No mystery what the state's mental health crisis is really about: money

Lost in the Sandoval administration dithering and stiff-arming and the Democrats’ hyperventilating and frothing  is the truth about what’s really causing the deficiencies at the Rawson-Neal psychiatric facility: It’s the money, stupid.

Mostly, that is.

As Gov. Brian Sandoval completes his evolution next week from “don’t worry, everyone at Rawson-Neal is happy” to “I’m begging you for $4 million to save the place,” it’s worth pointing out just how decimated the state’s mental health budget has been during the last five years.

I wish this were a new story. But from Gov. Bob Miller gutting the mental health budget more than 20 years ago to next week’s special Interim Finance Committee to consider Sandoval’s request, mental health has received short shrift in Nevada, an emblem of a state where the social safety net is as porous as a Bad News Bears infield.

I’m not sure what I have less patience for at this point – the governor’s sunny outlook or the Democrats’ doom and gloom. Both are forced; neither is persuasive.

(Even if the IFC request is approved, it's hardly the end of this story as a federal agency was in last week inspecting the facility. More on that below.)

But as the administration seeks that $4 million, including 23 new staffers and 22 new beds at Rawson-Neal, the facts are indisputable and all too telling. To wit:

►You have heard the figure of $80 million being cut from the already spare mental health budget since 2007. That’s real. The number actually is $498.3 million, with a 19 percent reduction in force (364 positions).

►In 2009, 94 positions were eliminated at Rawson-Neal. In the 2010 special session, one of two satellite inpatient facilities in Southern Nevada was shuttered. In 2011, the other one was shut down, leaving Rawson-Neal as the only state-operated inpatient facility in the state. (All of this came amid declines in funding for medications and capital projects, too.)

►If you include all the money, including federal dollars, Southern Nevada Asdult Mental Health Services spent $173 million in the 2010-2011 biennium -- $13 million more than in the fiscal year just ending. Overall state mental health spending declined by about $34 million during the same period. (The good news: It is slated to increase by close to $30 million, if the administration request is approved, in the next biennium.)

And that brings us to today. I asked Mike Willden, the long-suffering but universally respected and ever-stoic head of the Department of Health and Human Services, how much money can be blamed for the problems at Rawson-Neal.

Willden, who clearly has been pained by the patient-dumping scandal, said two of the three overall issues are all about money. The one that is not: Managing the facility. “We haven’t governed the facility as well as we should have,” Willden said when I asked him about the report from the Joint Commission, which denied Rawson-Neal its accreditation.

But the other two areas cited by the accreditation committee – the lack of discharge planning and lack of active treatment -- are about resources, Willden said. And that’s why he is asking IFC for those additional employees and beds.

This is not news, folks. But voices such as Randolph Townsend, the former state senator who made mental health a crusade, or Shelia Leslie, the erstwhile assemblywoman who made noise about the issue for years, were muted amid other priorities, the ones that get votes for politicians eager to get re-elected.

How often did you hear Sandoval  talk about the mental health system before the patient-dumping scandal? But, to be fair, how often did you hear Democratic leaders talk about it, either?

So now Sandoval has to go hat in hand to those Democrats on Tuesday, asking for $4 million amid murmurings among some lawmakers that they weren't given the full story by the administration during the session. But what do they do? Deny the money?

I doubt it. Willden has enough credibility across the courtyard and across party lines to get it done.

But lawmakers have every right to ask the administration if this is yet another Band-Aid and if patching up Rawson-Neal just shifts attention to other facilities, including some not in the South. What about Lakes Crossing in the North, for instance? Tick, tick, tick.

Willden clearly is frustrated with the Joint Commission’s decision, especially the two-track process that allowed the patient dumping scandal to trump an overall accreditation process that’s seemed to be going well. “We were making the improvements,” he sighed. “We were on track and getting ready to have a clean bill of health. It’s surprising to me”

But he is plowing ahead, asking for the additional staff next week. Put it in perspective, though: The facility needs 290 employees to be at full capacity. It has 190.

Willden also will be requesting $350,000 in capital improvements on a building and he wants to open a drop-in center on campus. He will also ask lawmakers for additional money to contract with a company that is helping to reduce emergency room populations by diverting patients elsewhere.

But even if the IFC says yes, as I think it will, the system is hardly out of the woods. Besides an ACLU lawsuit that surely will uncover more worms under the rock, Willden told me the Centers for Medicare and Medicaid Services (CMS) was inspecting the facility last week.

“You never want to lose your CMS certification,” he said. “We will not get that follow-up report for three or four weeks.”

Unlike the joint commission, CMS is a bonafide federal agency, with a lot of say over the tens of millions of dollars in federal funds Nevada gets for mental health services. And without that certification….

Yes, when it comes down to it, the money matters. The only factor that might be more important is the attitude of the elected officials, who will either decide it’s worth the investment or blithely return to decades of cancerous neglect.