A mental health crisis peaked around 2004, when the number of psychiatric patients — people with mental illnesses, sometimes worsened by drugs or alcohol — swelled to more than 100 per day at local hospital emergency rooms. Hospitals are required to hold these patients until they can go to an inpatient psychiatric facility.

Meanwhile, people injured in car accidents or other physical problems had to wait longer in the ER.

The state put about $35 million into building the 190-bed facility, which was named after state senators and mental health advocates Ray Rawson and Joe Neal. The hospital expects to have its first patients at the end of the month. Rawson-Neal was designed with high ceilings, muted desert colors and a large courtyard to help patients stabilize quickly.

The facility, at Jones and Oakey boulevards, was built similarly to the acute psychiatric hospital in Sparks but is larger in scope and size. In Las Vegas, Rawson-Neal will serve as a focal point for four — soon to be five — outpatient clinics in the valley. The existing state inpatient psychiatric hospital next door to Rawson-Neal will continue to provide some additional acute-care beds.

Dr. David Rosin, state medical director of Nevada Mental Health Developmental Services, talked to In Business Las Vegas about how the new hospital will make a difference.

We're hoping it will make a major one. We currently have 77 beds and 26 emergency beds, and when we're through, we'll be operating 217 beds. This hospital opens in two phases. The first phase is three pods, plus the psychiatric emergency room and the psychiatric observation unit, and in another month or so we'll open the fourth pod.

We have been running anywhere from 30 to 60 patients in the emergency rooms, plus we already have a 50-bed unit operating temporarily at WestCare. Over the last month we've had several days where, between those two, we've had over 100 people waiting to get services.

The problem in the emergency rooms was, and still is, that the people who are sitting there can sit there for three to five days, waiting to come here. And people with heart attacks, auto accidents, fractures — they can't get into the emergency room because our patients are occupying the beds. So it affects all the citizens.

It's not going to be overnight, because it's going to take them a period of time to get the people moved into this facility. When this facility opens, we have a lot of new systems we've never used before. We've got the automatic dispensing equipment, Pyxis. We have electronic medical records. Those are two systems that Las Vegas (state mental health facilities) have never used. In addition we've got all the operational things to work on in a hospital.

I would hope it's much less than that.

We responded to the crisis over the last couple of years by adding new services. We're continuing that, but in an expanded way. Right now we have recreational therapy and art therapy, and we're expanding to music therapy and craft therapy. The setups are state of the art. We'll almost double the size of our activity therapy department.

We were authorized to hire 99 new nurses and 20 new psychiatrists. They're not all coming in at this building. This building only serves as a hub to keep all the community programs going. There are no chronic hospital beds here. We are an acute-care service for when people have a need to get into a shelter situation for stabilization or for treatment for acute mental illness. We do that here and as quickly as possible return people to outpatient care. So the outpatient program gets about 70 percent of our budget, and the hospital gets about 30 percent, even though we have this massive increase in our hospital beds.

Our average length of stay here is between 19 and 21 days, and it's been so, north and south, ever since I've been in the state since 1995.

The model here is different than it is in other states. Nevada is one of the few remaining states which has a central government — a central office in Carson City actually not only funds but provides care. In most other states the central office puts out money to the surrounding counties and cities and each one runs its own individualized program. So there is very often tension between the hospital and the community. But here, once a week on Friday, we will have a meeting in this room with all the leadership from the entire community side and the entire hospital side, so we have a way every week to make sure we have free flow of information and patients, back and forth between the hospital. That is something that is not happening in the other states.

Currently we run four clinic sites: one on the campus here at Charleston (Boulevard), one in North Las Vegas and one in east Las Vegas, one in Henderson. Around the beginning of the year we will open a site downtown. At those sites we offer medication management, psychiatrists, nursing service. We have counseling service, housing services, case management services.

We have a relatively new concept — though it's been in this state for a while, it's new in the country — we have consumer services. (Patients are called "consumers of service.") We actually have consumers who have recovered and are now state employees, and they help us provide care with our own clients. We have what we call a Recovery Model in this state, and our goal is to help people recover to the maximum that they can, and in doing so there's no reason not to hire them. For many people who are chronically mentally ill, having someone who has been there before and has walked the walk with them really helps them in terms of counseling and advice.

The incidence of schizophrenia, the incidence of manic depressive disease is pretty constant throughout. A lot of people feel because we're a 24-hour city and we have people coming in from other parts of the country, that would be affected. But it probably is not that much. Our figures are probably pretty representative.

The problem is that, since I've been around, we have lost in Las Vegas, when Charter closed, we lost 80 beds, when Valley Hospital's psychiatric unit closed, we lost 10 beds and when the old Lake Mead Hospital closed, we lost another 22 beds.

Four or five years. Now Montevista is a private hospital and we have two other new private hospitals now that are beginning to accept private-pay patients. But the two I mentioned, the old Lake Mead, which is now North Vista Hospital, and Valley Hospital, were providers of Medicaid services. You can't get reimbursed through Medicaid unless you are in a psychiatric unit of a general hospital. And, of course, we can't get reimbursed. Those 50 beds that used to be in the community, they are totally gone and can never be replaced; that has added to the overall numbers problem.

This is a unique city. I don't know many other places in the country where you don't have small psychiatric units in general hospitals. The state only has one: It's in Carson City. None in Reno, none in Las Vegas and Carson-Tahoe Hospital has a small psychiatric unit.

