Carson City is building mental health resources but there still is a lot of work to ensure patients don’t fall through the cracks.
One difficulty is transitioning patients through the system, and making sure there is a continuity of care so they don’t veer off the treatment path and back into crisis.
“We lose a lot of people in the gap between services or different levels of care,” said Carson Tahoe Regional Behavioral Health Coordinator Jessica Flood. “We are all trying to come together to start working together to stabilize these individuals that kind of need wrap around support to really get stable in our communities.”
One of the biggest gaps is the lack of affordable transitional housing for those in residential or outpatient treatment. These housing programs help provide a stable, sober and safe environment while people are working out of crisis.
“The biggest gap that I see is that we don’t have a residential treatment facility for co-occurring persons with mental illness — so that’s a person who has a substance abuse issue along with mental illness,” said Carson City Forensic Manager Bekah Bock. “So what happens is, we are sending people outside of their community to get that treatment and we should be able to treat our people in our own communities.”
Once inpatient treatment is complete, patients may be forced to return to housing situations, even homelessness, that adds stress and reintroduces destructive environments.
“When individuals go through residential treatment they can come out with higher motivation to be stable and sober but return to homelessness and to poor living environments that often set them up for failure,” Flood said.
Community resources also are working on eliminating common difficulties associated with mental health care. Often, individuals will fall off of treatment plans, not because they want to, but because certain aspects of care can be difficult to obtain.
“We develop plans with individuals that can be helpful, but often don’t take into account the barrier that can keep an individual from succeeding, such as transportation or finances,” Flood said. “We are working to develop strategies to support the individual and ensure they get connected to the services.”
Without easy access to transportation, patients are more likely to miss appointments and other treatment needs, Flood said.
“Carson isn’t so bad, but you get to some of these areas like Lyon County and Churchill County, and transportation is a huge factor in people getting to their appointments, staying on their medications,” Bock said. “It’s huge in Nevada because we are so rural.”
For Barbara Jacobsen, a teacher and counselor with NAMI in Winnemucca, getting access to mental health resources means a nearly two and half-hour drive to Reno.
“Our challenge is that we have no access to anything,” Jacobsen said.
Jacobsen’s family members suffer from mental illness, but unlike a lot of rural residents, they have access to transportation.
“We are able to go to Reno for psychiatrist and psychologist appointments because we can afford it, but even then, when we have snow days we can’t get there and when you miss an appointment you can’t get another one for months,” Jacobsen said.
“A lot of parents will say that travel is the challenge because they can’t afford to go to Reno or Utah or Texas (where there are inpatient treatment facilities for children), so we give them resources and references but they say they can’t get to them.”
For now, the most she can do is offer her home. Jacobsen said she sets up rooms with coloring books and the children from around town will come over and color and talk to her about their mental state.
“I am not a psychologist or clinician, but I just have them come over or their parents will bring them over and we will just color and talk when they are comfortable,” Jacobsen said.
Sarah Adler, president of NAMI Western Nevada, said when NAMI presents classes and resources in rural areas, it always come across people who didn’t think mental illness was treatable because they had been exposed to so few resources.
“It is astonishing because people don’t always believe there is recovery because there are so few resources,” Adler said. “But this gives them hope and it is inspirational for the family to see because (their family member with mental illness) can still live a full life.”
Jacobsen said in a perfect world, rural communities need access to psychologist or psychiatrists, a group center for dual diagnosis patients, a staffed wing for mental health in the hospital and an increase in clinicians or counselors available to the children.
The negative stigma of mental health often dissuades individuals from talking about it or getting help.
“Mental health has a bad reputation because visible mental health is usually when things go very wrong because they are either in crisis or can’t function,” Flood said. “We just try not to talk about mental health even though about 20 percent of people suffer from it in any given city in this country.”
Flood said that a big problem with mental health in our community is the negative stigma associated with the disorder.
“The most visible aspects of mental health in our community are often individuals suffering who are homeless or intoxicated or unable to care for themselves on the streets of our community,” Flood said. “This can present a scary face of mental illness.”
This stigma of fear and negativity is what often keeps individuals from talking about the problem.
“If people can look at it as a disease, such as diabetes or high blood pressure, then we can look at it with openness and we can start in the schools because right now the stigma prevents schools from even talking about it, talking about mental illness, talking about suicide and if we didn’t have the stigma we would openly have that discussion, we would educate our children, we would educate our families to what the signs and symptoms,” Bock said. “We are making great progress in Carson City, but still have a long way to go.”
Flood said that for many, a mental health crisis isn’t that uncommon.
“We all have the potential to experience symptoms associated with mental illness when we have stressors in our lives,” Flood said. “I think if we all saw ourselves on that spectrum as opposed to seeing those individuals with mental illness as ‘other,’ it may be helpful for people to be less scared about mental health.”
“And less judgmental too because I think it is a fine line between you and the person experiencing a mental health crisis,” added Bekah Bock, forensic program manager for the Carson Rural Clinics.
Flood and a group of stakeholders recently held a Stepping Up Initiative workshop in March, focused on developing community support and diverting individuals with mental illness from the criminal justice system.
“Most of our goals are to deal with the criminal justice system and mental health and now we can bring in a community of providers into that decision making process so that it is not just law enforcement handling this,” said psychiatrist Dr. Joseph McEllistrem.
Many of their goals are to determine how to divert the mentally ill away from unnecessary jail time and to fill those gaps in services to avoid that as well as provide the necessary treatment to help stabilize those in crisis.
“Our intent is to identify them before they hit crisis level and to create change so we can flood resources to anyone,” Carson City Sheriff Ken Furlong said. “These are here to intercept the needs to get our arms wrapped around this and help create a better quality of life.”