Access to mental health services in Nevada is atrocious. The state ranks 51st nationally in overall mental health and last again for similar categories in youth mental health. Statewide, there is one mental health professional for every 460 residents, and every Nevada county is federally designated as having a mental health provider shortage.
Unfortunately, this is not news.
The lack of outpatient services often forces families to seek in-patient institutionalization for their children. Due to the unnecessary institutionalization of children with behavioral health concerns, this “solution” to Nevada’s mental health deficits recently resulted in the Department of Justice declaring that the State of Nevada is out of compliance with the Americans with Disabilities Act.
Exacerbated by the COVID-19 pandemic, the lack of mental health services extends beyond healthcare to impact jails, foster care, and schools.
What is occurring in our schools is particularly poignant. In 2022, Nevada had the third lowest ratio of school psychologists and the lowest ratio of school social workers in the nation. Our schools’ mental health workforce is operating with roughly a quarter of the recommended number of school psychologists and less than three percent of the recommended number of school social workers. Thankfully, the 2023 Omnibus Appropriations Bill signed by the president earlier this year allocated $111 million for the U.S. Department of Education to hire new school counselors, social workers, and psychologists. The bill also includes funding to continue the implementation of 988–a suicide crisis hotline.
The Lincy Institute at UNLV is currently collecting data on the impact of COVID-19 in Nevada. A dominant theme from our interviews with governmental and organizational leaders is the need for more comprehensive mental health services.
The good news is that the state is starting to respond.
During the 82nd Session of the Nevada Legislature, the state made important investments in building its pipeline of mental health providers. Assembly Bill 37, funded with $2 million for the current biennium, authorizes the establishment of the Behavioral Health Workforce Development Center of Nevada at an NSHE institution.
Desert Winds Hospital, which offers a range of recovery programs for youth mental health issues including substance use disorders, depression, and schizophrenia, recently expanded their capacity to treat adults by adding more beds and alleviating wait times for individuals waiting in emergency rooms’ psychiatric units.
The PRACTICE, a mental health clinic located at UNLV, now has a satellite clinic in the medical district, and with funding from the American Rescue and Recovery Act, will expand significantly with the completion of an ambulatory care facility being developed by the Nevada Health and Bioscience Corporation.
Equally important, however, are policy interventions that allow more providers, and more providers to sustain their practices.
Making it easier for providers to get approved and paneled to accept insurance is a good first step for increasing access to mental health services in the state. According to data from the Health Resources and Services Administration, Nevada would need 235 more mental health care practitioners to eliminate its federal mental-health provider shortage designation.
Meanwhile, according to a report by the Nevada Division of Insurance, insurance companies denied submissions for paneling from 92 mental health providers in 2022.
Once paneled, however, insurance companies often require providers to submit extensive documentation and pre-authorization for mental health services. They also limit the number of sessions or types of treatments that are covered under insurance or deny claims after they have been submitted.
As a consequence, some mental health practitioners opt out of insurance-based service altogether. For instance, of 169 behavioral health clinics in Nevada, more than half do not accept Medicaid. Due to low reimbursement rates or uncertainty about their patients’ insurance coverage, some providers only accept cash payments; a compensation model that further limits patient access.
As a state, we should be monitoring the rates of rejection of claims. We should also be enforcing the acceptance of valid claims by considering a renewed claims disposition process.
Nevada is not the only state experiencing the challenge of enforcing parity laws. In 2021-22, states asked the federal government for clearer guidance and grants, and our federal delegation here in Nevada can do the same. By encouraging dialogue at the federal level and across states, we would be better equipped to find more cost-effective solutions.
Ultimately, these issues cannot be solved without a concerted effort from policymakers. In addition to facilitating the development of training programs and improving insurance reimbursement rates, the state needs to be more aggressive in enforcing the 2008 Mental Health Parity and Addiction Equity Act’s requirement that insurers offer plans with coverage for mental health benefits that are comparable to plans that offer coverage for physical health services. Simply put, the two go hand-in-hand.
So, while the state has made significant strides in strengthening its mental health infrastructure and capacity, this work must be supported by reforms to mental health compensation. Failing to do so will continue to undermine Nevada’s ability to attract mental health professionals from neighboring states or to ensure that mental health providers who are trained here, stay here.
