Crisis close to home: Nevada's failing mental health services

Over the past three months I've been reflecting on my time here at UC Davis Law as a first generation student with a person history in a flurry of rural towns across Nevada and California. I wound up in law school as the result of what I tend to refer to as a line of "self-sabotaging matriarchs." From my great-grandmother to my mother and eldest sister, my family's intergenerational poverty can be chalked up in large part to the codependency of its women on men who were steeped in drug and alcohol abuse. The chaos and poverty were inflamed by my family confining itself to rural places, where the domestic violence and drug abuse were hidden behind the walls of single or double-wide mobile homes.

For me, the chaos peaked when my mom tried to force me to leave our destitute life in the "Cowboy Capital of the World," Oakdale, California to return with her to Winnemucca. She was running back to what was known: a rural town where she could indulge and conceal her addictions to substances and men. But to preserve my chance at a better life, I knew I couldn't go with her. So, after a turbulent back-and-forth, she told me simply: "you can [sic] stay here then." Those words caused us to be estranged for the past decade. 

But on the brink of graduation, I can't help myself from looking back. Through everything, there is still and will always be a part of me that loves the woman who brought me into this world and raised me as best she could. So, about two weeks ago, I called her on video chat. She was living with her boyfriend in a trailer park on the outskirts of Winnemucca. I wasn't sure which version of her I was going to get. She suffers from schizophrenia and bipolar disorder (the latter being the one I inherited), and when you add substance abuse on that, it forms different personalities that for her varied from the woman I called my mother to the woman who abandoned me. 

But this time it was neither. She could barely look at me, and I knew that meant something was awry. I tried lightening the mood by asking her positive questions: what are some great traits you gave your son? What things you are looking forward to over the next few years? It was the latter question that caused a pause and a tear. I called her again the following week and she told me she was going to check herself in to rehab. I asked what prompted the decision and she said, she couldn't say aloud because her boyfriend was in the trailer. She did say, however, "I couldn't give you an answer to where I want to be in the next few years," and when I asked her want she wanted to be, she cried and held up a note: "free."

My mom's journey to freedom could only begin by taking an Amtrak from Winnemucca to Reno - a 165-mile journey that would otherwise take two and half hours by car. And so I thought: "what mental health resources are available in remote, rural places like northern Nevada?" As it turns out, close to none. Nevada is in the bottom five states with the lowest ratio of licensed psychologists to population, just 12: 100,000. Humboldt County (the county seated in Winnemucca) doesn't have any licensed psychologists. Consequently, Nevada is in the top three U.S. territories with the highest rate of unmet needs for illicit drug use and alcohol disorders (closely behind Colorado and the District of Columbia) that often exacerbate preexisting mental disorders. 

Overall, the state only has 460 licensed psychologists. Each county in Nevada meets the federal definition of a professional mental health provider shortage. As a result, many psychologists in the state have waitlists for assessments for about two months, while the waitlists for treatment are often a year long. The largest medical provider in Humboldt County is the Humboldt General Hospital and where there is only one licensed "clinical social worker" and one psychiatric nurse practitioner. But one nurse practitioner cannot begin to meet the needs of a county with 17,600 people. 

Another part of the problem is the lack of public transportation. As noted above, people like my mother who live in northern rural counties that are hundreds of miles from Reno where many of the licensed physicians are located face transportation barriers. Because there are no "long range" transportation services in these parts of the state, it is harder for people in those counties to seek proper treatment for their mental health disorders -- or any other services for that matter. 

But there have been movements to address these issues. One solution relates to accessibility of housing for people who suffer from debilitating mental health disorders. A Nevada Senate Bill is trying to increase the real property transfer tax by 20 cents for every $500 of value to build affordable housing for Nevadans with mental health conditions, disabilities, and those who are lower income. The bill seeks to address the problem that one woman characterized as people having no place between "'the hospital and the streets.'" But the bill has been met with resistance by the corporate community in the state. The Nevada Realtors and Vegas Chamber testified against the bill, arguing that a new tax increase would harm first-time homeowners. On the opposite end, Reno + Sparks Chamber of Commerce, Nevada Rural Hospital Partners and other organizations dedicated to serving rural community mental health needs argue that the legislation is critical to support people in the state who already face insurmountable obstacles to getting proper care. 

These issues are only the tip of the iceberg, as insurance companies add fuel to the fire by denying benefits to people for mental health services as well as denying mental and behavioral health specialists into their networks. For people like my mother, who rely on a mix of public health benefits including Medicare and Social Security Disability, getting care for serious mental disorders is almost impossible in rural communities. As a result, millions of people living in rural areas across the country fall into hopelessness. In the wake of the COVID-19 pandemic, the problem of inadequate mental health care has received widespread attention but stakeholders have taken little action to meet the needs of people who suffer from mental and physical isolation. 

As for my mother, when I last spoke to her she hadn't been able to make the trip to Reno because the Amtrak was not running given the recent snowstorms battering northern Nevada. When I reached out to her again to see if she had made it to her intake appointment she didn't answer and hasn't since. I can only hope she made it. And for people in circumstances like mine (higher education students with no income other than financial aid) who have relatives living in rural areas trying to seek treatment for mental disorders, that's about all we can do for them: hope.