nevada for having urgent walk-in clinics and medication clinics and for its mental health courts. Included was a quote from an anonymous individual:

"The best thing is that Las Vegas has mental health courts. The illness is treated through the probation officer, the therapist, the mental health case worker, and the psychiatrist all working together."

But the organization urged the state to restore inpatient staffing, increase availability of case management, medications and therapy, and implement more supportive housing options. This comment came from another anonymous person:

"Southern Nevada Adult Mental Health Services is the mental health agency that serves my family member. The wait can be as long as five hours in a tiny lobby."

While acknowledging that Nevada's tourism-based economy has suffered distress, the organization wrote this about the state's mental health efforts as of 2009:

"The state's citizens deserve far better. Nevada has struggled to keep pace with population growth and demand for mental health services.

"Although the state legislature increased mental health funding in previous years, over $20 million in cuts in 2008 and an $11 million cut in 2009 have resulted in closures of clinics, reduced services, and staff cuts in state hospitals and outpatient care."

Nevada's greatest challenge was to adequately fund mental health services, including supportive housing, the organization stated. The report card also stated that Nevada needed to do a better job developing mental health services for the 40 percent of the state's population that includes racial or ethnic minorities.

"In a state with high rates of severe depression and other serious mental illnesses -- as well as suicides -- a strong commitment is needed to restore and expand the mental health safety net," the organization concluded. "Without one, Nevada will find its emergency rooms and criminal justice system overwhelmed, and costs being shifted to other sectors of state and local government."


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