Behavioral and Mental Health in Nevada

The Nevada Division of Public and Behavioral Health is responsible for providing public and mental health services to people living in or visiting the State. The Division is organized into four branches: Community Services Branch, Regulatory and Planning Services Branch, Clinical Services Branch and Administrative Services Branch. The Clinical Services Branch provides statewide inpatient, outpatient, and community-based public and mental health services. State employees provide mental health services, and contract providers deliver substance use services. Mental health services are additionally organized by age and geography. Adults with mental disorders are treated statewide through the Division of Public and Behavioral Health. Children with mental disorders are served through the Division of Child and Family Services within the populous urban counties (Washoe, Clark and Carson City) and the Division of Public and Behavioral Health across the 14 rural and frontier counties. Services are supported through Medicaid, the Nevada General Fund, and Federal grants. The Division of Public and Behavioral Health is located within the Nevada Department of Health and Human Services, under the Executive Branch of the State, and serves as its Public Health Authority and Mental Health Commissioner. By statute, the Commission on Behavioral Health is responsible for the following: establishing policies to ensure development and administration of services for persons with mental illness, persons with intellectual disabilities and related conditions, and persons with substance use conditions; reviewing programs and finances of the Division; and providing reports to the Governor and Legislature regarding the quality of care and treatment provided to individuals with mental illness, intellectual disabilities, and substance use disorders [Nevada Revised Statutes (NRS) 433.314]. Historically, the governance structure of Nevada’s behavioral and mental health system has been centralized at the state level with limited involvement at regional and local levels. A policy study conducted during 2014 identified Nevada as one of only four states in the country that directly operates community-based mental health services (Kenny C. Guinn Center for Policy Priorities, Mental Health Governance: A Review of State Models & Guide for Nevada Decisions Makers, December, 2014). During that same year, the State began to consider ways to move from its centralized governance structure to a more localized model involving regional, county and city entities. A key consideration was a growing recognition that increasing the State’s responsiveness to the unique needs of individual communities is crucial. Nevada’s plan to restructure the governance of its state mental health system is not without challenges. For example, the numbers of Nevada residents covered by Medicaid benefits almost doubled when Medicaid coverage was expanded by Governor Brian Sandoval under the Affordable Care Act (ACA) during 2014, increasing from 351,315 persons in 2013 to 654,442 individuals in 2015 (Woodard and Nevada Division of Health Care Financing and Policy, 2016). On its face, the increase in numbers of residents covered by Medicaid benefits is a positive outcome. However, the existing mental health provider network was not adequate to serve the increase in numbers of individuals covered. As detailed in later sections in this chapter, the increase in health care coverage appears to have impacted the frequency with which Nevada residents used health care services, most notably hospital emergency departments and inpatient facilities. Thus, the dual influences of increased health care coverage, and limited access to appropriate and optimal mental health services are reflected in the dramatic increase in residents’ utilization of emergency department services for a wide range of mental health-related conditions during 2015, after the expansion of Medicaid during 2014. Also discussed in later sections is the fact that almost all of the State qualifies as a mental health professional shortage area (Health Resources and Services Administration, HRSA). Therefore, moving from a primarily centralized or state control model to a local control model will require accommodation for the shortages in mental health professionals within communities that lie outside the State’s urban centers

We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in England

In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders' experiences and the local consequences of the implementation of an EHR system into a mental health hospital

Gut thinking: the gut microbiome and mental health beyond the head

Background: In recent decades, dominant models of mental illness have become increasingly focused on the head, with mental disorders being figured as brain disorders. However, research into the active role that the microbiome-gut-brain axis plays in affecting mood and behaviour may lead to the conclusion that mental health is more than an internalised problem of individual brains. Objective: This article explores the implications of shifting understandings about mental health that have come about through research into links between the gut microbiome and mental health problems such as depression and anxiety. It aims to analyse the different ways that the lines between mind and body and mental and physical health are re-shaped by this research, which is starting to inform clinical and public understanding. Design: As mental health has become a pressing issue of political and public concern it has become increasingly constructed in socio-cultural and personal terms beyond clinical spaces, requiring a conceptual response that exceeds biomedical inquiry. This article argues that an interdisciplinary critical medical humanities approach is well positioned to analyse the impact of microbiome-gut-brain research on conceptions of mind. Results: The entanglement of mind and matter evinced by microbiome-gut-brain axis research potentially provides a different way to conceptualise the physical and social concomitants of mental distress. Conclusion: Mental health is not narrowly located in the head but is assimilated by the physical body and intermingled with the natural world, requiring different methods of research to unfold the meanings and implications of gut thinking for conceptions of human selfhood

