Mental & Behavioral Health Advocacy

By the end of the 2019 legislative session just over 600 bills became law, with varying effective dates.  While the next legislative session does not begin until February 2021, we must ensure these bills are implemented and we must begin working through interim committees to prepare for the 2021 legislative session.

Going into the 2019 legislative session, League of Women Voters of Nevada had clear behavioral and mental health care priorities, so our main Advocacy During the Interim action is related to workforce development, Medicaid reimbursement rates, and the implementation of Senate Bill 89. 

Currently, Nevada’s budget for managing behavioral and mental health issues mainly funds crisis interventions and incarceration, with predictably poor outcomes, while dollars spent to address behavioral and mental health through early interventions and preventative care is comparatively minuscule.

League, therefore, seeks to allocate more tax dollars to early interventions and preventative care and to address behavioral and mental health in the same manner as we address other illnesses.  If we approached the treatment of cancer as we approach mental illness, we’d employ no screening tools, such as mammograms or colonoscopies, and we’d wait until a person presented with late stages of cancer before offering treatment.

By waiting until someone is homeless or exhibiting severe behavioral symptoms, we are treating people with mental and behavioral issues who are in the late stages of their illnesses.  Treatment at this stage usually involves law enforcement and is expensive because it will necessarily include confinement, emergency housing, and intensive care.

The League of Women Voters of Nevada, therefore, wants:

  • Accessible behavioral and mental health care that includes early interventions and preventative care. 
  • An end to tracking persons with mental and behavioral health illnesses into the criminal justice system. 
  • Substance abuse treatment that recognizes connections between untreated mental illness and substance use.

Based on successful models in other states and from policy research, we must construct a behavioral and mental health system that produces better outcomes, with sufficient providers, who can provide medically sound treatment to every patient and can offer family members access to needed services.

To appropriately address the needs of older children and adults who are coping with their illnesses independently, we need a broader and more robust network of behavioral health specialists, who are especially available in low-services neighborhoods and rural towns.  This effort must also include expanded internet access in all neighborhoods, rural towns, and Native American reservations to facilitate telemedicine.

In full, a proper mental and behavioral health system requires that we:

  1. Increase the number of mental and behavioral health care providers.
  2. Increase the number of educational psychologists and counselors.
  3. Improve internal workforce development.
  4. Increase Medicaid reimbursement rates.
  5. Maintain an efficient licensing process with efficient license reciprocity.
  6. Create processes for offering behavioral and mental health services earlier.
  7. Enable each school, K-20, to provide behavioral and mental health services to students and their families.
  8. Ensure access to stable behavioral and mental health treatment without transportation barriers.
  9. Expand internet services to provide telemedicine options.
  10. Pass criminal justice reforms that keep the mentally ill out of prison.
  11. Provide first responders high-quality professional development focused on behavioral and mental health.
  12. Provide treatment facilities not associated with the prison system for non-violent offenders.
  13. Enhance resources for criminal justice facilities treating persons with mental and behavioral health needs.
  14. Increase resources for diversion programs that provide treatment in lieu of court proceedings and incarceration.
  15. Strengthen support services for the formerly incarcerated to reduce the likelihood of returning.                          
  16. Support families who opt to maintain an adult family member who is undergoing treatment in their homes.

These are all major initiatives and reforms, so there are many different new laws, studies, committees, and reports that need to be tracked and supported this interim to ensure we go into the 2021 legislative session with a solid foundation for the above behavioral and mental health system.

If you would like to participate in this effort, here are needed action items:

Workforce development rests on partnerships between our education systems, the legislature, the medical community, and local governing commissions, councils, and boards.  To create workforce pipelines that reach into every school, our institutions of higher education must create or adopt a career development system that offers careers in behavioral and mental health to every K-12 student.   The Behavioral Health Center of Nebraska has a comprehensive workforce plan that addresses the same clinical provider issues we have in Nevada, and so it is a model we could follow.

You can watch this 6-minute video overview of the Nebraska system: https://www.youtube.com/watch?time_continue=4&v=2y2HtzuQnsY

This is an overview of the whole system, including the center’s budget:

https://www.unmc.edu/bhecn/_documents/FY16-17-legislative-report.pdf

To create or adopt a clinical behavioral and mental health workforce program our higher education Board of Regents must prioritize this need and our Governor and legislature will need to provide the funds. This does not necessarily mean increasing taxes.  We currently spend exorbitant amounts to fund our existing dysfunctional mental and behavioral health care systems, so this funding can be repurposed into a more rational system.  The amount we spend to treat someone who is mentally ill or suffering from a related addiction while incarcerated is often more expensive than treating someone who is not being held in a correctional facility.  

