Nevada builds behavioral health infrastructure, starting with new 988 hotline

Nevada, which is still in the ranking bottom of all states access to care and a high prevalence of mental illness face an uphill battle in creating a comprehensive crisis care system that will accompany the new 988 mental health line.

The deadline is in six weeks.

Congress passed National Suicide Hotline Designation Act of 2020 mandating that 988 become a new, national three-digit phone number that Americans can call when they or someone they love are in crisis and need to be put in touch with suicide prevention and mental health crisis counselors.

The law requires telephone service providers to forward all new calls from the existing National Suicide Prevention Lifeline to the new number by July 16.

The move to the three-digit number is part of a larger initiative aimed at building crisis mobile outreach teams and a more robust system of treatment options, including a crisis stabilization center that coordinates behavioral and mental health care.

“With physical health, we’ve had this coordination with 911 going on for 45 years, but behavioral health has been stigmatized for so long that we’ve never coordinated this,” he said. Rachelle Pellissier, Executive Director of Crisis Support Services of Nevada. “This one [legislation] allows us to create really good coordination and equality in behavioral health.”

The state will have to face challenges to take care of the locals and tourists, help one of the nations most diverse populationsbuilding services in the state’s vast rural areas and improving police training – all while building mobile crisis teams and crisis stabilization centers.

Nevada Crisis Support Services, a National Suicide Prevention Lifeline affiliate that began operating the state’s suicide hotline in 1966, will oversee the launch of the new issue this summer.

“The convergence of the 10-digit number to the three-digit number is something I think Nevada is very well placed for,” Stephanie Woodard, senior behavioral health advisor for the Nevada Department of Health and Human Services, said. †In many other states they might not have a nationwide call center, sometimes they had a lot of different call centers that weren’t even connected to each other.”

Nevada Crisis Support Services’ unique position as a government agency — as well as one of 12 backup call centers for the National Suicide Prevention Lifeline — makes it easier for its team to grow. It received funding to hire 25 additional employees in anticipation of increased call volume.

To date, it has hired 20 of those 25 employees and 10 have completed the crisis training for the call center, said Pellissier.

But there are still challenges with the rollout of the new issue. Calling the 988 system fields by area code, not geographic location like 911, she said.

If a person keeps their Nevada area code even if they move, their call will be forwarded to the Nevada Crisis Support Services despite closer services. Or if a person is visiting Nevada and going through a crisis, their 988 call will be handled to their area code.

National efforts to address this are underway, but may not be ready by July 16. said Pellissier.

Nevada also serves one of the most culturally and linguistically diverse populations in the country.

In Clark County, the state’s most populous state, more than 10% of households have no one over the age of 14 who speaks only English or speaks “very good” English, according to the Guinn Center’s Nevada 2020 Census Snapshot

Language barriers can be a challenge for crisis calls. While the state has a sizable Spanish-speaking population, other notable languages ​​include Tagalog, Korean, Arabic, and Amharic, according to the report.

Nevada’s Crisis Support Services received a grant to hire two more bilingual employees to answer calls, but the behavioral health care system still has a long way to go before it can truly serve all of the state’s residents. said Pellissier.

While the majority of the state’s population resides in the three metropolitan areas, nearly 10% of the population lives in rural and border areas, which make up 87% of Nevada’s landmass, according to the 2021 Nevada Rural and Frontier Health Data Book by the University of Nevada Reno’s School of Medicine.

According to data in the book, about a quarter – 24.6% – of those in rural and border regions have struggled with binge alcohol use in the past month, and 20.3% have had mental illness in the past year.

“Rural people won’t use it or trust it until they see how much support they’re getting,” Laura Yanez, Executive Director of NAMI Western Nevada, said. “I want them to understand that it’s part of an overall change in our mental health system in Nevada. It’s not just 988. It’s that crisis intervention model of today.”

