Bad Gamble

Nevada Sued For ‘Greyhound Therapy’ For Mentally Ill Patients

How do you deal with overcrowding at a state psychiatric hospital? Give patients a sack lunch and a one-way bus ticket out of town, according to a lawsuit.

Shannon Stapleton/Reuters

Around the overrun state mental-health campus in Las Vegas, staff psychologists sometimes called the decision to relieve overcrowding via a one-way bus ticket “Greyhound therapy.”

It wasn’t considered cruel or controversial but was understood to be a realistic way of opening precious bed space in a state with a booming need and a draconian history of public mental-health service. Patients from out of state were stabilized, then escorted to the downtown bus station, handed a one-way ticket, and occasionally a sack lunch, and sent packing back to their town of origin.

What was sure to seem callous to outsiders was under the circumstances deemed the most humane way to keep down costs and treat patients with serious mental disorders such as schizophrenia. Despite inviting millions of tourists to come drink and gamble away their blues, a new lawsuit alleges Nevada officials were neither equipped nor motivated to treat the resulting human wreckage.

More progressive states might call such action a scandal, but in libertarian Nevada it was business as usual. And the business of transporting clinically depressed and mentally ill patients to other jurisdictions continued apace until March according to a spokeswoman for Nevada’s health agency, when the Sacramento Bee reported that mentally troubled James Flavy Coy Brown had been sent from the Rawson-Neal Psychiatric Hospital in Las Vegas to the California state capital.

Trouble is, Brown didn’t have family in Sacramento. It took days before his closest relative was able to come to his side.

Brown ended up safe, but he also became a symbol of what some critics have called Nevada’s legacy of unabashed neglect of the mentally ill.

In keeping with a long tradition of denial in the face of bruising facts, Nevada Gov. Brian Sandoval’s office at first denied a problem even existed. Then he downplayed the matter and issued a standard political bromide: “Let me be clear, improperly discharging one patient is one patient too many. I take the concerns regarding Rawson-Neal Psychiatric Hospital very seriously, and it is not the policy of the State of Nevada to engage in ‘patient dumping’ as has been alleged by some. Rather, patients have a right, and a desire, to return home to their friends and families.”

But as the days and stories continued, it became clearer the issue wasn’t going to fade into the state’s rear-view mirror. When the Bee reported that some 1,500 patients were given Greyhound therapy since July 2008, Sandoval’s spin team shifted gears. Denial morphed into looks of concern. By July, Sandoval was wringing his hands and state Department of Health and Human Services chief Mike Willden chided legislators for dragging their feet. By then, a joint commission analyzing the Rawson-Neal complex had announced it was calling for a “preliminary denial of accreditation,” a move that threatened the facility’s federal funding and future.

Perhaps in other states such an obvious issue would take on great political weight for a governor nearing the end of his first term, especially one who has been touted by national GOP officials as potential vice-presidential material. But although state Democratic Party mechanics continue to use Sandoval’s evolving focus on the state’s mental-health crisis to ankle-bite the popular governor, they have yet to find a viable challenger for the upcoming 2014 campaign.

Under the threat of losing precious Medicaid receiver status for its facilities, in August a Nevada legislative panel unanimously approved $2.1 million in emergency spending to improve the quality of care at state mental-health facilities in Las Vegas and outside Reno.

By its shabby standards, Nevada had been getting downright generous in its mental-health funding. A $4 million bump was seen as a bright sign for a state ranked 41st in funding. Senate Finance Committee chairwoman Debbie Smith, a Washoe County Democrat, expressed the frustration felt by many when she shrugged, “We just have to acknowledge the fact that we need more money.”

Increased funding was not forthcoming until the Bee began stinging the issue and raising welts at the governor’s office. The issue has since gained traction with Nevada reporters.

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So far, the popular and well-connected Sandoval hasn’t yet attracted a credible Democratic challenger. In a state dominated by a few political kingmakers and with campaigns underwritten by a handful of major players, it’s likely to take more than a scandalous state of mental health to generate a gubernatorial horse race.

But the issue isn’t going away any time soon—not with San Francisco City Attorney Dennis Herrera filing a September lawsuit against the state and its mental-health administrators. Herrera is seeking to have the city reimbursed for its care of indigent patients it claims were dumped there by Nevada.

The Bee’s enterprise reporting caused a stir, but its review extended back only a few years. Former staff psychologist Ed Loughlin, who served at the southern Nevada facility from 1975 to ’93, recalled patients being taken to the downtown bus terminal throughout his tenure.

“It’s been going on a long, long time,” he said. ““They got a ticket and perhaps a lunch. I don’t recall. They were just driven down to the bus station and dropped off.”

And the reason for the Greyhound therapy?

“We always had a full house,” he said.

Meanwhile, Nevada officials were so flummoxed by the criticism of the state’s supposedly spartan mental-health system that they couldn’t resist lashing out at California when it was discovered that a single patient was transported from the Golden State to the Silver State. The find made the recent running tally something like 1,500 to one.

Take that, California.