RENO—Important. historic. unprecedented.
These are just a few of the words state administrators, advocates, and service providers use to describe recent investments in mental health services in Nevada.
Most of these funds, under the American Rescue Plans Act, were approved by the Interim Finance Committee at their August and October meetings, totaling more than $59 million.
Funds have been allocated to several projects statewide, including $15 million for youth care and case management and $2 million for the establishment of the Children’s Behavioral Health Authority.
However, despite the potential meaningful impact on the state’s needs, many stakeholders in the state’s mental health care ecosystem believe that this allocation is a first step to address longstanding funding shortfalls. He says that it is nothing more than
“We’ve neglected the system for so long that we can’t fix the problem overnight,” said Amanda Habousch, president of the Clark County Children’s Mental Health Consortium.
Mental health has long been underfunded
Nevada has long ranked last in the nation for youth mental health services. According to Mental Health America, Nevada has been ranked 51st in the nation for youth mental health services for the past five years. Rankings, including the District of Columbia, are based on prevalence of mental illness and access to care.
And the need for mental health services has skyrocketed during the COVID-19 pandemic, said Kim Abbott, an attorney at the Legal Aid Center for the Child Lawyer Project in Southern Nevada.
“It kind of blew the door on an already very broken and very fragmented system. The needs increased significantly. say.
In the meantime, the Southern Nevada Legal Aid Center has met with several other stakeholders, including the Clark County Child Mental Health Consortium and the Clark County Department of Family Services, to “develop a list of problems and possible solutions.” said Abbott. He said.
What they discovered, and what many other providers have experienced over the years, is that the state lacks what is known as a strong continuum of care.
A good way to think of the continuum of care as an umbrella of colors, from black to white with shades of gray in between, is child and adolescent psychiatrist Dr. Lisa Durette.
On one side of the spectrum is outpatient care, which can include an individual speaking with a therapist once a week. hospitalization may be included.
Durette, who also serves as interim chair of psychiatry and behavioral health at the University of Nevada, Las Vegas, said Nevada lacks many of the services that fill those shades of gray.
“The part where we haven’t necessarily closed the gap is that interim level of care,” she said. It’s a set of care that we really need to fill in the gaps over time.”
When the continuum is broken, children are often placed in a harsher environment than necessary for their behavioral health needs, and this can do more harm than good.
“We always want children and families in general to be served in the least restrictive and most appropriate environment. Abbott said.
A lack of services within the state may also result in children being sent to other facilities out of state, which is costly for the state and can be costly for the mental health of young people.
“The state reports that in March 2021, 305 children were being treated in residential facilities, of which 130 (43%) were in residential facilities outside of Nevada. July 2019 Between through February 2021, Nevada funded 779 institutional treatment stays for 667 children, and 37% of these residential treatment stays were out-of-state. It took place in a facility,” the U.S. Department of Justice report details.
The report, published three weeks before the Interim Finance Committee’s October meeting, found that the state has been unable to adequately serve children with behavioral disorders due to ongoing care gaps, and is seeking alternatives. details the heavy reliance on residential treatment. Facility.
The report also said the state’s failure to provide services violated the Americans with Disabilities Act and that the U.S. government could sue if the state “cannot reach a resolution.” I am warning you.
Fix the continuum of care
Missing in the continuum of care are community-based providers, according to Child and Family Services Administrator Cindy Pitlock, Department of Health and Human Services.
“Efforts to build more of that community-based provider network should continue to ensure that the state lacks a robust and accessible community-based provider network,” Pitlock said.
Because states are not the only providers of all clinical services, we work with what we call community-based providers, including hospitals, clinics, and community-based mental health companies that see patients on a daily basis.
“These are important touchpoints that young people and families access every day,” she said.
However, building a community-based provider network has been difficult. Workplace shortages plague nearly every industry in Nevada, and mental health care is no exception.
“We are trying to bring more qualified mental health professionals to Nevada to meet the needs of our community,” said Dave Doyle, a foster parent of 20 years. said. They have had to carry so far because there are not enough quality manpower. Look at all the vacancies at the state level, county level and even among private providers and agencies. We’ve all experienced it. ”
Doyle is the Director of Operations for Eagle Quest. EagleQuest began as a small foster care program, but expanded to provide treatment and medication administration and is now one of the largest therapeutic foster care agencies in the state.
