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Treating People in Crisis


ER Triage by Therapeutic Communities for Substance Abuse and Mental Health Disorders

Beyond the shining neon lights of the glamorous Las Vegas Strip lies a community rife with social problems. What happens in Vegas stays in Vegas is as much a tourist’s mantra as it is a local’s curse. Despite its world-renowned image as a resort destination, Las Vegas has struggled and continues to struggle with a problem that plagues one of the nation’s fastest growing regions. 

On July 9, 2004, Thom Reilly, Clark County’s manager officially issued a state of emergency, perhaps for the first time in U.S. history because of the number of mentally ill individuals occupying local emergency room beds.

Unlike other metropolitan areas, Las Vegas had already designed a system to treat co-occurring disorderes in individuals. In early 2003, the Community Triage Center, or CTC, began operating. Housed in an aging detoxification facility, the CTC quickly became known to police officers and EMTs throughout the growing metropolitan area. The goal of the CTC is to alleviate emergency room overcrowding and to provide law enforcement and emergency personnel with a place to take individuals suffering from behavioral health crises.  This includes mentally ill substance abusers. The CTC provides local municipalities and local hospitals with a more cost-effective solution to a segment of the population that often ends up in emergency rooms or detention centers.

More importantly, however, is the efficacy of the triage concept. Persons brought to the CTC are assessed for substance abuse and mental health disorders. Staff determines the best course of treatment for each individual who comes to the Center. A part-time psychiatrist prescribes medications and consults with staff clinicians. Social workers create treatment plans. Clients receive treatment instead of being held in emergency rooms and detention centers. 

The Southern Nevada Regional Planning Coalition (SNRPC) is the brainchild of the CTC concept in Clark County. In response to a growing concern by law enforcement and hospital personnel, the SNRPC convened a mental health task force. The task force was charged with finding a solution to a growing problem—the number of mentally ill persons admitted to emergency departments and detention centers. The task force recommended the creation of the Community Triage Center.  

Once the concept was approved, the SNRPC designed a funding formula. Operating costs would be shared equally among the state, local municipalities, and local hospitals. That way, no single entity would be burdened with funding the service. The initial funding formula was pro-rated on several factors: population, number of referrals, and other factors. After the first year of operation, modifications were made to the formula in order to equitably distribute costs. 

During its first year of operation, the CTC provided services to over 6,000 individuals, or approximately 500 a month. The facility, licensed by the Bureau of Alcohol and Drug Abuse, has 52 beds. Most days, the CTC operates at capacity.  

At the time of the mental health crisis, the CTC was operating as usual. Had this service not been available, the declared state of emergency might have been much worse. Had it not been for the leadership exhibited by Richard E. Steinberg, president/CEO of WestCare, the operator of the CTC, many persons in need of treatment would go without.  

As more communities encounter the problems inherent in addressing co-occurring disorders, the triage concept may become more prevalent across the country. It offers a cost-effective, humane and therapeutic option to communities in need of a solution to a growing issue. It also offers an opportunity for therapeutic communities to step forward and lead the way toward this innovative concept.