Mental Health and an Update on the 988 System

May marks Mental Health Awareness Month.

So are Nevadans getting the mental health support they need?

That's this week on Nevada Week .

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt.

-Welcome to Nevada Week .

I'm Amber Renee Dixon.

The White House says the country is facing an unprecedented mental health crisis.

And in Nevada, suicide rates rose among two specific age groups.

We're going to explore why with our panel of experts ahead, but first, an update on the rollout of 9-8-8 in Nevada.

The mental health hotline helps people who are experiencing suicidal thoughts.

And for those who may be sensitive to discussions on suicide, please be aware this is our show topic.

988 launched last year, and the State and Crisis Support Services of Nevada, or CSSNV, are responsible for implementing it.

CSSNV has operated as a crisis call center in Nevada since 1966.

And its Executive Director, Rochelle Pellissier, joins us now from Reno, where the call center is based.

Rochelle, let's launch right into this.

988 launched in July 2022.

What kind of response have you seen in terms of how many people are utilizing this hotline?

-Well, tremendous response.

Now, just so for history, 988 actually comes into the same line as what was known as the Suicide Prevention Lifeline before July 16.

It was a 10-digit 800 number that we use nationally to get ahold of crisis centers.

So when 988 launched, that line went directly into with that, that lifeline.

So we've really been answering those calls for 30 years.

It's just that the new three-digit number launched officially on July 16.

So that allowed us to compare the increase in volume that we got in Nevada, and it-- the first weekend, because everyone was trying it out, it launched on July 16, which was a Saturday last year.

So the first weekend, because there was a lot of media around it, it increased volume by about 45%.

But after that, in the last eight months, that's reduced to about an increase in 30% in calls only.

The other thing that 988 did was provide a place to do text and chat, which did go live for us for Nevadans on July 16.

And that added another 10% to 12% volume to the overall crisis care volume.

-Let's talk in-state answer rates.

We spoke about this on the phone.

But there was the Kaiser Family Foundation Report which recorded in-state answer rates in the month of December-- collected that data, compared them to other states across the country.

And in that month of December 2022, Nevada had one of the lowest 988 in-state answer rates, with 65% of calls made in Nevada actually being answered by someone physically in Nevada.

For a perspective, Alabama had the lowest rate at 51%.

Rhode Island and Mississippi, the highest in-state answer rate at 98%.

When I asked you about that report on a phone call, you expressed frustration.

You thought it was an inaccurate representation.

Why?

-Because answer rates go up and down monthly and sometimes drastically.

Our average answer rate currently is about 75% of those in-state calls that we answer.

Also those answer rates are based on a system where you call from Nevada, it goes to the organization who oversees this whole system, Vibrant, you get a 50-second message with lots of different options of buttons to push, and then you come to us.

And we have found that a lot of times-- You know, 50 seconds in a crisis is really a, is a lifetime, unfortunately.

So sometimes by that 50 seconds, you know, they might just be finally getting to us, but they've dropped off because they can't wait anymore or whatever is going on in the crisis.

And they may call back, or they may not.

But we're finding that that initial 50 seconds is cutting off a lot of the people getting to us in the end.

And again, you know, what we found is also Vibrant's data is, especially for the last three months of last year, was about 7% lower than what we show our answer rates are.

-When you talked about the 50 seconds, people are having to wait 50 seconds to get in touch with someone?

-To get to us, yeah.

It's a "press 1 if you're a vet, press 2 of you're Spanish speaking, press 3 if you're..." But that whole thing takes 50 seconds before they're even transferred to the appropriate state and appropriate call center.

So that is something we've been working on at a national level with Vibrant and with SAMHSA, because that really needs to be reduced.

-So you said a 75% answer rate is what you're averaging right now.

Is that a good number for you?

Is that acceptable?

-It's not, but it's all based on how much funding we have to hire staff.

We were at 75% before 988 went live, and that really just covers that increase of volume of 30% to keep answering those calls.

And staying at 75% is amazing.

So, no.

Is that what we want to be at?

Absolutely not.

We want to be at 90-95%, but until the State comes up with what they talked about, you know, when you contacted them, that RFP and that program to pay us sufficiently for all of the, all of the services, 75% is what we can do right now.

-I want to talk about the plan to fund 988.

There is a plan, it's just not enacted right now.

In the state, it involves charging a fee on phone lines of 35 cents per month.

But the original legislation had a loophole where it left out charging cell phones.

So now in the State Senate, there is a bill that would include cell phones for that charge.

If it's not closed, though, if that bill does not go through, the State would need to, quote, scale back crisis prevention programs significantly.