For most of the population, the first people to respond to mental health crises are law enforcement — something that’s even more common in rural communities overseen by Yanez. But she said more law enforcement agencies in rural Nevada are being trained in crisis intervention.

more than 30% of people with severe mental illness first come into contact with mental health through law enforcement agencies, but they are also 16 times more likely to be killed by law enforcement officers.

The state has partnered with more than 50 different local, state, and national organizations, including Washoe County Sheriff, Reno Police Department, Carson City Sheriff’s Office, Las Vegas Metro Police Department, Lander County Sheriff’s Office, and Douglas County 911 Emergency Services.

The 988 National Deployment Model hopes to create a separate mobile crisis response team to divert most crisis calls away from law enforcement. These teams often consist of two mental health specialists, such as a clinician and a peer support advocate, who appear first in cases that cannot be de-escalated by the 988 call center.

“Like EMTs, they would go out and help,” Pellissier said. “Do we have all those mobile teams together by July 16? Absolutely not, but we do create them.”

Most of Nevada’s existing Crisis Mobile teams are located in urban environments. Ensuring a timely response to the rural and border regions with the currently available resources is a challenge, said Woodard.

The state currently operates several models of Crisis Mobile Teamsaccording to Kendall Holcomb, a spokesperson for the DHHS. Some operate through various law enforcement agencies. Others specifically serve children in Washoe and Clark counties. Nine are affiliated with several certified community-based behavioral clinics in Nevada.

Each of the teams is managed separately, but there would be state-wide coordination under 988, she said.

The final part of the 988 implementation plan is to build crisis stabilization centers for those who need a special environment that is not a hospital emergency room or prison to get help and then more accessible resources in the community to provide post-crisis care. support.

“The mobile teams may not be able to fully stabilize [a person]maybe they really need to be in a more clinical setting somewhere,” Pellissier said. “They don’t want to go to an emergency room and be stuck in a paper dress and strapped to a stretcher for 8 to 10 hours… [They] should not be treated like a criminal.”

But the state has yet to build those centers as it awaits a request from the American Rescue Plan Act of 2021 (ARPA) dated June 21 for $20 million and hopes to have these centers up and running within a year. Holcomb.

Even if those centers are built, insurance parityaccess and cost are major barriers to those receiving mental health care — not just in the state, but national† Nevada is still figuring out how to fix these issues, said: Pellissier.

The 988 deployment model is a systemic shift in increasing access to behavioral and mental health services, but Nevada has had just over a year to prepare for the deadline, it said. Woodard.

While federal funding has been allocated to the states to implement the new number, there have been no assessments of how prepared the states are for the July 16 deadline, according to until a report released this month by the Rand Corporation.

But Nevada, along with Virginia, Colorado and Washington, are the only states that have passed legislation to secure state funding for 988. Nevada did it until 2021 Senate Bill 390† The bill would allow up to 35 cents per person, per month, per line to support these services, Holcomb said.

The amount of compensation is still being approved by the Nevada Legislative Commission and State Board of Health. That’s why there’s no set start date, she said.

In addition, Nevada received millions of federal funding to help implement 988. The state decided to use $3.5 million from ARPA for the 988 and received an additional $1.06 million from the Drug Abuse and Mental Health Services Administration (SAMHSA).

That time constraint coupled with a high prevalence of mental illness and limited access to care, a culturally and linguistically diverse population, and the state’s vast land and frontier areas come together with Nevada’s long history of being one of the country’s worst states in terms of of psychological problems. healthcare.

“Will it be perfect on July 16? Definitely not, but boy will it be a lot better and thank goodness we’re all working on it,” Pellissier said. “It will be a hundred times better than it is today in the next 10 years and really allow us to be open and talk about these issues and give people the help they need.”

The National Suicide Prevention Lifeline is 800-273-8255. The National Suicide Prevention Lifeline will change the number to 988 on July 16, 2022. The original lifeline will still be active after the change.

To find mental and behavioral health services in Nevada, visit: treatmentconnection.com

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