Sandoval has chance to help mentally ill

Historically, the mentally ill in Nevada haven't fared well under the state's budget.

In 1991, when the budget had to be balanced, the main cuts were from the prison system and services for the mentally ill. Out of 266 layoffs of state workers, 131 worked in mental health.

While mental health advocates try to protect and defend funding for services, Nevada fares poorly in this area.

For 2010, one research group found Nevada ranking 40th among the states in spending on mental health services. It penciled out to $68 per person in Nevada. Idaho spent the least, with $37 per capita, while Maine was at the top, with $347 per capita.

On Dec. 11, Gov. Brian Sandoval's decision to expand Medicaid under President Barack Obama's Affordable Care Act was welcomed by many because it would cover previously uncovered poor populations, such as single, childless people needing mental health services.

Three days later, Adam Lanza first shot his mother and then murdered 26 people at the Sandy Hook Elementary School in Newtown, Conn. He was yet another example of angry, young and often white males run amok on a shooting rampage.

The "how can we stop these shootings" debate began immediately because 20 of the victims were 6 and 7. These 27 murders immediately launched a national debate about gun control, security in schools and mental health services.

Quite wrongly, I assumed Sandoval's decision meant that in Nevada, extra money might go to mental health. When I checked, Mike Willden, director of the Nevada Department of Health and Human Services, straightened me out. For mental health, this is a swapping of dollars, not an expansion of funding, as I had hoped.

Right now, the state's mental health programs are paid for almost entirely by state general funds. Next year, federal dollars will cover the bulk of the mental health costs for the poor.

There are now 26,154 Nevadans using state mental health services. Of that number, nearly 15,000 have been diagnosed with a serious mental illness or are children with a serious emotional disturbance, Willden's office says.

"When the governor made the decision to opt in, that decision expands Medicaid to two groups: It expands coverage to childless adults - and most of our mental health patients are childless adults and often homeless - and it expands coverage to drug and alcohol programs," Willden said.

A childless adult with an income of up to $15,415 will now qualify for insurance under Medicaid.

The money swap shifts $17 million in money previously paid by the state general fund to those new federal dollars. About $15 million is from mental health and another $2 million is from drug and alcohol programs, which also did not previously qualify for the Medicaid dollars.

Basically, it's a swap of dollars, not an enhancement. And after three years, the financial responsibility begins shifting back to the state, one concern of lawmakers responsible for reviewing and approving the next budget.

Willden believes in-patient mental health services are adequately funded, it's outpatient services that need more money. He's particularly enthusiastic about two programs, the Mobile Crisis Team and the Program for Assertive Community Treatment, both outpatient response efforts designed to keep people out of psychiatric hospitals.

Sandoval's proposed budget stays under wraps until Jan. 16 and Willden certainly isn't going to reveal the governor's plans.

However, it's quite likely that in the aftermath of the Newtown shootings that Sandoval is taking a hard look at the mental health budget he will suggest for the next two years.

For Sandoval, it's an opportunity to show a willingness to pull Nevada up from it's perennial low ranking among states when it comes to providing funding for services for the mentally ill among us.

For them, Christmas Eve may not be jolly and merry but depressed and lonely. Maybe even murderous.

Jane Ann Morrison's column appears Monday, Thursday and Saturday. Email her at Jane@reviewjournal.com or call her at 702-383-0275. She also blogs at lvrj.com/blogs/Morrison.