Already bottom-ranked, Nevada unprepared for ‘mental health catastrophe’

Mental health providers across the country are reporting increased demand for their services as the nation grapples with an uncertain economic environment and the ramifications of months of social distancing.

In Nevada, where the unemployment rate reached 28.2 percent in April and the state is anticipating long-term economic consequences, a history of underfunding public mental health resources, staffing shortages and obstacles to sufficient reimbursement for providers could leave the state unprepared for “mental health catastrophe,” said psychotherapist Jim Jobin.

Jobin, president of the Nevada Counselor Association and member of the Clark County Regional Behavioral Health Policy Board, said the need for mental health services has exploded since the coronavirus pandemic began.

Previously, he saw an average of 36 patients each week and worked four days a week. He’s now moved completely online, working six days a week and seeing an average of 66 patients a week with dozens of people on his waiting list.

He said peers of his have similar anecdotes of booked schedules and have struggled to accommodate demand. 

Though the pace is actually sustainable, he’s concerned about how the economic effects of coronavirus will affect providers and Nevadans, particularly those who utilize public health resources, given the state’s strained mental health infrastructure.

Virginia-based nonprofit Mental Health America ranked Nevada last overall in its 2020 report on the State of Mental Health in America, which takes into consideration 15 factors evaluating youth and adult mental health status and resource availability. The Silver State, which placed 49th in the access to care category, has consistently ranked at the bottom of the list since 2017 and has never cracked the top 48 in overall rankings provided by the report, which began in 2015.

Recently, a Southern Nevada behavioral health hospital quietly closed after the Centers for Medicare and Medicaid Services last year found instances of patients being placed in “immediate jeopardy,” further limiting treatment options for patients.

In a November 2018 interview, then Gov.-elect Steve Sisolak declared the state had a “mental health crisis” and said he wanted to bring more attention to funding of its mental health resources.

Now, as Nevada awaits a clear picture of the pandemic’s permanent job losses and the fiscal health of the economy, the governor must shift from discussion of what he wants to grow to what the state is able to cut. To what extent the federal government’s relief bills will help offset the economic impact of the coronavirus shutdown and save state agencies from cuts is unclear.

The state announced in April that it was the recipient of a $1.9 million grant to fund access to psychiatric care. Nevada Sens. Catherine Cortez Masto and Jacky Rosen were also among the co-authors of a May 15 letter to U.S. Senate leadership calling for “significant new investments in behavioral health care” in upcoming coronavirus-response legislation. The letter suggests addressing issues including funding for behavioral health providers and research as well as assessment of telehealth pay and provision of personal protective equipment.

A spokeswoman for the Nevada Department of Health and Human Services told the Current last week that the agency could not comment on the impact of any budget cuts on the agency and whether or not mental health services would be affected because the budget is not finalized. A spokeswoman from the governor’s office did not respond this week to a question on how the office would handle mental health budgeting in light of increased demand for services.

If job losses and other economic effects of the coronavirus last, it’s unlikely many Nevadans will have the extra funds to pay for therapy sessions themselves and many would eventually lose their employer-provided insurance, a blow to the payment models reimbursing many of the state’s mental health professionals, Jobin said. Those job losses could lead to a swell in the number of Nevadans on Medicaid, which means increased reliance on state-funded services at a time when the state is looking to lower expenses and the number of providers approved for reimbursement by Medicaid is less than ideal.

“The members don’t get the care they need at all levels. The providers don’t have the compensation we need to function … and it becomes a really big problem at exactly the time that Nevada is probably likely to be ground zero for the upcoming mental health crisis as a result of this new virus crisis-depression that we’re in,” he said.

During the Great Recession, behavioral health services were first on the chopping block of many state budgets, followed by education, said Debbie F. Plotnick, vice president for state and federal advocacy at Mental Health America.

“It’s taken us quite a few years to get back in terms of state funding and state support,” she said.

Studies suggest that rates of suicide, alcohol abuse and domestic violence increased as those cuts were taking place, Jobin said.

Amaris Knight, chair of the Nevada Coalition for Suicide Prevention and research analyst with the Nevada Institute for Children’s Research and Policy, said 2020 is different than past economic recessions because the continuing effects of the coronavirus shutdown remain unclear. As of now, much of society is paused.

“What I think we’re worried about most is a year or 18 months from now when most people are back to work but some aren’t and figuring out, ‘How are we going to be able to support the people who aren’t able to go back to their previous jobs and are having trouble finding a new one?’”she said.

In times of economic crisis, states grow concerned over the amount of money they’re spending on programs such as Medicaid and public mental health resources.

But cuts to public mental health resources directly affect “the portion of the population that’s most at risk,” Jobin said.

About a third of people who access behavioral health services in the country do so through Medicaid, Plotnick said. 

The good news is that the federal government has increased the share of the costs it’s paying for Medicaid services in recent coronavirus legislation. 

Other good news: Nevada’s decisions to participate in Medicaid expansion in 2014, allow health insurance special enrollment on the state exchange during the pandemic, and work to encourage telehealth for Medicaid recipients in recent months will likely expedite the process of delivering care to those who need it, Plotnick said.

Jobin said the state has responded quickly to concerns raised during the coronavirus pandemic and has made progress on cutting red tape for health providers. He and Knight agreed that Nevadans must take an active role in looking after their neighbors in light of the pandemic and seeking help early on if red flags present themselves.

Part of the problem in addressing the wave of mental health patients who need care now and will need it soon is that states like Nevada have infrastructures built around responding to the worst mental health situations, rather than early preventative care, Plotnick said.

“It’s very difficult in Nevada to find consistent and reliable and across-the-board kinds of services,” she said. “Like many states, they only go back to that waiting-until-crisis (mode).”