Renault – important. Historical. Unprecedented.
These are just some of the words state officials, advocates, and service providers use to describe recent investments in mental health services in Nevada.
The money has been earmarked for several projects across the state, including $15 million for youth care and case management and $2 million for the creation of the Children’s Behavioral Health Authority.
But despite the potential for making a measurable impact on the state’s needs, many stakeholders in the state’s mental health care ecosystem say the allocation is just the first step in making up for years of underfunding.
“It’s not going to solve the problem overnight because we’ve neglected the system for so long,” said Amanda Habboush, president of the Children’s Mental Health Federation of Clark County.
Mental health has been underfunded for a long time
Nevada has long ranked lowest in the nation for mental health services for young people. According to Mental Health America, Nevada has ranked 51st in the country in youth mental health services over the past five years. The ranking, which includes the District of Columbia, bases its rankings on prevalence of mental illness and rates of access to care.
This need for mental health services has skyrocketed during the COVID-19 pandemic, said Kim Abbott, an attorney with the Southern Nevada Children’s Advocate Project Legal Aid Center.
“It kind of opened the doors to what was already a very broken, very broken system. We saw the needs grow exponentially. We just didn’t have the right placements and services,” Abbott said.
During that time, the Southern Nevada Legal Aid Center sat down with several other stakeholders, including the Clark County Children’s Mental Health Federation and the Clark County Department of Family Services, to “devise a list of problems and possible solutions,” Abbott said.
What they find — and what many other providers have struggled with for years — is that the state lacks what is known as a strong chain of care.
It’s a good way to think of the continuum of care as an umbrella of colour, from black to white with shades of gray in between, said Dr. Lisa Dorrit, a child and adolescent psychiatrist.
On one side of the spectrum is outpatient care, which can include an individual talking to a therapist once a week. On the other side of the spectrum are residential inpatient services, which can include a hospital stay for a short period of time, sometimes extended.
Dorrit, who is also the interim chair of psychiatry and behavioral health at the University of Nevada Las Vegas, said Nevada lacks many services that fill in those shades of gray.
“The part where we don’t fill in the gaps is necessarily the temporary level of care,” she said. “There are a lot of types of interventions that fall between the two extremes of the spectrum and this is the continuum of care that we really need to take some time to fill in the gaps in.”
Breaks in the chain often result in a child being placed in an environment that is more restrictive than is needed for their behavioral health needs, which can cause more harm than good.
“We always want children and families in general to have access to services in the least restrictive and most appropriate environment. We don’t want to unnecessarily institutionalize children,” Abbott said.
A lack of services in the state can also cause a child to be sent out of state to other facilities, which is costly to the state and can be costly to a young person’s mental health.
The state reported 305 children undergoing residential treatment in March 2021, of whom 130 (43%) were children in residential facilities outside of Nevada. Between July 2019 and February 2021, the state of Nevada funded 779 treatment stays for 667 children. 37% of these treatment stays were in out-of-state facilities,” says a report from the US Department of Justice.
the Reportpublished less than three weeks before the Interim Finance Committee meeting in October, details the state’s continued failure to provide adequate services to children with behavioral health disabilities due to gaps in continuity of care, and instead relies heavily on treatment facilities. residential.
The report also warned the state that its failure to provide services violates the Americans with Disabilities Act and that a lawsuit by the US government is possible if the state is “unable to reach a solution.”
Determine continuity of care
What’s missing in the continuum of care are community-based providers, according to the Department of Children and Family Services’ Division of Health and Human Services Cindy Petlock.
“We need to continue our efforts to build more of a community-based provider network to ensure that we have a robust, accessible, community-based provider network that lacks jurisdiction,” said Petlock.
Since the state is not the sole provider of all clinical services, it works with so-called community service providers, which include hospitals, clinics, and community mental health companies that receive patients on a daily basis.
“These are the vital touch points that young people and families reach every day,” she said.
But building a network of community service providers has been difficult. Workplace shortages afflict nearly every industry in Nevada, and mental health care is no exception.
“We’re trying to bring more qualified mental health professionals to Nevada to meet the demands our community needs,” said Dave Doyle, who has been a foster parent for 20 years. “It’s been difficult because people have had to carry heavier loads than they have had to carry in Any time because there aren’t enough quality people. Look at all the job vacancies at the state level, at the county level, and even among service providers and private agencies. We’re all testing it.”
Doyle serves as Director of Operations for Eagle Quest, which started as a small foster care program, but expanded to provide therapy and administer medication and is now one of the largest therapeutic foster care agencies in the state.