That is according to the Legislative Council Bureau's Fiscal Analysis Division.

Scaling back crisis prevention programs significantly, what do you think when you hear that may be a possibility?

-Well, that's unfortunate, you know, and we'll have to figure out how to fund it a different way at a state level.

So that's not something I can control at all.

All I can do is, we can do, is answer the phones and do the best we can with the levels of funding that we have right now.

Hopefully, we'll get this figured it out.

It has taken the State a couple of years since the initial funding, and we're still not through an RFP process to really solidify and fund the call center and other services effectively.

-It could take some time.

-And it will.

It absolutely will take some time.

And 988 is-- You know, when 911 started 40 years ago, it was new too.

It was a newfangled thing, you know, and we had to figure out how to fund it.

And it's taken 40 years to really get to a place where they are now.

This is a new system, a vital system, and it's not going to be perfect overnight by any stretch of the imagination.

And all the states have to figure out how to fund their 988 system.

We were one of the five states that actually put legislation in place for that fee.

And that was a big thing across the nation.

-It makes it a little ironic that now it is up in the air.

The last question for you: That bill did pass through the Senate Finance Committee with two Republicans reportedly voting no.

What would your message to lawmakers be who are considering still voting no when this legislation advances?

-It was not "no" to the funding 988 call hub.

I believe they voted no because they were concerned about funding other services, such as crisis stabilization centers and mobile teams, if I'm not mistaken.

But I wasn't there.

So, you know, I think that it will go through.

It will depend on what they're going to cover with these fees.

-You are correct in that aspect.

And those are further rollouts of the 988 plan.

But as you and I mentioned-- -Exactly.

-And as the State has mentioned, those are in the process of being worked out right now, but doesn't sound like anywhere in the near future will we have mobile crisis response teams or crisis stabilization centers.

Do you agree with that?

-Yes.

It will take a couple of years to get that.

Now, they do have, if I'm not mistaken, the State does have a contract with Renown now to build out that one crisis stabilization center.

And as you, as you can imagine, someone to answer the phone in a system is not a system.

Yes, that's important, but you have to have all of the other pieces of a system in order to, for us to refer people out to appropriate services, you know, after we get them out of the crisis.

-Right.

-So without that, it's not a system.

It's a place where you can call, but not get the services you need.

-That's where it stands right now.

There's a place you can call, but there's not a mobile crisis response team to come out.

And there is not a crisis stabilization center to go to instead of an emergency room.

Rachelle Pellissier, thank you so much for your time.

-Thank you so much.

It's a pleasure to speak to you.

-We move now to new data analyzed by the Office of Suicide Prevention at the Nevada Department of Health and Human Services.

According to that office, preliminary data collected from the Clark and Washoe Counties' Coroners Offices shows that from 2018 to 2021, suicides among 18 to 24 year olds increased by nearly 42% and by nearly 20% among people aged 65 and over.

Joining us to discuss what may be behind these increases are Sheldon Jacobs, a licensed marriage and family therapist; Brenna Renn, a clinical geropsychologist and assistant professor of psychology at UNLV; and Ivet Aldaba, a licensed social worker and lecturer at UNLV.

Everyone, welcome to Nevada Week .

Thank you for making the time.

Let's start off with the 18 to 24 year olds, a startling increase in suicides at 41.9%.

Ivet, this is the age group that you work with at UNLV.

What is going on with this age group?

(Ivet Aldaba) I think coming out of COVID, right, you know, there's been the sense of, how do I connect with people, right?

And at the same time, expectations.

There's a lot of big expectations for this age group to succeed, to engage, to accomplish their educational goals.

But yet, the big looming question is how, and what type of support, you know, do I have to help me reach those goals?

But I often see the difficulty with connecting with people again.

And so I see a lot of young people struggling with that.

-How do you see that?

-Communicating.

You know, communicating their needs, communicating that they might be struggling, right?

And then also how to build those interpersonal relationships post COVID.

-Sheldon, is that something that is related to COVID, because of lack of interaction?

(Sheldon Jacobs) Yes, I'll say it has a big part of it in terms of the lack of connection that happened during that time.

But also when we think of this age group, when we think about this age group, we think about a lot of times college age, young adults, but there's also a large number of individuals within this age group who are not in college.

And so-- and a lot of them are isolated.

A lot of them don't have those connections; whereas, referring to college students, now any college campus, there's a, there's a wealth of resources.

I think every college campus has a mental health clinic as well.

So there is the support and resources for college youth.

-But we're assuming that everybody is in college, and not everybody is.

Ivet, one more thing you mentioned, the expectations that this age group is facing.

Are they any bigger than they were in the past?

