Dr. Joseph McEllistrem
While running and staffing programs for mental health resources isn’t cheap, mental health professionals say it is more costly in time, resources and money for a community to let individuals go untreated.
While in crisis, a mental health individual could use millions of dollars in services, according to health care professionals. Carson City Forensic Manager Bekah Bock said Carson City officials discovered this after a case study on a Reno man who was in and out of hospitals and jail for 10 years because of alcoholism and mental health problems that cost the taxpayers nearly $1 million from the cycle of services he was using.
“Considering we are such a conservative state, it seems like there are more cost effective strategies we could be doing, but we aren’t. We are forcing individuals to use our emergency services,” said Carson Tahoe Regional Mental Health Coordinator Jessica Flood.
Cases like this aren’t uncommon. Mentally ill individuals often cycle through the jails, hospitals, inpatient and outpatient psychiatric facilities multiple times while in crisis, creating large strains in the resources and costing taxpayers.
An average ambulance ride is about $1,500; an emergency room admission for regular insurance is about $3,000; inpatient psychiatric with Medicaid is $900 a day; and a jail visit is $124 a day, Flood said.
“There are these individuals in our community who are in chronic crisis due to mental health or substance abuse issues and they are going through all of our services; the jails, the ERs the impatient psychiatric unit and they are using our ambulances on repeat and calling dispatch,” Flood said. “These are the most expensive services in our communities and it’s apparent that when they use these services they aren’t getting stabilized, we kind of patch them up and they go right back into the community where they go back into crisis.”
According to Carson Tahoe Hospital officials, in 2016, there was a total of 11,271 hours of psychiatric boarding in the emergency room, which averaged out to about 939.25 hours per month. The average stay time for a psychiatric patient in the emergency room was about 54 hours. This was creating larger wait times and less hospital staff available to treat patients who had actual medical emergencies.
In addition to just housing for these services, the positions needed to help mental health individuals are expensive.
For example, in the jail, to have the psychiatrists who work with the FASTT program, costs roughly $222,000 per year to pay the professionals as well as $80,000 for the cost of the program itself.
Though, not all of the service costs come out of the city’s budget, the Sheriff’s Office MOST program doesn’t cost the department any money — funding comes from the state as part of the mental health budget from the Division of Public and Behavioral Health (DPBH), Bock said.
The Nevada Legislature’s mental health budget totals more than $341 billion for the 2017-2019 budget biennium. This includes budgets for adult mental health services, behavioral health prevention and treatment, Northern Nevada adult mental health services, rural clinics and facilities for offenders with mental health problems.
The Carson City Sheriff’s Office gives a deputy to the program and DPBH provides the funding to pay for a clinician (Bock) to ride with the deputy and handle mental health calls. However, this isn’t the same for all counties. Some use grant funding to obtain the money to pay deputies overtime to work with the program, which can cost about $80,000 as well.
But, this cycle of mental health care also takes a toll on resources needed to get an individual stabilized, only to have them re-enter the cycle.
“Some of them it takes an extraordinary amount of time (working with them) because you want to gain their trust to see what problems they are having,” said former Carson City MOST Deputy Nick Pinochi. “It takes a while just to open the communication line.”
Carson City Sheriff Ken Furlong said while responding to calls with mental health individuals, deputies may spend extraordinary amounts of time on scene of one call. However, this increased interaction saves the community money and time in the long run when resources and treatment can be administered before the jail or hospital becomes an option.
“We look at the resources of FASTT, MOST and CIT by the officers to put prevention on top of our emphasis,” Furlong said. “Options such as jail and the ER only clog the system and do harm to those whose circumstance are of a mental health nature.”
Like the deputies, one of the biggest costs for community resources is time; however, they have discovered that taking that time to collaborate and find solutions has been much more beneficial in the long run.
“The cool part about the coalitions is that it doesn’t cost anything for people to talk to each other,” Flood said. “But we are doing cool stuff without funding because willingness is the one ingredient needed for all this stuff… Now it’s coming up with more ideas on how we can work better and formalizing them.”
Many of the community partners agree this method is what helps reduce costs when providing those mental health services.
“For example, when we are doing our meetings, the room fills up with non-profits and government agencies and they are all learning the names of people they never have met before and because non-profits operate on little money, they are always looking to do things innovatively and inexpensively and they are sharing those ideas,” said Kathy Bartosz, executive director of Partnership Carson City. “With the collaborations it helps out because you don’t have that sense of competition you often see in larger cities. When I see those meetings, there is lots of sharing, lots of resources talked about to benefit the client, whereas in other places there is a disconnect so the gaps are wider and that is what we are working on to avoid.”
The preventive measures taken by law enforcement, counselors and others in the community help decrease the cost of mental health.
“It is a huge cost savings because (it’s expensive for) all those services when these folks are going from service to service,” Bock said. “It’s cost effective if no one entity is managing it, it’s working together and having those community health workers bridge that gap.
“You do put money into the front end of the programs but in long term you save lives and people live longer, happier and healthier lives.”