The Nevada Board of Regents meets regularly throughout the year and has a Health Sciences System Committee that reviews information on health care related issues.  We need League advocates to attend the Health Sciences System Committee meetings to ask the Regents to address Nevada’s severe shortage of clinical behavioral and mental health providers through a comprehensive workforce development plan.

You can see the committee meeting schedule here: https://nshe.nevada.edu/leadership-policy/board-of-regents/meeting-schedule/

You can subscribe to receive meeting agenda one week in advance here: https://nshe.nevada.edu/contact/subscribe/

Agenda for current and past meetings, are located here: https://nshe.nevada.edu/leadership-policy/board-of-regents/meeting-agendas/

Recordings of past meetings are located here: https://nshe.nevada.edu/leadership-policy/board-of-regents/board-meeting-archive/

Presentations made during past committee meetings are embedded in the meeting agenda, for instance, at the last Health Sciences System Committee meeting there was a presentation on the shortage of physicians in rural Nevada.  The presentation is embedded in this agenda: https://nshe.nevada.edu/wp-content/uploads/file/BoardOfRegents/Agendas/2019/09-sep-mtgs/HSS0919.pdf  Here is the presentation: https://nshe.nevada.edu/wp-content/uploads/file/BoardOfRegents/Agendas/2019/09-sep-mtgs/hss-refs/HSS-6.pdf

The presentation includes statistics for the behavioral health provider shortages and arguments for investing in workforce development in these careers.

Here is a Legislative Counsel Bureau report from January 2017 on our severe behavioral health provider shortages:

https://www.leg.state.nv.us/Division/Research/Publications/InterimReports/2017/Bulletin17-06.pdf

Here is a report from the UNR School of Medicine from December 2018 also quantifying our shortage of behavioral health specialists. http://www.behavioralhealthworkforce.org/wp-content/uploads/2019/02/Y3-FA2-P2-Psych-Sub_Full-Report-FINAL2.19.2019.pdf

Here is a U.S. Commission on Civil Rights report on policing and Nevada’s severe shortage of mental health providers: https://www.usccr.gov/pubs/2019/09-18-NV-Policing-Practices.pdf

Another issue our higher education system can address in the area of workforce development is the shortage of school psychologists and counselors.  These two professions have degrees through the Education Departments in our higher education institutions.  This will connect our advocacy efforts through Senate Bill 89.  SB89 sets long-term goals for increasing the number of psychologists and counselors assigned to schools in the K-12 system.

Unlike clinical psychologists and social workers, who are licensed through the medial workforce pipelines, school psychologists and counselors are licensed through the Department of Education and are paid through our K-12 budgets.  SB89, unfortunately, did not set goals for providing behavioral and mental health services for our higher education institutions, but that does not limit our ability to ask for more funding and attention to be paid to our community colleges as well.

To advocate for strengthening the workforce development of school psychologists and counselors, you can speak at the Nevada System of Higher Education Academic, Research and Student Affairs Committee.

You can see the committee meeting schedule here: https://nshe.nevada.edu/leadership-policy/board-of-regents/meeting-schedule/

You can subscribe to receive meeting agenda one week in advance here: https://nshe.nevada.edu/contact/subscribe/

Agenda for current and past meetings, are located here: https://nshe.nevada.edu/leadership-policy/board-of-regents/meeting-agendas/

Recordings of past meetings are located here: https://nshe.nevada.edu/leadership-policy/board-of-regents/board-meeting-archive/

Lastly, our higher education system can address an issue that crosses over between workforce development and Medicaid reimbursement rates: student debt.  To ensure our mental and behavioral health care workforce reflects Nevada’s rich diversity, we must also ensure that our workforce degree programs are affordable for every student.

In 2017, our legislature passed, and the governor signed the Nevada Promise Scholarship program.  Based on a similar program in Tennessee, under the Promise program graduates from Nevada high schools who complete their Free Application for Federal Student Aid are eligible to apply to any of the state’s community colleges for free or reduced tuition. 

