More people commit suicide in Nevada than in any other state, when measured by population.
More people also are prone to alcoholism and other addictive behaviors per capita in Nevada than in almost any other state.
And while many of these problems can be linked to mental illnesses, critics charge Nevada ranks among the worst in the nation for funding mental- health programs.
Statistics for Nevada's mental health funding are sketchy. Depending on the statistic and organization, Nevada ranks anywhere from 5th to 47th in the nation for funding mental health.
For 2001, the state has budgeted about $61 million for mental health. Half the money is heading to Las Vegas, leaving $7.5 million to fund Rural Clinics Community Outpatient Services, which runs the backbone of Carson City's mental health system, Carson Mental Health Center.
Carlos Brandenburg, administrator for the state Division of Mental Health and Developmental Services, said the state mental health system is recovering from 1991 budget cuts that crippled the department. Brandenburg said Nevada is rising in the national statistics and that the department garnered an extra $55 million in funding in both legislative sessions since 1995.
However, the department has "a difficult time organizing itself for the funding we managed to secure in the last two legislatures," says Brian Lahren, executive director of the Washoe Association for Retarded Citizens and a member of Washoe County's Community Unity Coalition, a coalition similar to Carson City's Mental Health Coalition.
"It would be fair to summarize (the) statistics by noting that where Nevada appears good, they are used by the state to defend a system that still clearly fails Nevada citizens with mental illness," Lahren said. "Where the statistics are bad, state officials argue that somehow Nevada is 'unique' and somehow the offending statistics don't apply.
"My response would be that Nevada is 'unique' in that it has been singled out as the worst state in the nation on almost every significant health care indicator at some point in recent years. It is 'unique' in the extremes of rationalization to which state officials are willing go in defending their ineffective service systems.
"And finally it is truly 'unique' in its willingness to sacrifice such a large and vulnerable part of its total population to lives of desperation, sadness and isolation when it could, for relatively low cost, help its disabled citizens return to productive and useful lives.
"Of course, that would require both vision and the understanding that wise expenditures in the present can effectively reduce taxpayers' costs in a not too distant future. The latter strategy involves a kind of wisdom and humanity that Nevada has been uniquely lacking."
Lahren said movements in Carson City, Washoe and Clark counties point to problems within the state system and a need to fund more community-based services for the mentally ill.
"The political reality is the Division of Mental Health Services is obligated to say everything is pretty much OK, that the governor's budget is adequate," Lahren said. "The rest of us in the community who deal with this know it's not true, but we have to play the game. The state refuses to acknowledge its status as one of the most dysfunctional state mental health systems in the country. We have an inability to address our realities. It's almost a form of bureaucratic mental illness."
Brandenburg said he is the first to admit that "things are not OK" in the state's mental health system.
"People say they would like to have all these programs, but the state doesn't have enough resources," he said. "We're building the system. It takes time. There are fragmentations within the system, I'll be the first to say that. But we've been working on that. We have unique challenges; that doesn't mean the state's not investing (in mental health care.)"
In Nevada, mental health services are separated into three regions - Las Vegas metro, Washoe County and the rest of the state.
Last year, the rural clinics served 5,000 people through rural Nevada, 1,500 of those in Carson City, Lyon, Douglas and Storey counties.
In any one month, 2,800 people walk through the doors of the rural mental health clinics and "we'll see anyone who walks through the door. We're often the only service in town, " said Larry Buel, director of the state's rural clinics community outpatient services.
While Buel agreed that things could be better, rural clinics are doing the best they can under the circumstances.
"Carson's population is at 53,000. Carson Mental Health's staff hasn't grown equally," Buel said. "The state of Nevada doesn't have all the resources necessary to meet mental health needs. There are budgetary issues, limited resources versus demands. Where do you put those dollars? In health, when there are roads to be built?"
Brandenburg said the state is doing the best it can.
"We're ranked 35th. We were worse at one time," he said. "People recall the cuts in 1991, but they don't see the tremendous changes. People don't know the facts. We have some areas we might do a better job, but the proof is in the pudding. We have a lot of great programs now. People look at the gaps and say (the funding) is not there. It's hard for me to say we haven't been supported. We've been very blessed."
Editor's note: This is the first in a series of articles examining mental-health issues in Nevada and, specifically, attempts in Carson City to improve the level of treatment for the mentally ill.
Where Nevada stands
Source: National Association of State Mental Health Program Directors, 1999
Statistic Nevada's rank
Actual dollar/per capita revenue by state 35th
Mental health expenditures at community based programs 20th
Mental health expenditures for psychotropic medications 5th
Mental health expenditures at state mental health hospitals 47th