A denial of funding from the 2001 Legislature took some of the wind out of the Carson City Mental Health Coalition's sails, but the group is still working to improve services to the capital's mentally ill.
The coalition, made of regional and state government agencies and local mental health providers looking to better help the mentally ill in the region, asked the Legislature for $500,000 to create a mental health crisis team.
The team would have allowed for coordination between multiple agencies treating the mentally ill.
However, in the face of a state budget deficit and opposition from some legislators, coalition leaders had to "rethink where we were going," Carson City Manager John Berkich said.
"We began to focus on other opportunities such as the jail, and we've begun to research some significant trends in mental health care," he said.
A scaled-down coalition is focusing more on mental health care in Carson City rather than on a regional level, and the most visible changes have occurred in the city's justice system -- from the courts to the jail.
At the top of the system in district court, Judge Michael Griffin now has a list with details of agencies and a variety of certified therapists to which he can refer people.
Frequently, judges will require counseling or rehabilitation as part of a sentence. Unless he has a specific person he wants those in court to see, Griffin said defendants are left on their own to find treatment from substance abuse to family counseling.
"Would you know where to go? Most people wouldn't," Griffin said. "Now we have a quick reference for who can treat what. For the first time, I can sit down and see who provides what kind of mental health treatments.
The list was compiled by Coalition Coordinator Mary Ellen Waltz, who pointed out that while the job wasn't necessarily hard, no one had taken the time to do it.
"The mental health coalition is about streamlining resources," she said. "This is about the right referral for the right person who then shows up at the right agency. We have a lot further to go, but what we have here is a beginning."
Jails across the country often are occupied by people who suffer from mental illnesses, and Carson City is no exception.
Chief Deputy Jerry Mather said inmates are often brought to jail under the influence of drugs or alcohol, making it difficult to discern whether their problems stem from substance abuse or an underlying mental condition. Previously, inmates have had access to health care one day a week. Inmates needing medical care on other days either had to wait or were sent to a hospital emergency room.
Since many do deal with mental health issues, they had access to medications, but not the therapy needed to complete their treatment. And when they left jail, they were on their own.
Dealing with this problem was identified during early coalition meetings, and now "we're hooking up the pieces," Waltz said.
Mather said since the jail opened in 1999, there have been two successful suicides and several attempts. Jail staff also has to deal with behavioral problems as a result of substance abuse problems or mental illness.
"We thought we ought to have medical services more often," Mather said. "We felt there was a need to have some professional psychological services available to the inmates."
Now, the jail has a physician's assistant at the jail daily and the services of forensic psychologist Joseph McEllistrem at least three days a week.
"They're working together in addressing the physical and mental issues of the inmates," Mather said.
McEllistrem said he was asked to help stabilize mentally ill patients and link them to outside agencies for help upon release. He figures he's treating up to 8 percent of the jail population.
"It's important because for a large part of the inmates I work with, re-offense behavior relates to mental illness or addiction," he said. "When people are well treated, well medicated and abstinent from alcohol or drugs, they are much less likely to re-offend. If we can hit those two big areas, we will have success deterring reoccurrence."
Despite the successes, at least one group that deals with the mentally ill daily hasn't seen much in the way of change because the coalition lost momentum after the legislature.
Jeanne Paquin, with the National Alliance for the Mentally Ill, said her group hasn't see changes primarily because the coalition didn't receive funding to expand its influence fully into the community. Her group is working with state leaders to create a system to deal with the complaints of the mentally ill going through the state system.
"We haven't seen any direct assistance, education or outright information that the coalition is working on," she said. "Because they weren't funded, they've become inert in some ways."
Waltz, whose $50,000 position is funded by Carson-Tahoe Hospital, said continuing goals for the coalition include beginning discussion of gaps in mental health services for children as well as research to help gear up for the 2003 Legislature.
"We want to tell elected officials we're here, we're real, we're committed," she said.
Supervisor Pete Livermore, who serves on the coalition, said the group geared up too late to be successful in the 2001 Legislature, but is working to be the most recognized metal health group in the state for the next session.
"Hopefully, we can deliver to our residents some changes in our mental health care," he said.