-You know, I think that they are in the sense that, you know, coming out of COVID, right, now we have to somehow bounce back to in-person classes, interacting with their peers, and yes, you know, we do have a lot of resources at the institution, at UNLV.

But oftentimes it's, you know, how do I connect with those resources?

Right?

I think when we talk about the issue of mental health, we can't talk about mental health without addressing that there's still a stigma.

-Among all age groups?

Among 65 and older as well?

(Brenna Renn) Absolutely.

So I think for a long time, you know, speaking about mental health struggles has been very stigmatized and still is.

And we see differences across generations and the values that communities grew up with.

And for a long time, that's been, I think, unreported, perhaps sometimes undetected by healthcare providers as well, for lack of perhaps recognizing how suicidal expression might present in older adults and groups who might be less apt to talk about it.

-Will you expand on that.

That stuck out for me from our previous conversation that healthcare providers themselves may be having a negative impact on the mental health of older adults, 65 and older.

How?

-So I would perhaps say it's more that I think healthcare providers are stretched so thinly, right?

I mean, healthcare providers are doing amazing jobs and just went through, I mean, you know, the COVID pandemic in ways they could have never anticipated, and yet acknowledging that training, I think, is lacking, both with regards to training in mental health and substance use needs across healthcare providers broadly.

So just to unpack that for a quick moment, older adults in particular, as well as other underserved communities, are more apt to come to primary care, for example, to express mental health concerns.

So when there's that lack of training around mental health awareness and substance use, you know, that can be one place where those symptoms are underrecognized.

They might present with sleep difficulties or uncontrolled pain or kind of vague, you know, not feeling too well.

But those might not be purely medical or physical symptoms.

And then there's also a lack of training with regards to gerontology or the geriatrics or the unique needs of older adults.

And that's also the case even within mental health specialties.

So older adults are sometimes this forgotten group.

-Why?

-Well, that's a big question.

I think that they're-- I'm a mother, for example, and there's a lot of passion around how do we serve the needs of children, for example, right?

And obviously, when it comes head to head with funding priorities, kind of every group needs funding in different ways.

I think older adults have just historically been forgotten.

I mean, there's probably cultural factors within the U.S. to unpack around that, right?

We're not a culture that has historically revered our elders, so to speak.

It's less common to live multigenerationally here in many communities, particularly white communities in the U.S. And so I think there's many layers to that.

I also think we, broadly speaking, in the U.S. value independence and autonomy.

And so when somebody reaches that age of consent, when we're not worried about protecting our children, perhaps we're less worried about protecting those that we see as independent or self-sufficient.

So I think there's many, many layers to that.

-And I remember you mentioning that healthcare providers may take for granted some of the symptoms that are being reported.

-Yeah.

So I think that there's also aspects of ageism, potentially.

And I don't mean intentional ageism, but things like our own beliefs about what does it mean to age?

What does it mean to age with chronic disease as most Americans do experience and this idea that maybe it makes sense that somebody would feel hopeless or feel depressed, right?

And just to say that, while that may be common, it's not normal.

It's not normal to expect an older adult to be suffering.

So sometimes that expectation, I think, can cloud judgment around what might actually be a mental health condition and what might be what they see as a normal part of aging.

-Sheldon, you had mentioned finances bother older adults as well, that can get into their psyche as well.

-Yes, absolutely.

I think finances is a big-- or, I'm sorry, a significant variable when it comes to just the strain it can put on one's livelihood.

So if I'm not financially stable, it's going to impact me mentally.

And so I think that that's an area that I think doesn't garner enough attention for this population.

-All right.

Ivet, I think we often hear that if someone is in a mental health crisis or suffering mentally, just go get help.

Go get help.

How easy is that though, in Nevada, where according to a report by Mental Health America, Nevada ranks last in youth and overall categories in providing accessible mental health care to its residents?

How easy is it to just go get help?

-Well, I mean, we have resources like 988.

You know, we have resources like 211.

I know we're gonna address other resources at the end of this segment, but I think a lot of it starts with, you know, the psychoeducation around mental health.

You know, what does it mean to get help?

And how can a person get help?

Oftentimes they come across-- we're talking about finances.

Sometimes it is an insurance issue.

They may not have insurance.

They do have insurance, but then trying to access those providers can be very challenging.

I know that working with young people, adults, oftentimes they tell me, I have insurance, but there's a waitlist.

And I-- at the same time, I don't know which one is going to be the right, fit for me.

And so there's also some cultural barriers with how to get help and really understanding that process.

-Sheldon, do you want to talk about the cultural barriers or about the access to therapists, for example?

