LAS VEGAS - On the campus of the state psychiatric hospital, hearing master Jon Norheim holds court.
David (not his real name) sits before Norheim on a Legal 2000 hold, a system used to initiate involuntary commitment of a severely mentally ill person. David, according to his doctors, tried to circumcise himself with a box cutter to ensure his entry into the "kingdom". Now on medication, David sounds lucid.
"I feel fine. I feel a little bit stupid about it all," he said.
That is a far cry from his demeanor nearly two weeks earlier at a local emergency room. State law requires those seeking psychiatric help to first undergo a medical evaluation. Though the process typically takes a matter of hours, patients like David often languish in the ER for days.
"That's our frustration," said University Medical Center Director of Emergency Services Dr. Dale Carrison. "We've medically cleared them. Now, there's this big line, and if Southern Nevada Mental Health for whatever reason can't turn the patients over, then it builds up."
On the day the I-Team interviewed Carrison, UMC housed four people waiting for transport to a mental health facility. Multiply that by 14 hospitals valley-wide, and the number jumps dramatically. According to statistics kept by several different agencies, between one in four or one in five emergency room patients are simply waiting for psychiatric care. The state insists the number is closer to 10 percent.
"If you're in the community, and you're sick, and you need to go to the ER, you would like to know there's a bed available when you get there. A significant portion (is) being taken up by mentally ill patients. That limits the ability of the emergency department to see patients with medical emergencies."
"I agree with that conclusion. That's exactly correct," said Southern Nevada Adult Mental Health Services Director Dr. Stuart Ghertner said. "We're one of the few communities in the country that still requires our psych patients to go to an emergency room first before showing up in say a 24/7 walk-in clinic that could do both medical clearance and a rapid evaluation."
Without such a facility, Ghertner explains, the seemingly simple task of moving patients out of the emergency room and into the mental health hospital accounts for a large part of the log jam. The majority of those who wait have no health insurance, making their transport a low priority for private ambulance companies.
On the day the I-Team interviewed Dr. Ghertner, his mental health facility had four empty beds in its observation unit with no way, logistically, to fill them.
"If we had funding or some type of a psychiatric emergency response center where these people could go, then we could begin to eliminate the problem," he said.
Until then, patients like David wrestle with their demons for days without treatment. "We try with the limited resources we have to do the best we can for these patients," Norheim said. "We do a lot of good for a lot of patients. We could do better if we had better funding."
The psychiatric triage center Dr. Ghertner spoke of has a $10 to $12 million price tag. While it sounds like a lot, it could save the hospitals, and by extension the taxpayers, tens of millions of dollars every year.
The average stay per day for a mental health patient in the ER, according to UMC, is nearly $3,000.