A psychiatric hospital in Las Vegas used Greyhound buses to ship severely disabled patients out of Nevada to other states.
A psychiatric hospital in Las Vegas used Greyhound buses to ship severely disabled patients out of Nevada to other states.


by Kamran Abri

In September 2013, the city of San Francisco sued the state of Nevada for the wrongful transportation of patients with severe mental health diagnoses across state lines.
It had been a common practice of Rawson-Neal Psychiatric Hospital, a state mental health facility in Las Vegas, to hand out bus tickets and a bag lunch to approximately 1500 patients, “transferring” them to states all over the country.
In many of these so-called patient transfers over the previous five years, patients were sent to states where they had never been a resident or known anyone who was a resident. They were sent to areas that had no infrastructure for health, or had no mental institution prepared to receive them.
Instead, they were released with cryptic instructions like, “Discharge to Greyhound bus station by taxi with 3 day supply of medication… Follow up with medical doctor in California.”
San Francisco identified 24 patients dumped from Rawson-Neal Hospital in total, 20 of whom were in need of medical care “within mere hours of getting off the bus,” according to the lawsuit.
In September 2015, Nevada and San Francisco agreed to a settlement amount of $400,000 to cover the $500,000 the lawsuit estimated had been spent on the care of these patients.
The wrongdoing in this case was fairly clear. Nevada state and health officials strung together a thin veil of excuses, ranging from denial to arguing that they were sending these patients directly to family members and other mental health facilities (possibly true in some cases, blatantly false in a majority of them).
Meanwhile, Rawson-Neal had its accreditation temporarily suspended pending drastic amendments to their “patient transfer program.” The amendments came, and accreditation was restored (in its new form, the program has become strikingly similar to San Francisco’s own “Homeward Bound” program, which contains strict guidelines requiring documentation that someone at the destination is planning to receive the transferred individual).
Now, it may seem that everything in this situation has been resolved. Although it has been at the expense of effective, ethical, and common-sense care for thousands of patients that Rawson-Neal scattered all across the United States, they have fixed their immensely flawed and horrible system and now exist under close scrutiny of the federal government.
However, the Rawson-Neal incident is simply a reminder of something that is surprisingly common in the United States: “Greyhound Therapy.”

Stories from The Suitcase Clinic.
Stories from The Suitcase Clinic.

The practice of packing up patients with severe mental health problems into Greyhound buses to send them to cities and counties across the United States began in the 1960s as a result of the massive, sweeping budget cuts imposed on inpatient mental health facilities. The closing of inpatient facilities forced the patients onto the streets, and Greyhound therapy became a means to remove patients from the facilities that managed to stay open and deliver them to streets elsewhere in the country, where they would no longer be a problem (or an expense) for that facility.
An estimated 20-25 percent of the homeless population in the United States suffer from severe mental health issues. These individuals provide concrete evidence that the mental health system in the country has broken down completely, and the continued practice of Greyhound Therapy is a stark reminder that we have made few, if any, improvements over the decades.
In truth, Greyhound Therapy is the inevitable result of a combination of issues, and therefore remains an extremely important symptom for us in measuring the dire straits of mental health care. With few inpatient and outpatient facilities devoted to mental health, we see an inevitable overcrowding of the services that remain available.
These available services are overworked and underfunded, and thus we see the barbaric practice of Greyhound Therapy march on. But this also reveals the “out of sight, out of mind” mindset that has been adopted by mental health facilities across the country. There is no consideration for more effective programs, such as increased transitional housing and Housing First. In the case of Rawson-Neal, there was not even the consideration of sending patients to another hospital or to a family member.
Our nation’s mental health system is in a state of crisis. A class of internal refugees has been created, refugees of failed mental health care and social policy systems whose administrators and lawmakers choose to ignore proven interventions and instead predictably opt to shuttle the homeless and underserved to other cities, counties, or even states.
This is not ethical, nor is it effective. The fact that Greyhound Therapy is still alive and kicking in the modern era in cases like Rawson-Neal should be a sign to us all that very little has changed.
Everything must change, and it must change now. If it does not, then we must all come to terms with the fact that those with the agency to make change are no longer listening.