Beginning in the Sixties, changing winds in medical thought and budgetary constraints sent scores of thousands of psychiatric patients into America's towns and cities.

Gone were the days of Ken Kesey's "One Flew Over The Cuckoos' Nest" (1962), replaced by scenes of men and women shuffling around on the street, congregating in parks and at public libraries. Now, the state of Nevada is shipping its mentally ill elsewhere, mostly to California.

Since mid-2008, Rawson-Neal Psychiatric Hospital in Las Vegas, the state's primary mental hospital, has exported more than 1,500 patients by Greyhound bus, sending at least one mentally ill person to every continental state in the U.S. - with one-third going to the "Golden State."

As hard times hit Nevada amidst the Great Recession, the state cut funding for mental health services and bussed more patients across state lines, including more than 200 to Los Angeles County, approximately 70 to San Diego County and 19 to Sacramento. The number of inpatient out-bussing grew by 66 percent from 2009 to 1012, according to a media review of bus receipts kept by the state's mental health division.

Last year, the hospital expunged about one patient per day, busing nearly 400 mentally ill people to 176 cities and 45 states across the country. But the cost-saving strategy drew criticism when one of the state's former inpatients presented as suicidal and confused at a homeless shelter in Sacramento. Mental health professionals there say the hospital sent James Flavy Coy Brown, 48, diagnosed with schizophrenia and a variety of mood disorders, on a sojourn to a random destination. Out of medication after the 15-hour bus ride and lacking identification or access to his Social Security income, he wandered into the University of California at Davis Medical Center's emergency room, where he stayed for three days until social workers secured temporary housing.

While Nevada admits mistakes were made, officials refused to apologize for the busing policy. People who've traveled to Las Vegas, an international destination, have the right to return home if they desire, the state's health officer, Dr. Tracey Green, told legislators at a hearing last month. She and other officials said most of the patients they discharge to Greyhound are mentally stable with familial connections - and that treatment programs are waiting for them in other states.

However, Brown was effectively sent away with a note: "Discharge to Greyhound bus station by taxi with 3 day supply of medication... Follow up with medical doctor in California." The hospital instructed the indigent and mentally ill man to 'call 911" upon his arrival in Sacramento.

Though health officials blundered Brown's case, an internal investigation found no pattern of misconduct, Nevada Health and Human Services Director Michael Wilden said at the hearing. Yet, at least two other patients from Nevada arrived by bus in Sacramento last year "without a plan, without a relative," said Jo Robinson, director of Sacramento's behavioral health services department.

"We're fine with taking people if they call and we make arrangements and make sure that everything is OK for the individual," Robinson told the Sacramento Bee. "But a bus ticket with no contact, no clinic receptor, anything - it's really not appropriate."

A spokesman for Greyhound said the company has had a contract since mid-2009 with Southern Nevada Adult Mental Health Services, which did not respond to repeated requests from the Sacramento Bee and other media outlets for comment.