The state of troubled minds
Members of the Nevada Legislature are fond of saying “Thank God for Mississippi” at budget time. That’s because often we find our state ranked almost dead last in human services, with only Mississippi keeping us from the bottom of the heap.
I thought of that line when I read a recent piece by Pro Publica on the deplorable status of mental health care in Mississippi, leading to its last place ranking in access to care in the 2018 Mental Health America state scorecard. The statistic drew my attention because last year Nevada was ranked 51st in access to care, and I was relieved to see that Mississippi managed to take over our place of shame. Curious about Nevada’s gain and Mississippi’s loss, I checked out the latest report where, indeed, Nevada improved its access ranking, moving from 51st to 47th. States that scored lower than Nevada were all Southern states whose governors refused to accept Medicaid expansion, unlike Gov. Sandoval, the first Republican governor to take the Federal assistance.
Looking deeper into the report, my optimism about Nevada’s improvement in mental health care faded. We are still 51st in the country for the prevalence of untreated adults with mental illness, with a disturbing rate of 66 percent going without care. And I imagine legislators in Mississippi will breathe a sigh of relief when they see that once again Nevada ranked lower than their state in the Overall Ranking in mental health, at 51st in the nation. After all the work done in the last few decades, under Governors Guinn and Sandoval, and many sessions of the Legislature, we’re still the worst.
The latest suicide data is also disheartening. Advocates celebrated last year when Nevada moved out of the top 10 states for suicide after decades of ranking as the state with one of the highest percentage of suicides. When the 2015 suicide rankings moved Nevada to the 11th worst, a status that would embarrass most states, human services professionals here applauded our movement in the right direction. The 2016 suicide data was recently released, revealing the celebration was premature as we are now tied with Colorado as the fifth worst state. In 2016, 650 people chose to end their lives in Nevada, a huge increase over 2015, when 558 people died by suicide in our state. Many mental health professionals expect 2017 suicide data to intensify the trend in the wrong direction.
Nevadans who end their lives by their own volition do so for their own reasons, making it difficult to know what might have made a difference in preventing the tragedy. Nevada has spent millions to improve mental health care, dramatically improving the inpatient reimbursement rate and adding innovative new programs, familiar in other states, like Assisted Outpatient Treatment and Assertive Community Treatment. Medicaid expansion theoretically provided thousands of Nevadans with new behavioral health benefits, but finding a willing provider is difficult for many, especially for severely mentally ill people forced into a managed care system they don’t understand.
Nevada’s poor rankings in behavioral health stem from a complex set of factors, including an historical tendency to underfund human services and a libertarian outlook that shuns government services in favor of personal responsibility. Combine a high rate of addiction and a constantly struggling treatment system with high levels of transiency and low wages, and it’s easy to see how depression can lead someone to the cliff’s edge. Gun shows nearly every weekend and easy access to prescription drugs offer the means to ending it all, especially if family ties have weakened due to time and distance.
Mental Health America suggests policy solutions encompassing prevention, early identification and intervention, integrated care and treatment, all with the goal of recovery. Our situation is dire, but giving up is not an option.
