I-Team: Few Patients Committed to Psychiatric Hospitals - 8 News NOW

I-Team: Few Patients Committed to Psychiatric Hospitals

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Ed. Note: The national debate about gun violence and gun control has generated strong emotions on all sides following the tragedies in Connecticut and Colorado. To examine these volatile issues, earlier this year, the I-Team launched an ongoing project called Guns of Nevada. At the center of each gun massacre is a story of the holes in the mental health system. Nevada ranks near the bottom when it comes to mental health services. You will find extensive information in The Mental Health Debate.

LAS VEGAS -- Few people in Nevada are involuntarily committed to a mental health facility.

Last year, about 200 people were committed. Instead, most people with a mental illness cycle through a system that has more patients than resources. It's a process that for many happens over and over again.

Nevada Ranks Toward Bottom in Mental Health Spending

At the Rawson Neal Psychiatric Hospital, in a small room off the cafeteria, hearing master John Norheim decides whether the mentally ill patients before him meet the legal standard for release.

"How are you feeling today? How are you feeling today?" he asks the patients.

Unable to respond coherently, a patient by the name of James is found incoherent.

Norheim continues James' case for a week to allow more time for his medication to work.

Another patient, identified as Michael, asks "Excuse me, am I an adult?"

Circumstances such as Michael's offer no easy solutions.

"Things haven't been going well for you," Norheim said to Michael. "You keep coming back here and I don't know what's wrong."

Since January, Michael has called the police on himself five times to initiate the civil commitment process known as a legal 2000.

"They never let you come into Rawson Neal voluntarily, ever," he said to the hearing master.

"I know," Norheim replied.

The commitment process begins with a 72-hour hold, often in an emergency room, for evaluation, observation and treatment.

If, during that time, a doctor deems the patient a risk to himself or others, a petition for review is filed with Norheim's court.

"The majority don't actually make it to court," said Judge William Voy of the 8th Judicial District Court.

Most, Voy said, will stabilize before their first hearing, usually held within five days.

On this day, of the 152 petitions on the court calendar, only 38 patients make an appearance.

The rest have already been released.

"A lot of people who suffer major axis 1 diagnoses can get stabilized and function appropriately," Voy said. "The problem is when they're not in a controlled setting, when they have no one there reminding them that you still have the illness, you still need to take the medication. "They feel good. (They say) ‘I don't need this.' And they go off and they quickly decompensate."

That cycle is repeated by many at the court, in part because of a lack of services, such as housing.

Nevada Mental Health Services Face Hurdles

Michael said he recently left a group home because, as a young man, he said he felt uncomfortable with its older clients.

"You stayed out of the hospital for six months," Norheim said to Michael. "It's the only time you've been successful since you've been here."

Michael replied, "I understand that. I tried the group home and I could not do it."

Michael said he has money for a weekly hotel and unless he meets commitment criteria, Norheim can't force him to accept services.

Even if Michael were a danger to himself or others, commitment spans at most for six months.

"The problem is, if I send you home today, this is what will happen," Norheim said to Michael. "You'll be back in a couple of weeks."

To which Michael replied, "No, I won't. No, I will not."

Attorney Donald Williams spoke up: "Your honor, I think he's psychotic as all get out, but I don't think he's a danger to himself or others."

The court's doctors disagreed, so Norheim set another hearing for a week later.

"The judge is going to have you stay a few more days," Williams said to Michael.

"That's not fair," Michael said. "That's not fair, Judge."

Michael's social workers now have to try to find a place that works for him, and for the community.

"There's no easy answers," Voy said. "I'll tell you one of the big answers, but no one wants to hear it: (It) is providing those services. If you want a safer community, it comes at a price."

To try to stop the cycle of patients going in and out of the state's psychiatric hospitals, a bill before the Nevada Legislature would provide for outpatient commitment.

Under the proposal, patients who don't show up to their medication and therapy appointments would be picked up and transported to them by order of the court.

Supporters hope this will prevent patients from going off their medications and going into crisis mode.

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