A system in the past
It’s one of those topics that people are loathe to discuss, yet it deeply affects every community and nearly every extended family. We ought to be talking about it more often since we spend far more money on the consequences of inadequate care than if we were to guarantee that every person with a severe mental illness could have immediate access to a psychiatrist, medications and housing.
It’s a pleasant surprise to see that addressing mental health concerns is practically the only thing the lame duck Congress and the president can agree on, as exemplified by the Dec. 21 passage of the 21st Century Cures Act, a broad $6 billion public health and medical research bill, which includes funding for criminal justice reform measures related to mental health, setting a strong foundation for improving care for millions of Americans.
Prioritizing mental health concerns is long overdue, especially here in Nevada where we trail every other state in the 2017 Mental Health America report, ranking 51st in the nation in 15 indicators having to do with vital components of a mental health care system, such as access and an adequate workforce. It’s another embarrassing ranking for Nevada, although dreadfully normal for our state.
According to the State of Mental Health Report, 67.5 percent of adults in Nevada with a mental illness do not receive treatment; 71 percent of youth with major depression do not receive mental health services. And Nevada has just one mental health worker per 570 residents.
Nevada has struggled with its mental health system for decades, often destroying what little system existed whenever the budget got tight. Predictably, when services were cut, mental health crises emerged from the shadows, often leading to tragedy as people in desperate need of assistance were turned away, many to the streets or shipped to other states via Greyhound buses.
When Medicaid was expanded to include childless adults under Obamacare, several hundred thousand Nevadans had health insurance for the first time in decades, including thousands of people living with severe mental illness. Nevada’s leaders made a conscious decision to then push these newly insured Nevadans away from state institutions and into the arms of private sector providers, mostly through a managed care model that unfortunately has not responded well to the challenge.
Last week, a mental health and regionalization report was delivered—a legislative staff study, not the full-fledged legislative study requested by Clark County Democratic Assemblymember Nelson Araujo. The study showcases grim and shocking workforce data in Nevada when compared to the national average of professionals available to help struggling patients. Nevada is 47th in psychiatrists, 48th in psychologists, 50th in social workers, and 51st in counselors. The raw data is revealing in its simplicity. For example, Nevada has just 50.4 counselors per 100,000 residents whereas the national average is 181.
The report covers a variety of problems in Nevada’s mental health system but doesn’t offer concrete recommendations. It does provide an overview of new initiatives and community-based strategies that are making a difference but on a scale that’s much too limited. The report outlines options for regionalizing services, including organizational structures that would give local communities more control over service delivery.
It’s unclear if the 2017 Legislature will take up regionalization of mental health services, but it seems likely there will be little to no additional resources for Nevadans with severe mental illnesses.
But once you’ve been ranked 51st in the nation, there’s really no where else to go but up. Perhaps 2017 will be the year that Nevada keeps its New Year resolution to confront its dismal history of neglect of the mentally ill and save money and lives by investing in its citizens.