We've had a wonderful governor. We've had wonderful legislators. Since we're not allowed to lobby being state employees, I think that under (Administrator) Dr. (Carlos) Brandenburg's direction we all tried to educate as much as we could. In addition, both in the north and here, we've had advocacy groups that have stepped forward, Mental Health Coalition Group in the north and Mental Health Coalition Group here, which have really carried the message. Mentally ill people aren't good at expressing themselves. We've had a lot of support throughout the state and community support down here with the crisis in the hospitals. We've had hospital support, and again we've all had wonderful legislators and wonderful governors.

You never stop with the wish list. But I think right now we're faced with continued growth. We're always at least going to be looking for funding to catch our growth experiences. We all have our hands full right now getting everything up and running.

One of our programs is called PACT (Program for Assertive Community Treatment), which are like "hospitals without walls." We currently have two such programs in Las Vegas. They're a group of folks who are managed by social workers, psychiatrists, psychologists and case managers. These are people who have multiple hospitalizations. What happens is that we provide wraparound service with a specialized team and we have reduced the number of days in the hospital tremendously by providing that support.

The second team we put in place a couple of years ago, is focusing on the homeless. We would like to have a third such team. I told you we would be opening up another clinic. At some point in the center, it would be very important to have a drop-in center or a clubhouse. That's something we don't have. It would be very important as our relationship with BADA — the Bureau of Alcohol and Drug Abuse — is now coming under mental health in terms of how this thing's organized. My hope is we will be able to increase our services to folks who suffer from both mental illness and chemical dependency, and that's a large number.

On the private side are attempts to manage that; on the public side we're just beginning. The north actually has a program and the south we've been able to provide some services. Whether that will take new funding or we'll be able to do that with the combined funding efforts of BADA and mental health, I'm not sure.

We have our hands full, putting all these programs in and getting the new hospital and new clinic up and running smoothly. Plus, we've expanded the Henderson site and will expand the North Las Vegas site, and although we are still in the Charleston campus here, we've expanded that site as well.

Basically our system has almost doubled in size in the last two legislative sessions.

We wanted to be good neighbors. This is state land. We could've just built this place and never talked to anybody, but we were trying to be good neighbors so we went to the City Council and we had neighborhood meetings, and we tried to educate people.

Instead of just ignoring the community, what we said is we want to be an active part of this community. We've been an active part of this community — actually we've been on this same block of land since the 1970s. The community really built up around it, but a lot of folks didn't know we were there.

That's a difficult thing. Every time you talk about security, they think you're talking about a forensic facility or people who are permanently deranged. One of the things we tried to do is educate everybody that that is not the case. Everybody is here civilly, we don't handle criminals. Lakes Crossing (Center for the Mentally Disordered Offender) in Sparks is where folks are managed. It is conceivable that there may be an expansion of Lakes Crossing somewhere in the south because now they fly people up to Lakes Crossing for services.

So there's an impression that we are like a prison, and we're not. On the other hand, this is a secure environment. As soon as you say escape proof, someone will land a helicopter. But basically this is very secure. It takes several doors to get out. You walk through the security doors and it takes a code, and the codes are all individualized.

We have a drive-in behind locked gates (for ambulances). In the north you won't find that, but because we are functioning in this community, we wanted to put everybody at ease. Today we don't do that. Ambulances come up to the old hospital and drop people off. But we decided with all the concerns expressed to us before the building process started that we would modify plans and install that security. We have security on site at all times, and it's state of the art.

We're still recruiting. I've been recruiting in preparation for this for the last two years. The (state) Department of Personnel was very good to us in giving support, which is over and above what they usually give or have to give. I've been interviewing people and getting people hired for a long time. We went out to all the nursing schools and out to conferences and did national advertising.

One of the things that has made it doable is we're in Las Vegas, and people like to come to Las Vegas. I would not like to have this job if I were sitting in Arkansas.

And the recruiting process still goes on for the positions we haven't hired. We have contracted with three nursing agencies for a group of nurses that are all trained on our policies and procedures so we can backfill. We use what we call "locum tenens" psychiatrists, contract psychiatrists. Until we are totally independent with state employees, we fill in with locum tenens.

This state made the decision several years ago to bring electronic medical records into the state. It was decided a couple of years ago that the first installation would be in the north, because it's a much smaller facility. It has been operational in the north and in rural Nevada, and now it's been brought down to Southern Nevada for the opening of this hospital. After we have gotten it up and running in this hospital, and we're satisfied, it will be generalized to all the services throughout the valley.

When that's done, any patient served by the division, that's the underinsured or the uninsured, no matter where they live, it doesn't matter. We'll be able to get online, like the VA system throughout the country, and bring up their history, bring up their hospitalization, bring up the case management. Those are service coordinators, people who go out and see them on a regular basis, who will be able to bring up all the material, all the medications. At a computer keyboard, we'll have all the history. If someone is traveling anywhere within the state and has problems, we'll be able to manage it.

No. This state employs all of its own doctors and clinics. This system is internal within the state, and HIPAA laws say we cannot share anybody's personal information without having some kind of contractual relationship, so we can share with Reno, we can share with Carson, we can share with Henderson at our clinic. We're all the same state facilities. Like the veterans' system, they can share throughout the country with the mental-health system, we can share throughout the whole mental-health system within the state.

If somebody is in Henderson and they've been seen and they have trouble, and they're getting care there, but on Saturday at 2 in the morning they get into trouble and somebody brings them in here, we know everything about them. Otherwise, they might as well be coming from Mars. You have to wait until Monday or Tuesday to get medical records, try to call and find out, whatever. This way it's all at your fingertips.

Currently anybody who goes into any psychiatric facility, private or public, in the state has got to be medically cleared in the emergency room. That's because many medical illnesses masquerade as psychiatric illnesses. You don't want to bring someone into psychiatric care if in fact it's a thyroid problem or diabetes or blood pressure or reaction to one of those meds for those treatments that's causing the mental problems.