Because I know you have opinions on both.

-Yes, certainly.

Well, first, access.

Access is a big issue, especially in our community, because what we're seeing is a lot of providers that are in the private practice space are moving away from accepting insurance because reimbursements may be too low.

Sometimes they may not get reimbursed on time or in a timely fashion or even reimbursed at all for their services.

And so you have more providers going into cash pay private practice options because it's less red tape.

-So even if someone has insurance, they're gonna face the possibility that they can't find anybody accepting it?

-Yes.

And then also the insurance companies, they need to be held accountable as well, because insurance companies, when it comes to their conditioning process, a lot of times they're very selective of who they add to their insurance panels.

And sometimes they may say, Okay, we have a-- our provider network is full, but then that's not always necessarily the case, either.

So our insurance companies have to do a better job of meeting our community where they need to be met.

-Okay.

What can be done to address the mental health issues of people 65 and older, Brenna?

-Yes.

I think to Shelton's point about access, one powerful demonstration, or one powerful model that works well in many communities, particularly among older adults, but also rural communities, is embedding behavioral or mental health services into primary care, for example.

So if we can cast this net where people are actually coming in, right?

You can make the same argument for pediatrics clinics, kind of just primary care broadly, right, across populations.

But that also comes back to reimbursement issues.

That can be a difficult model to reimburse in traditional fee-for-service models.

And so, but I do think it really shows that if there is embedded or integrated behavioral health, those providers can both help serve the patients directly, but they can also build provider knowledge and help providers perhaps better identify mental health and substance use issues.

And one other thing, just to acknowledge that healthcare providers are under increasingly abbreviated time windows to see their patients.

So for the case of somebody over the age of 65, if I'm coming in with concerns about my diabetes management and some new pain and I need to make sure that my blood cholesterol and blood pressure are within normal limits, am I also going to have time to screen for depression and substance use and suicide?

And so having embedded behavioral health can help sort of offset some of that burden that the primary care providers are increasingly tasked with.

-If they can find the time to fit it in.

Ivet, what can be done for the 18 to 24 year olds?

-Oh, I'm sorry.

-It's hard, right?

-It is.

It is very hard.

-It's a big question.

-It is a big question, and I think at the end of the day, it's fostering a sense of connection with our young people, continuing to check in and ask how they're doing, you know, how can we help in various spaces.

As an educator, I make it a priority, you know, to prioritize their mental health.

Yes, your education is important.

That's why you're here.

But at the end of the day, so is your mental health.

So how can I help?

Or how can this institution help you find the resources that you need.

And so a lot of the times it's fostering those conversations and providing that safe space for our students and for this population.

-Not just from the teacher perspective, but we could all kind of implement that when we're dealing with 18 to 24 year olds with, with anyone-- -Absolutely.

- --in the population.

We are running out of time.

Sheldon, you wanted to talk about the suicide rates among youth in the African American community and LGBTQ community.

What worries you about what's going on with them?

-What worries me is the numbers.

The suicide rates are climbing within each of these respective demographics or populations, and that concerns me because I think that it could be prevented.

I think that there's more that we need to be doing to address this issue.

And one of the things that we can be doing is having more culturally informed providers, because I think that there is a lot of cultural bariers when it comes to, especially within the black community, when it comes to seeking help and what that looks like.

You know, historically in the black community, we were always been taught to keep it in the house or pray your problems away.

Go go to church and just pray about it, and all your problems will go away.

And we know that more work has to be done.

So really it's just trying to get the message out and provide that awareness so that we're normalizing it as much as possible.

-Lastly, real quick, can each of you provide a resource that you find especially helpful for people?

Brenna?

-Sure.

I would love to promote the Practice.

It's our clinic at UNLV.

But don't be misled.

It actually is a community facing mental health clinic.

So it's not for exclusively for students.

Any member of the community can call.

We offer assessment as well as group and individual psychotherapy.

-Ivet?

-Yeah.

I mentioned 211 earlier.

And so 211 provides a plethora of resources, not just around mental health, but also housing, transportation.

You can dial 211, or you can also download their app or also check out their website.

-And that's great because it provides resources that could lead to impacting your mental health if you don't have housing, for example.

And Sheldon?

-Yes.

NAMI-Southern Nevada.

So you can google NAMI-Southern Nevada.

We offer free support groups, peer support groups, family of family support groups.

And again, free is a big deal, especially during this climate.

-Wow!

Thank you all so much for your insight, and thank you for watching.

Remember, if you are struggling with thoughts of suicide, please call 988.

And for any of the other resources mentioned here, go to our website vegaspbs.org/nevadaweek.

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