We respectfully present the following list of recommendations for the Northern Regional Behavioral Health Policy Board. These recommendations are listed in order of board member ranking:

1. Obtain sustainable funding for crisis stabilization and criminal justice diversion initiatives and programs including: MOST, FASTT, CIT and Mallory Crisis Center.

As noted above, these crisis stabilization programs have significantly assisted the region in responding to individuals in behavioral health crisis. The Board recommends obtaining long term funding for these programs to ensure that the progress gained in the region would not be lost.

2. Support continued funding for Regional Behavioral Health Coordinator position.

Our region continues to advocate for a sustainable funding stream to maintain the regional behavioral health coordinator position. We deeply value our coordinator with her longstanding commitment to the position and experience. The board recommends that the state sustain current funding levels to attract qualified candidates for this essential position. In addition, the coordinator position is tasked with coordinating the region’s initiatives, providing technical assistance, and administrative support to the board. Ideally, the board could use more staff to support administrative activities, development of data reporting, and initiatives moving forward. This neutral position, funded by the state, but housed in a community organization, facilitates collaboration between local, regional, and state stakeholders that reduces silos, fosters honest discussion about gaps and needs, and develops innovative solutions to shared problems.

3. Support the regional implementation of the Crisis Now model, supporting efforts that respect community informed solutions in addressing local and regional gaps, challenges, and existing resources.

Like the other behavioral health regions in the state, stakeholders in the Northern Region see real value in developing an alternative behavioral health crisis response system through the Crisis Now Model. As discussed above, our region has made significant progress in developing that model through our MOST co-responder teams and the Mallory Crisis Center. The board recommends that the state support the region in developing the Crisis Now model with adaptations that meet the unique needs of our region which include:

• Development of Crisis Now using locally based providers and solutions when possible.
• Access to both in-person mobile crisis response and county-based co-responder teams. Both programs respond to different populations. The mobile crisis teams respond to individuals who are voluntarily connecting with services, while the co-responder teams are able to use wellness checks to build rapport with individuals who lack insight into their illness or may not be motivated by treatment.
• Development of scaled down “living room” model crisis access points to support individuals in crisis and assess their needed level of care.
• Establish a strong coordinated relationship between state run services such as Crisis Support Services of Nevada and community owned crisis response programs and providers.

4. Increase workforce: Increasing recruitment and retention of psychiatrists, behavioral health clinicians, substance use treatment professionals, and/or behavioral health professionals with the capability to treat youth.

As discussed above, the Northern Region struggles to attract and retain a skilled workforce to provide quality behavioral health services. In addition, there is a dearth of mental health professionals who can treat youth. While the board does not have an identified solution, the board recommends the state explore mechanisms for recruitment and retention of workforce including licensing, reimbursement, and increasing local opportunities for education.  

5. Increase access to residential treatment and housing:  In particular, inpatient/ residential treatment and housing, and transition support to reenter community.

Stakeholders in the region continually report that there are not enough inpatient and residential behavioral health beds to care for the population. In addition, they see a gap in transitional housing and support for those reentering the community after treatment. The board recommends the state prioritize this critical issue in its policy development and planning.

6. Increase options for supportive housing. 

As noted above, stakeholders in the Northern Region have reported a lack of group homes and long-term care to support individuals in chronic sub-acute crisis. Due to lack of housing, these individuals are unable to be discharged from hospitals for long periods of time or live homeless in the streets interacting with law enforcement and impacting our emergency services system. The Northern Board does not know enough about this complex issue to provide specific solutions but seeks the state’s support in identifying resources and technical assistance to progress on this issue.

7. Develop services to support continuity of care (e.g. continuation of medication/ service connection with community health worker).

As noted above, providing funding for services to support continuity of care could address the clinical workforce gaps and allow for community-based services. Several members of our Regional Behavioral Health Policy Board are interested in exploring mechanisms that support community health workers, as it is believed that these can provide community-based support and fill some of the gaps created by the lack of clinical workforce.

8. Support efforts to increase use of telehealth for behavioral health services to reach isolated populations such as rural communities and older adults.

In response to the ongoing issues with lack of behavioral health workforce, timely access to various levels of care, and the increased risk of isolation in rural communities, the Board is motivated to explore opportunities and solutions to implement and expand the use of telehealth for behavioral health services where appropriate. The Board recommends the state sustain the expanded use of telehealth that was initiated by the COVID- 19 response. This includes the use of telephones for behavioral health where videoconferencing capabilities are inaccessible. This is important as many rural counties struggle with connectivity issues and the board has heard stories of individuals experiencing challenges in affording or operating smart phones or other videoconferencing technology.

9. Develop initiatives to support regional behavioral health authorities for formalizing behavioral health infrastructure in the region, improve advocacy and collaboration with the state, and develop cost sharing among counties for behavioral health resource use.

Since the Northern Region started meeting as a coalition in 2013, stakeholders have experienced issues in applying for grants and receiving funding without a central regional authority. In addition, other states have used regional authorities to manage data and funding to respond to the unique needs of the region. The Board recommends that the State provide technical assistance in conducting a feasibility assessment.

10. Support development of behavioral health emergency response through regional and state collaborative efforts on initiatives such as PsyStart, Psychological First Aid, and Behavioral Health Disaster training for first responders.

Through multiple stakeholder workgroups and input from the Northern Regional Behavioral Health Policy Board, the Northern Region has developed a draft Northern Regional Behavioral Health Emergency Operations Plan. This plan will assist stakeholders in responding to the behavioral health needs of the community and first responders during a disaster. The Board recommends that the state provide resources and training to make this plan operational.

11. Develop increased support for older adults to maintain stability in their living environment.

Older adults in the Northern Region have experienced increased stress and isolation during COVID-19. Many of the supports and services they received in-person prior to the pandemic, such as Senior Services lunches and activities, and in-person support services were scaled down or temporarily closed, leading seniors to experience increased loneliness and less support. Community stakeholders are seeing increasing numbers of older adults experiencing crisis and need for hospitalization. The Board recommends that the state explore additional community level services be put in place to support seniors in their environments.

12. Support initiatives to increase cultural awareness and provide behavioral health services to minority populations including LGBTQA+.

The Board seeks to advance health equity in behavioral health care in our region where everyone has a fair and just opportunity to be as healthy as possible. This includes advocating for funding education on culturally competent care, which can be defined as the ability of providers and organizations to effectively deliver and promote health care services that meet the social, cultural, and linguistic needs of patients. Some examples include: educating medical professionals about healthcare challenges specific to LGBTQA+ individuals, advocating for workforce development policies that increase the number of bilingual providers in our state, working with healthcare providers and organizations to deliver unconscious bias training into the workplace, advocating for robust data collection that will help us to identify gaps in services that disproportionately impact minority populations, and developing best-practice guidelines that help behavioral healthcare providers and organizations develop a provider community that reflects the community it serves. 

Advancing health equity also requires collaboration with, and support of, community partners who are removing barriers to care including food insecurity, discrimination of all kinds, and housing insecurity, to name a few. Additionally, we seek to foster collaboration and partnership with community organizations and entities that serve minority populations to learn how best to support their work, better understand the needs of the diverse populations in our region, and recruit individuals with diverse experiences and perspectives to boards such as this one.