From housing to skimpy services: Area experts trace systemic health risks

Panelists discuss approaches to address the needs of vulnerable populations at the Nevada Population Health Conference on Nov. 15. From left: moderator and UNLV public health Assistant Professor Max Gakh, Sunrise Health GME Consortium psychiatry Program Director Dr. Jonathan Wirjo, Southern Nevada Health District Chief Health Officer Dr. Joseph Iser, Volunteers in Medicine of Southern Nevada founder Dr. Florence Jameson, UNLV School of Dental Medicine Professor Dr. Georgia Dounis and Nevada Homeless Alliance Executive Director Emily Paulsen. (Photo: Pashtana Usufzy)

Ensuring the health of Nevada’s vulnerable populations will require workforce development, a focus on mental health care and investment in nonmedical areas like housing and transportation, experts said Friday at the Nevada Population Health Conference.

Among the ideas proposed by conference panelists to strengthen the state’s health care system were preparation of high school-age and younger students for health care jobs, screening children for adverse childhood experiences and creation of a statewide, online jobs portal for mental and behavioral health fields.

Lawmakers, physicians and professors were among the speakers at the conference, which was backed by a coalition including insurance company UnitedHealthcare and law firm Holland & Hart. 

Over the past decade Nevada has seen steady growth in the number of licensed health professionals, including the addition of almost 900 doctors over the past two years, said John Packham, associate dean for the Office of Statewide Initiatives at the University of Nevada, Reno School of Medicine.

But adjusted for the state’s population growth, Nevada is “almost treading water” with severe workforce shortages, he said. 

“If we look at a per capita number or a per capita rate of health care workers to population, we’re kind of holding our own and in some cases actually even declining,” he said.

Exceptions include nurse practitioners and physician assistants, which have doubled in less than a decade, growing per capita as well.

Especially in Southern Nevada, population growth is stretching already taxed health care resources, Packham said. In addition, across the state but particularly in rural Nevada, the state’s aging population generally means many residents require more health care attention than in the past.

Workforce growth is important not only to ensure the state is well-staffed but also to match the diversity of Nevada’s population, Packham added.

“There’s what I would call a gross mismatch between what our workforce looks like and what our populations that are served look like — very few geriatricians in a society that is getting older, very few Spanish-speaking or persons of color in health professions,” he said.

Sara Hunt, assistant dean of behavioral health sciences at the UNLV School of Medicine, said solutions can take inspiration from the work of other states like Alaska, where career camps allow high school students to see mental and behavioral health workers in action and even offer college credit.

Hunt also pointed to Nebraska’s efforts to develop a pipeline of mental health workers by offering kids early insight into different fields and connecting them with local colleges and mentoring.

Packham argued that solutions to Nevada’s shortfalls are clear but that political will is needed to get them passed. 

Moves like investing in higher education programs that train future health professionals, continuing to invest in residency programs as the state is doing now and enacting licensing rule revisions to cut red tape for professionals moving from other states would go a long way, he said.

Dr. Joseph Iser, chief of the Southern Nevada Health District, echoed the licensing note, criticizing the state’s medical board and its process for licensing doctors already licensed in other states. He referred to their role as a “barrier” in the process. 

“I thought California was bad when I got licensed there. It’s not as bad as Nevada,” he said.

Meanwhile, the state continues to lag behind in workforce numbers. Nevada would need 139 additional psychiatrists and 221 more licensed clinical social workers simply in order to meet the national average for those professions.

With the exception of small parts of Washoe County every county in the state is considered to be a mental health professional shortage area, including all of Clark County, according to Packham and data from the U.S. Health Resources and Services Administration.

Dr. Melissa Piasecki, executive associate dean and professor within the Reno medical school’s psychiatry and behavioral health sciences department, explained that mental health issues can touch every aspect of a person’s life.

Individuals with serious mental illness are 10 times more likely to be in a jail or prison than to be in a psychiatric hospital, she said.

Increasingly, research shows strong correlations between mental health issues and traumatic events in childhood, referred to as adverse childhood experiences (ACEs). Screening children for such experiences, discussing those issues with expectant parents and providing resiliency programs to preschool-age children are some of the ways Nevada could adapt to tackle the issue, she said.

“We see not just the social determinants of health in terms of your ZIP code but your lived history, what happens inside your house, can very much lead to mental health issues,” she said.

The subject of mental health care in Nevada heavily affects the state’s homeless community, said Emily Paulsen, executive director of the Nevada Homeless Alliance.

Paulsen emphasized that without affordable and stable housing, the vulnerable population she serves will continue to be at risk and excluded from much of the health care system. 

“We need to start talking about housing as healthcare,” she said.

Housing, transportation, education, chronic conditions and other factors can influence patient interactions with the health care system, Iser said.

Research released by the Center on Budget and Policy Priorities in February indicated that social determinants of health like affordable housing and food access “figure significantly in whether people and communities are healthy” and some matter more than health care. 

In Nevada, an investment in housing and other social determinants would be vital to ensuring homeless individuals benefit from systemic attempts to improve the state’s overall health, Paulsen said.

“Housing is the number one factor that is necessary to connect someone to health care (and) to mental health care,” she said.

Pashtana Usufzy
Pashtana Usufzy is a freelance general features and health reporter based in Las Vegas. She previously worked as a health care reporter at the Las Vegas Review-Journal and prior to that as a local news reporter at the Las Vegas Sun.