Lower income students who qualify for the full Pell Grant through the federal government can attend any of the community colleges without any personal contribution from the student or his/her family for tuition.  The scholarship can provide tuition and fees for up to three years.

https://collegepromise.org/programs/nevada-promise-scholarship/

Any student who completes an associate degree at one of the community colleges will have completed the general education requirements for a bachelor’s degree.  UNLV is now offering a similar tuition program for Pell Grant eligible students to pay for 12 credits per semester and to offer $1,000 a year for textbooks.  https://www.unlv.edu/finaid/scholarships-grants/tuitionplus?fbclid=IwAR3d8lVPpVHAU0To7omMNXY3pA5Wj8jIxuW2G7LqashdgQJ-Ji1AZ5fX-M8

If the state will then pay for or forgive tuition and fees for graduate degrees in behavioral and mental health professions from a Nevada university for students who agree to stay and work in the state for at least five years, more students would see a possible path into a health care profession and Nevada will gain more mental and behavioral health care professionals.

Related to the student debt problem is our low Medicaid reimbursement rates.  Many health care providers have high student debt and must cover costs associated with managing an office, which means they cannot afford to accept Medicaid patients due to the low reimbursement rates.  So, we will need to also focus on increasing Medicaid reimbursement rates while creating a free to low-cost college program.

In the 2019 legislative session, the Health and Human Services Committee reviewed, but did not pass a study of Medicaid reimbursement rates.  https://www.leg.state.nv.us/App/NELIS/REL/80th2019/Bill/6137/Overview

We must engage the interim Committee on Health Care to continue the dialog on Medicaid reimbursement rates.

You can view the calendar of meetings for the interim Committee on Health Care here:

https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019/Committee/1570/Overview

There are several interim committees that also focus on issues related to mental and behavioral health care. Anyone can sign-up to receive meeting notices for interim legislative committees here: https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019

A set of non-legislative boards that can advocate for behavioral and mental health workforce development, improving Medicaid reimbursement rates, and licensing reforms, are the regional Behavioral Health Policy Boards.  

There are five regional boards that review behavioral and mental health needs for their specific regions; each board has one bill draft request to submit each legislative session.  You can view the boards here under Non-Legislative Committees https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019

The interim Education Committee reviews issues related to the education system, including providing behavioral and mental health screenings and recommendations for services to families through psychologists and social workers. https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019/Committee/1568/Overview

The interim Legislative Committee on Child Welfare and Juvenile Justice reviews our systems that care for children who are experiencing trauma.  We need to ensure that children who are experiencing trauma are not put on a track that leads to incarceration.  Trauma needs treatment, not punishment. https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019/Committee/1567/Overview

The Advisory Committee on the Administration of Justice reviews Nevada’s criminal justice system to ensure it is fair and protects civil rights while also keeping Nevadans safe.  We need more support for law enforcement that provides alternative outcomes for individuals experiencing a behavioral or mental health crisis. https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019/Committee/1558/Overview

For legislative and non-legislative committees, if you click on Meetings, in addition to seeing the meeting agenda and meeting materials, you’ll also see a link to live-stream the meeting on any device that will connect to the internet.  And after a meeting has passed, you’ll see a link to watch the archived recording of the meeting.  You can see an example of this here: https://www.leg.state.nv.us/App/InterimCommittee/REL/Interim2019/Committee/1430/Meetings

The most consequential bill for behavioral and mental health being treated through preventative and early interventions care is SB89.  It is a complex bill with many parts that will need to be implemented over this interim, so it will be important for us all to track the progress.  https://www.leg.state.nv.us/App/NELIS/REL/80th2019/Bill/6036/Overview

The bill requires the Governor to create a statewide School Safety Committee and for the school districts and the State Board of Education to track the bill’s implementation. The State Board of Education maintains information on statewide committees and districting reporting: http://www.doe.nv.gov/

Our counties and municipalities are also addressing behavioral and mental health services through their initiatives to address homelessness.

https://www.nevadacurrent.com/2019/09/19/public-cost-of-homelessness-projected-to-skyrocket/

https://www.clarkcountynv.gov/social-service/announcements/Pages/Clark-County-Commissioners-Provide-Additional-Help-for-Homeless.aspx

We need to engage with these local governing bodies to ensure that homeless services include behavioral and mental health treatment.