Disrupting the Path from Childhood Trauma to Juvenile Justice: An Upstream Health and Justice Approach

A groundbreaking public health study funded by the U.S. Centers for Disease Control and Prevention (CDC) and the Kaiser Foundation found astoundingly high rates of childhood trauma, including experiences like abuse, neglect, parental substance abuse, mental illness, and incarceration. Hundreds of follow-up studies have revealed that multiple traumatic adverse childhood experiences (or “ACEs”) make it far more likely that a person will have poor mental health outcomes in adulthood, such as higher rates of depression, anxiety, suicide attempts, and substance abuse. Interestingly, the original ACE Study examined a largely middle-class adult population living in San Diego, but subsequent follow-up studies have examined the prevalence of ACEs and its impact on mental health in other populations, including among people involved in the juvenile and criminal justice systems. Unsurprisingly, individuals entangled in those systems are more likely to have experienced higher numbers of these traumatic events, despite a frequent lack of access to critical mental health treatment, including the treatment necessary to address past childhood trauma. The ACEs framework for understanding health and mental health outcomes resulting from childhood trauma has received a high level of attention recently following an in-depth, multi-part series on these issues by National Public Radio (NPR) and other media. Because the ACEs public health research shows us that events in childhood can cause “toxic stress” and have a lasting impact on the mental health of a child well into adulthood, this framework provides us with an opportunity to consider how to more effectively intervene to stop the pathway from ACEs to juvenile justice system involvement and address the related health, mental health, developmental, and legal needs of children and their families. Before a child becomes an adult facing a mental health crisis or incarceration, attorneys, doctors, and other professionals can collaborate to disrupt that fate. This Article argues for a more upstream approach to address mental health using a medical-legal collaboration, based on the experiences of the authors, a law professor and medical school professor who work together to try to improve outcomes for children who have experienced trauma and their families. In Part I, we begin by examining the groundbreaking ACE studies, exploring the toxic stress and health and mental health outcomes that are associated with high rates of ACEs in childhood. Next, in Part II, we analyze the research revealing high rates of trauma and ACEs among populations involved in the juvenile justice system. Finally, we conclude in Part III by arguing for a more upstream public health and justice approach. We examine a particular problem in the city of Albuquerque, the largest urban area in New Mexico: children who have a particular ACE right from birth in the form of substance abuse by a household member. These infants are born with prenatal drug exposure and many experience symptoms of withdrawal in their first weeks of life, often quickly followed by an accumulation of additional forms of early childhood trauma. We discuss an approach through which the authors work to address those issues and disrupt the path from that childhood trauma to poor outcomes and juvenile justice system involvement. This approach engages attorneys with doctors and other health and developmental professionals to address ACEs among young children ages zero to three and their siblings, parents, and other caregivers. We advocate for an early, holistic, multi-generational, multi-disciplinary public health and justice approach to address ACEs early and improve the trajectory for children who have experienced childhood trauma

Observation, reflection and containment: A psychoanalytic approach to work with parents and children under five.

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: clinical applications in diverse settings across the age range the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare

Psychiatry and psychoanalysis: A conceptual mapping.

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: Clinical applications in diverse settings across the age range. The relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare

Beyond safety to wellbeing: How local authorities can mitigate the mental health risks of living in houses in multiple occupation

The regulation of houses in multiple occupation (HMOs) by local authorities focuses on ensuring the physical safety of occupants through adequate standards of building quality, safety provision and management suitability. However, it has been suggested that HMOs may also pose a particular threat to the mental health of residents. In this paper we consider the suitability of current regulations to tackle the possible risks to the mental health of HMO residents and then outline how the current public health agenda may present an opportunity for environmental health professionals to tackle these issues in new ways. Using a framework which encompasses the psychosocial processes thought to link residents? mental health with their housing conditions, we describe how local authorities can address some of the mental health risks posed by HMOs but that the current enforcement culture, in which prosecution is seen as a last resort makes decisive action against landlords very difficult. In recognising the many vulnerable households living in HMOs, we argue that local authorities dealing with housing standards and environmental management are strategically placed to be more ambitious and proactive in protecting the health of local residents particularly through the developing public health and wellbeing partnerships. We call for empirical research to look at how local authorities actually use current legislation as well as other strategies to manage HMOs and protect the mental health of tenants

The shock of the real: Psychoanalysis, modernity, survival

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: Clinical applications in diverse settings across the age range the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare

Working with ambivalence: Making psychotherapy more accessible to young black people

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: clinical applications in diverse settings across the age range the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare