State, Las Vegas wrangling delays delivery of forensic mental health services

A plan to convert unused units at the Las Vegas City Jail into psychiatric beds for incarcerated people has been pushed back at least 18 months, according to the Nevada Division of Public and Behavioral Health (DPBH).

The city is even less optimistic, saying it can’t provide a timeline until agreements are made with DPBH. Meanwhile, DPBH says it’s still waiting for actions from the city.

Forensic psychiatric beds aim to provide mental health care in a correctional setting and reduce the risk of recidivism in the least restrictive manner, stabilizing a person who is waiting for their case to be adjudicated or an assessment for competency to stand trial.

Currently, 102 people in custody are waiting for forensic beds in Clark County, housed in jails, according to DPBH. The renovated units at the jail would add 44 beds and accompanying staff, using $55.4 million in American Rescue Plan Act (ARPA) funding.

“With this delay are we housing these patients/inmates that need to have these forensic beds in jails?” Republican State Sen. Robin Titus asked DPBH at a legislative Health and Human Services Joint Subcommittee meeting earlier this week.

Lisa Sherych, an administrator for DPBH,  answered that the individuals are in jail waiting for services from DPBH, but that the jails do have some mental health services available. 

In his 2023 State of the State Address, Gov. Joe Lombardo described the need for additional forensic mental services as “critical,” and noted his budget included funds for the Las Vegas Jail conversions as well as upgrades to the Rawson-Neal facility in Las Vegas and the creation of an additional new facility in Southern Nevada. 

The delay in getting people into forensic psychiatric care can exacerbate mental health conditions. 

“Being in a confined setting like that, a lot of times it exacerbates people’s symptoms,” Sheldon Jacobs, a family therapist in Southern Nevada and vice president of (the National Alliance on Mental Illness) NAMI-Southern Nevada, said in an interview.

Jacobs said the NAMI’s policy stance is to divert as many away from the criminal justice system with community-based competency restoration and getting mental health care before their mental illness exacerbates. 

Nevada continues to rank at the bottom of all states in access to care and high prevalence of mental illness, has limited access to community-based outpatient services, and about one-third the national average of psychologists with wait times varying from two months to two years. 

People with mental illness are more likely to be victims of violent crimes than perpetrators yet are more likely to be arrested, charged, and incarcerated for a longer time in jail compared to the general population.

While Nevada is one of 16 states that have community-based competency restoration services, where individuals with low-level misdemeanors can get assessed for competency outside of the jails, its competency restoration system, as in much of the nation, is still overwhelmed and faces significant backlogs. The average wait time for inpatient competency restoration is 142 days. 

“People who have a mental health condition have to have their competency restored in a timely fashion. Obviously, there’s the constitutional part of it, but at the end of the day, we [NAMI]  believe in minimizing the justice system’s response to people with mental health conditions while also ensuring that it actually preserves health, well-being, and dignity. That’s the bottom line,” Jacobs said. 

During this week’s legislative meeting, Democratic Assembly Speaker Steve Yeager voiced concerns that the wait times for beds could be putting the state at risk of “getting involved in litigation on the state side of not being able to provide these services.” 

‘Once the agreement is finalized…’ 

In October 2022, state officials told the legislative Interim Finance Committee (IFC) that the Las Vegas City Jail was to be partially renovated into forensic beds and ready to be used by July 2023.

But, according to a DPBH document from the committee hearing this week, the earliest the renovations would be completed is by December 2024, and that date could only be met if “lease negotiations and the city’s necessary renovations prior to commencement of the division’s construction project are done timely.” 

“I remember talking about it in front of IFC and obviously being supportive of it then, and I thought the impetus of it then was the fact we weren’t servicing folks in a timely manner and didn’t have bed space,” Yeager said at this week’s hearing, adding he was  “disappointed to hear that there are delays, but I understand that is the reality of the world we live in.”

DPBH had frequent meetings with the  City of Las Vegas before and after the approval of the ARPA funds in October 2022, but the DPBH said the city cited multiple reasons for delays, including holidays and annual leave in November and December when ”key personnel from the City of Las Vegas” were not available to confirm a lease agreement, according to DPBH document provided to the Human Services Joint Subcommittee.  

The DPBH document also stated that the units the City of Las Vegas had initially proposed for the beds would not meet the division’s standards without significant construction and that DPBH advised the city it wanted to proceed with different units.

In March, the City of Las Vegas said it was unable to move populations out of the agreed upon units last fall as planned, further delaying the renovation process, according to DPBH.  

The City of Las Vegas told the Current in an email “the agreement between the State and the city of Las Vegas is still being worked on and has not been finalized. Once the agreement is finalized then there would be a timeline for the project.”

Earlier this year, DPBH said it is continuing to recruit staff for the Las Vegas facility’s forensic units and hired seven contract staff, including four administrative assistants, two social workers, and one psychiatric nurse.