And it’s not just the heavy workload that makes it difficult to hire quality professionals. Medicaid reimbursements are often not competitive.
Compensation for higher levels of care and hospitalization is lower with Medicaid than with private insurance, said Dr. Syed Khurana, a child and adolescent psychiatrist and medical director of Nevada Mental Health.
“When residents and fellows who have finished their internships and have astronomical student loans are making decisions about where they are going to intern.” He said. “Since they have loans to be paid off, what they will provide professionally becomes an important factor and insurance reimbursement.”
Habboush said this affects the number of service providers in the community, especially when they are concerned about earning a living.
They get paid according to what they have to do for those services. She said it was really hard to convince someone to stay in our state and go into this field when they would be struggling and worrying about making a living themselves. “Adequate reimbursement for services provided is essential, and because so many families may receive these services through Medicaid, Medicaid needs to work to reduce barriers to their system as well.”
Legislation is making some progress
Some of the money allocated by the Interim Finance Committee is intended to address some of these long-standing issues.
Director Dina Schmitt said the money awarded to the Department of Health and Human Services’ Division of Aging and Disability Services will be used to remove its waiting list for services, increase provider capacity in communities and hire specialized providers.
“There is a great need for specialized service providers to serve our individuals with intellectual and developmental disabilities who also have a behavioral health need,” she said. “This is a really complex group of people to serve. We are trying to recruit some service providers for this population in our state that doesn’t exist right now.”
Schmidt described the personalization as “one opportunity in my career” to invest in increasing the number of specialty service providers in Nevada.
Federal funding will also add a face-to-face component to the Mobile Rural Crisis Response Team, which was established in 2016 through a Nevada System of Care grant and uses telehealth to connect those in need with a physician through a crisis communication line.
Ellen Richardson Adams said the funding will create four new positions at Elko, which will include two teams consisting of a caseworker and a consumer services aide who will work alongside telehealth services.
Richardson-Adams oversees outpatient services for Southern Nevada Adult Mental Health Services and rural clinics.
Funding is just the beginning
But Abbott said getting the money was the easy part of addressing Nevada’s mental health crisis.
“The allocation of money, in a sense, has been the easy part. Now the real work begins, because we have to stop the programs. The state has to be able to get that money out,” Abbott said.
But once these programs are established, they will need funding after federal funds run out to keep them running.
“The next steps really double down on the sustainability piece,” said Petlock. “ARPA has been a huge boon, a huge boon to the state of Nevada, for children’s mental health. But now we need to make sure that these programs continue after ARPA money is no longer available or has been fully spent. Because what we don’t want to do is stand on a high-quality, robust, and complete system of care Hence, we will not be able to maintain it over time.”
That sentiment was echoed by other providers, including Nevada PEP Executive Director Karen Teicher, who called the CFC funds a “starter.”
“We definitely needed this to get things started. What needs to be done is kind of evaluate these programs that we’re funding with ARPA, make sure they’re working and then create sustainable funding because the money arc ends,” Teicher said. “The legislature must be involved in sustaining it.”
Senate Majority Leader Nicole Cannizzaro said the mental health system is a “major concern” for her.
“We know these are essential services and we need to work to make sure Nevadan is accessible,” she said. “We’re building the kind of system that will help support mental health here in this state.”
In a statement, Assembly President Designate Steve Yeager said he looks forward to working with other lawmakers to address the issue.
“We are not where we need to be as a country in terms of behavioral health services and treatment,” he said. “The problem is multifaceted and requires a multifaceted solution. I look forward to working with my legislative colleagues and Governor Lombardo on those solutions in the next legislative session.”
Lombardo’s spokeswoman, Elizabeth Ray, said the governor was looking to “outline his investments in mental health services during his upcoming state of the state address.”
The governor is scheduled to deliver a state of the state address Monday in Carson City.
Continuing to build the mental health care services system is important, Doyle said, because the problem is not going away.
“Mental health is everywhere. No one is immune from mental health problems.” Mental health does not discriminate. he’s there. Which is very real, and needs to be addressed before it gets any worse. And we can save lives by investing in mental health.”
If you are considering suicide, or are worried about a friend or family member, help is available 24/7 by calling or texting the Lifeline Network at 988. Live chat is available at 988lifeline.org. Crisis Support Services in Nevada can be reached by calling 1-800-273-8255 or by texting CARE (2273) to 839863.
Contact Taylor R. Avery at TAvery@reviewjournal.com. Continued Hahahaha on Twitter.