When James Flavy Coy Brown stepped off the bus in Sacramento on Feb. 12, he set in motion a series of events that would send a shock wave through Nevada’s political system.
As the Nevada state senator whose district includes the Rawson-Neal Psychiatric Hospital, the hospital from which Brown was discharged, this case has been a wake-up call to me and my fellow legislators. It has made all of us take a hard look at how we provide mental health services in our state.
Historically, Nevada has struggled to adequately fund mental health programs. For the last 50 years, Nevada has been the fastest-growing state in the nation, attracting people from all parts of the country. In addition, Nevada, with only 2.8 million residents, has a tourist-based economy, attracting more than 52 million visitors a year. This, coupled with our frenetic 24-hour lifestyle, places an unusually heavy burden on our mental health system.
The Great Recession hit our state hard. Unemployment soared to more than 15 percent. Our narrow, limited tax structure, which relies mainly on revenue from gambling and sales taxes, could not adapt and public revenue fell precipitously. Beginning in 2007, the Legislature and governor slashed funding for all kinds of public services. Mental health services were hit hard. Current annual funding is nearly 30 percent less than it was in 2008.
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By the beginning of this year, Nevada’s mental health system was beginning to crack under the strain. Staffing levels had been deeply cut, many staff positions remained unfilled because of low wages, and the remaining staff were making less than they had in 2007 due to salary reductions and furloughs. Emergency rooms were filling up as mental health patients waited to be evaluated. At any given time, about 38 people with possible mental illnesses are sitting in our local ERs. The number of inpatient beds, especially at Rawson-Neal Psychiatric Hospital in southern Nevada, were severely limited.
Truth be told, the primary goal was survival, not treatment. All of this had tragic consequences for patients such as James Flavy Coy Brown, who so desperately need professional care.
While it is easy to blame the poor economy for Nevada’s mental health woes, as a fourth-generation Nevada legislator I see a more insidious cause – the requirement that any tax increase requires a two-thirds legislative vote.
Given the Republican Party’s mantra of “no new taxes,” our Legislature’s hands have been tied. Until and unless the Democrats obtain supermajorities like you have in California, anyone wanting to improve mental health or anything else is basically impotent. And impotence leads to apathy.
The reality is that there are undoubtedly thousands of cases in which patients have been treated like Brown or worse, given Nevada’s pitiful mental health system. Even the most committed of us will be forced to shake our heads and apologize for being Nevadans for the foreseeable future.
In the aftermath of the Brown case, we have taken steps to ensure that this kind of tragedy does not happen again. The Nevada Legislature, during the 2013 session, established a new 24-hour urgent care and drop-in center at Southern Nevada Adult Mental Health Services. We established a pilot mental health home visiting program and re-established a multidisciplinary program of assertive community treatment. We established targeted case management programs for patients with recurring mental health crises. We added additional inpatient beds in southern Nevada, and we increased the frequency and intensity of legislative oversight, including quarterly reports on progress made in diverting mentally ill persons from emergency rooms.
At the same time, the federal Affordable Care Act has made it possible for us to expand Medicaid coverage for childless adults. Obamacare has also expanded the Mental Health Parity and Addition Equity Act of 2008 to increase access to treatment for mental health and substance abuse disorders.
The Brown case has caused me and other members of the Nevada Legislature to search our souls and consider again the needs of the mentally ill in our state. We are asking hard questions such as whether our tax structure needs to be reformed to provide adequate revenue to fund mental health and other social services. It has been a difficult lesson, but we are grateful to The Sacramento Bee and other media outlets that have worked so tirelessly to bring this situation to light.