Left Foot Forward: Will the Legislature help Nevadans with mental-health challenges?

During the run-up to opening day at the 2023 Legislature on Feb. 6, Gov. Joe Lombardo and legislative leaders sparred about criminal-justice reform, the protection of reproductive rights, the correct level of education funding—and how best to spend Nevada’s budget surplus to address crumbling prisons, highways and other capital improvements while saving an appropriate amount of money in the state’s “Rainy Day” fund.

One key issue receiving far less attention was the reform of Nevada’s mental health care system, although Lombardo did announce the expansion of forensic services in Southern Nevada, including expensive new facilities. The emphasis on forensic needs is no surprise; as a former Clark County sheriff, Lombardo understands the mental-health pipeline into our state’s jails and prison system very well. Hopefully, the forensic focus will be more on effective treatment and supportive care rather than endless competency evaluations which churn offenders through the system, spitting them out with little more than a bus ticket downtown.

Lombardo also plans to expand Certified Community Behavioral Health Clinics (CCBHCs) throughout the state to increase capacity for outpatient treatment. While the enhanced Medicaid rate is welcomed by the community-based organizations willing to become CCBHCs, it’s not enough to develop the extensive supportive services needed by individuals with severe mental illness to lead safe, productive lives.

Nevada desperately needs a more comprehensive and creative approach to mental health care reform, especially for those who are treatment-resistant and prefer to live on the street with their personal demons than in crowded noisy shelters where they are preyed upon, or in poorly run group homes where living conditions aren’t much better than the river. The best way to assist them is a combination of regulated subsidized housing and community teams to provide comprehensive care 24/7, through evidence-based models like Assertive Community Treatment, which includes medical and mental health care along with intensive case management.

In Washoe County, Judge Cynthia Lu oversees the Assisted Outpatient Treatment program designed to reduce incarceration and involuntary hospitalizations by providing housing, treatment and medications, and intensive case management to those who are historically noncompliant with treatment. The program works, but only with sufficient housing resources and well-trained, well-compensated staff—two components the program struggles to provide.

There is at least one bill this session that could help address the housing problem, however. The Clark Regional Behavioral Health Board has submitted Senate Bill 68 to build affordable housing for Nevadans with behavioral-health concerns, the chronically homeless and those with other disabilities; it would be funded by a small increase in the real property transfer tax. The tax is collected when a property is sold, although a recent investigation by the Las Vegas Review-Journal found that at least $27.5 billion worth of sales involving casinos, malls and other properties close to the Strip avoided the tax, thanks to legal loopholes exploited by savvy corporations with good lawyers. If the Legislature tightened the law, millions of dollars would be generated for low-income housing, education and the state’s general fund.

Lawmakers are unlikely to take on Nevada’s gambling palaces, however, making the passage of SB 68 imperative. Taxpayers will save money in jail costs and hospitalizations, and many low-income Nevadans living with disabilities and mental-health challenges will be able to choose stable housing that meets their needs.

Another game-changer would divert mental-health care to elementary schools, to intervene early when a teacher notices a child is aggressive, having difficulties with peers, or experiencing other behavioral issues. Teachers know when students are struggling emotionally. Parents and relatives know. Even children often know when something isn’t right with a classmate. School counselors know as well, but they’re busy and not always clinically trained to provide the care needed by students whose problems get worse over time if left untreated. Intervening early with the child and family can address issues before they become insurmountable—or even life-threatening.

If legislators balk at the price tag for new mental-health services for children, they can cancel the hundreds of millions of dollars in new tax breaks that the Governor’s Office of Economic Development seems poised to approve for the richest car company in the world, headed by an infamous billionaire intent on causing chaos wherever he goes. They can tell Tesla once and for all that Nevada’s kids matter more than Elon’s bottom line.