The offices of HELP of Southern Nevada span three office buildings on the east side of town, where the agency provides services such as job-training, parenting classes and crisis intervention.
The lobby is covered with posters of pregnant women in English and Spanish and chock-full of pamphlets explaining the various benefits — from food stamps to rental assistance — offered by the agency. HELP is as close as you can get to a one-stop shop for social services, the nonprofit equivalent of a Super Walmart, with programs for everyone from the chronically homeless to the low-income homeowner. But even HELP, with all its resources and real estate, can’t do everything. It had to sit on the sidelines as other agencies recently scrambled to find services for almost 80 Salvation Army clients with severe mental illness.
“We don’t have the resources,” said Terrie D’Antonio, president and CEO of HELP. “We’d have to hire psychiatric nurses and other staff.”
Fortunately, a coalition of service-providers, including WestCare and Southern Nevada Adult Mental Health Services, came together to absorb the Salvation Army’s clients. None of them ended up on the street.
But the closure of the Salvation Army unit broke another link in the social safety net, that patchwork of public and private resources that serve our neediest citizens. The Salvation Army had been losing money for years when its leaders decided to pull the plug on mental health. And it’s far from the only one. Over the summer, Nevada Treatment Center, a methadone clinic, shut its doors due to lack of funding. The Adelson Clinic took on its indigent clients. The Area Health Education Center of Southern Nevada and Nevada Association of Latin Americans closed in 2010. Clark County’s mental health court barely survived the last state budget and is always in danger.
With each closure, the cargo net of poverty programs frayed a little more, opening holes just big enough for people to fall through. The shortages have coincided with an unprecedented demand for services. Statewide unemployment has hovered between 12 and 13 percent for the last four years. The number of people receiving food stamps surged from 125,709 in July 2007 to 355,940 in July 2012. Most of those who lost their jobs also lost their health care, pushing the number of Medicaid recipients from 171,634 to 310,260. With all that demand, the state Department of Health and Human Services managed to expand its budget during the last five years, but it lost more than 200 staff members.
Even in the best of times, Nevada didn’t provide much money for mental health programs or substance abuse. And those programs have struggled to get private donations. Mental illness and substance abuse can seem like hopeless causes for would-be donors. Clients at the Salvation Army struggled with some of the toughest conditions in the diagnostic manual and required round-the-clock care.
“With mental health, sometimes you can’t fix it,” said Major Rhonda Lloyd, command coordinator for The Salvation Army in Clark County.
Julie Payne, the founder of Nevada Treatment Center, also struggled to raise money. Her clinic served hundreds of opiate addicts and was the first nonprofit methadone clinic in the valley. For decades, it was the only clinic that served indigent addicts, regardless of their ability to pay. As the economy worsened, paying patients began to fall behind on their bills, and donations dried up. Payne admitted that her service was a hard sell in a tough economy. Most of her clients were single men and chronic drug addicts who lived on the streets or in low-income housing. As the amount of charitable funds dwindled during the recession, she found it difficult to compete with more palatable charities, like those focused on animals or education.
“This is not a popular population,” Payne said. “If they were women with children, it might be a lot easier.”
Nevada never funded mental health services adequately and never had enough psychiatrists and other health professionals. Even before the recession, a shortage of treatment beds for psychiatric cases often drove people in crisis to the emergency room. The state’s suicide rate has long been above the national average.
“Our community never really had the full support that we needed,” said Ron Lawrence, director of the nonprofit Community Counseling Center of Southern Nevada. “Right now, we have 150 people waiting for mental health services.”
Beds were found for the Salvation Army clients, and the Adelson Clinic took in almost all of Payne’s methadone patients, but the closure of both agencies mean that there will be fewer options for those who need help in the future.
A net is an apt metaphor for those programs that help the neediest citizens. Clients who turn to HELP for rent assistance or job training may have other problems that need to be addressed by other agencies. Drug addiction and mental illness could impede a person’s ability to get and keep a job. And job loss and economic insecurity can aggravate underlying mental illness. The loss of mental health and addiction services has a real impact on the community.
“There are certain spinoffs of not serving the mentally ill,” Lawrence said. “Public safety is affected. Crime goes up.”
Lawrence said the center routinely referred patients to Nevada Treatment Center, Area Health Education Center and the Nevada Association of Latin Americans for additional help. So even though his agency has maintained its funding through the recession, it has struggled to fill the gaps left behind by those nonprofit groups.
“What we’re seeing now is the decaying of the safety net,” Lawrence said.
No groups have emerged to fill the void left by other agencies. The Nevada Association of Latin Americans used to run a low-cost day-care center. The organization filed for bankruptcy after a dispute with the Southern Nevada Regional Housing Authority over the number of children enrolled from nearby public housing complexes. To date, no other organization has taken over the old Maryland Avenue space, which has been collecting graffiti since the association left in 2010. In addition to child care, the association also provided HIV/AIDS prevention services and job training.
Other gaps have opened up in service areas administered by the state. The Nevada Department of Health and Human Services is trying to restore funding to several critical programs for children and adults with developmental disabilities. The state cut the budget for early intervention, which provides therapy for young children with disabilities and delays. Right now, the program has 300 children on the waiting list. Mike Willden, director of the Department of Health and Human Services, said he is asking for $30 million to expand the program and get those children off the waiting lists.
“We haven’t made a significant cut,” Willden said.
Instead, the service shortages have been caused by low staff, increased demand and closures in the nonprofit sector.
During the recession, the waiting list for in-home services for older people with cognitive disabilities also grew. That forced some families to make tough decisions about care, and may have forced adults and older children who needed assistance into nursing homes.
Nicole Schomberg of the Arc of Nevada, an advocacy organization for people with disabilities, said many families are just doing without services. Those with private insurance have been able to make up some of the gap in state services, but many are just going without.
“How do we get services when the state doesn’t have any money?” she asked. “We don’t want to say our population is more important than teen pregnancy. We just need to find a way to fund it all.”
The safety net is particularly important for people struggling with mental illness or disability because these populations often struggle for financial security. Most of the growth in the Medicaid and food stamps has been funded by the federal government. The state is struggling to handle additional cases with a limited staff. Demand for Temporary Aid to Needy Families has actually started to go down as the economy began to improve.
“What puts stress on the state is not having enough workers,” Willden said.
But there are a few bright spots on the horizon. Willden has asked for money to bolster programs for the elderly and developmentally delayed. The Affordable Care Act could also potentially bring some relief, if the governor approves the Medicaid expansion. The number of people on Medicaid in Nevada could increase from the current 310,000 to about 480,000. The Silver State Health Insurance Exchange will also match some of the state’s uninsured with affordable policies. More people covered by health insurance means more access to health services, including counseling, addiction treatment and therapies for people with disabilities. Unfortunately, the state still doesn’t have enough health care providers to handle the demand, Willden said.
“I’m an optimist, and I think jobs will be coming back and some of the funding sources will return,” Willden said.