DOJ investigation finds Nevada unnecessarily institutionalizing children

Nevada is violating federal law by unnecessarily institutionalizing children with behavioral health disabilities, according to a report issued Tuesday on an investigation of the state by the U.S. Department of Justice. 

The state is responding with a $43 million investment in community-based programs, but the one-shot funding from the American Rescue Plan leaves the provision of future services in question.   

“The governor has made the commitment to not raise taxes,” says former state Sen. Patricia Farley, a child welfare advocate, who fears the one-time infusion of money won’t be enough to salvage the programs in the long run.. “I don’t know where the money is going to come from. And these are not one-shot funding programs. This is addressing a long sustained civil rights issue.”

Gov. Steve Sisolak’s office noted he is budgeting to sustain the programs, but did not say how the state will fund them once the ARP dollars have dried up. 

The report says given the lack of community-based resources, hospitals in Nevada are a primary source of behavioral health care and a “gateway to long-term residential placements.” Subjecting children to unnecessary institutionalization violates Title II of the Americans with Disabilities Act.  

“Over 1,700 of Nevada’s children were admitted to a hospital for psychiatric care in fiscal year 2020,” the report found. “That same year, over 480 children received services in residential treatment facilities.”

Children are remaining in residential placements for nine months to a year, on average, the report says.  

“Many stay even longer—27% of the children admitted to residential treatment facilities between August and October of 2019 stayed for over a year,” the DOJ wrote.  

The Current reported last year on the DOJ’s investigation into the state’s placement of hundreds of youth in facilities as far away as New York.  

The DOJ found the state lacks community-based services such as intensive in-home services, crisis services, care coordination, respite, therapeutic foster care, and other “family-based supports. As a result, hundreds of Nevada children are segregated for months, often very far from home,” says the DOJ’s statement. 

The report says most children in a recent sample of residential placements did not receive behavioral support services from the state before or after placement.  Less than one-fifth of children with behavioral health disabilities received intensive care coordination through wraparound services in 2020.  

“Children with disabilities should receive the services they need to remain with their families and in their communities,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The Civil Rights Division looks forward to working with Nevada to bring the State into compliance with federal law and prevent the unnecessary institutionalization of children.”

“We believe that the ARP recommendations for improvements in the children’s mental health system will be transformational in addressing the gaps in children’s mental health services in the state,” said Barbara Buckley, executive director of Legal Aid Center of Southern Nevada and former speaker of the Nevada Assembly. “If you examine the package developed by those who collaborated on this for over a year, you will see each level in the continuum of services addressed.”

“Why did we have to have a DOJ finding to get here?” asks Farley, adding the lack of funding for behavioral health “has been brought up every legislative session. And whether it be Republican or Democrat, these budgets were always cut.”

The governor said in a statement that Nevada has failed to invest in “appropriate health resources for our children and our families….”  and says he’s committed to working with the DOJ to create “lasting systemic changes… Funds are already being built into my recommended budget…”

“It is significant that the Governor and many legislators expressed their support for continuing these programs in the future, even if future state funding was required,” Buckley said.