And the difficulty in hiring quality professionals doesn’t just add to the workload. Medicaid reimbursement is often uncompetitive.
Sid Khurana, Ph.D., a child and adolescent psychiatrist and medical director of Mental Health, Nevada, says higher levels of care and reimbursement for hospitalization are lower with Medicaid than with private insurance. increase.
“When a resident or fellow is out of training with astronomical student loans and deciding where to practice,” he said. “They have loans to pay off, so what they are going to do professionally becomes a factor, and insurance reimbursement is important.”
This affects the number of providers in the community, Haboush said, especially if they are concerned about making a living.
“They are paying what they need to provide these services. It’s really hard to persuade, she said. We must also work to reduce
Congress has made some progress
A portion of the funds allocated by the Interim Finance Committee are intended to address some of these longstanding issues.
Funds donated to the Department of Health and Human Services’ Aged Disability Services Division will be used to eliminate waitlists for services, increase the capacity of community providers and recruit specialized providers, said administrator Dena Schmidt. says Mr.
“There is a great need for specialized providers who serve individuals with intellectual and developmental disabilities who need behavioral health problems,” she said. “It’s a really complex group of people to serve.” We are seeking to recruit providers specific to that population into our state that do not currently exist.”
Schmidt called it a “once in my career opportunity” to invest in increasing the number of specialty healthcare providers in Nevada.
Federal funding will add a face-to-face component to local mobile emergency response teams established in 2016 through a Nevada System of Care grant, using telemedicine to connect people in need and clinicians through emergency phone lines. You can connect doctors.
The funds will create four new positions in Elko. This includes her two teams of psychiatric caseworkers and her assistants at Consumer Services, who work in tandem with telehealth services, she said, Ellen Richardson-Adams.
Richardson-Adams oversees outpatient services for adult mental health services and rural clinics in Southern Nevada.
Fundraising has just begun
But in dealing with Nevada’s mental health crisis, funding was easy, Abbott said.
“In some ways, allocating the money was the easy part. The real work begins because the program needs to be launched. The state has to be able to get that money out,” Abbott said. said.
However, once these programs are created, they will need funds to continue operating after federal funding runs out.
“The next step is to double down on the sustainability part,” said Pitlock. “ARPA has been a tremendous boon to the mental health of children in Nevada. We need to make sure it’s maintained, and what we don’t want to do is set up a complete system of care that’s high quality and robust and we can’t sustain it for long.”
This feeling was echoed by other providers, including Nevada PEP Executive Director Karen Tycher, who called the Interim Finance Committee funding a “kickstart.”
“We definitely needed this to get things started. The Arc of Money is expiring, so it’s about raising sustainable funding,” said Taycher. “Parliament will have to get involved in that sustainability.”
Senate Majority Leader Nicole Cannizzaro said the mental health system was a “huge concern” for her.
“We know these are essential services and we need to work to make them more accessible to Nevadans,” she said. We’re building systems that help support health.”
In a statement, House Speaker nominee Steve Yeager said he looked forward to working with other lawmakers to address the issue.
“We are not where we should be as a state when it comes to behavioral health services and treatments,” he said. I look forward to working with my legislative colleagues and the Governor of Lombardo to consider these solutions in Congress.”
Lombardo spokesperson Elizabeth Ray said the governor “looks forward to outlining investments in mental health services in his next state address.”
The governor is scheduled to deliver a state address in Carson City on Monday.
Doyle said it’s important to continue building a system of mental health care services because the problem hasn’t been resolved.
“Mental health is everywhere. No one is immune from mental health problems,” he said. “Mental health doesn’t discriminate. It’s out there. And it’s very real and needs to be addressed before it gets worse. And investing in mental health can save lives.” ”
If you’re having suicidal thoughts or are worried about a friend or loved one, call or text Lifeline Network at 988 for 24/7 support . Live chat is available at 988lifeline.org. Crisis Support Services in Nevada can be reached by calling 1-800-273-8255 or texting CARE (2273) to 839863.
Please contact Taylor R. Avery at Tavery@reviewjournal.com.follow @travery98 on Twitter.