The Southern Behavioral Health Region

The Southern Behavioral Health Region consists of Esmeralda, Lincoln, Mineral, and Northern Nye Counties. This region stretches across approximately 28,000 square miles in southern rural Nevada. The total population of the Southern Region is estimated to be less than 16,000. Lincoln County borders Clark County which is to the south as well as Utah to the east and Arizona to the southeast. Nye County, the largest geographic and most populated county in this region, has California on the southern border and sits in the middle bordering Lincoln to the east and Esmeralda and Mineral to the southwest and other Nevada counties to the north. Mineral and Esmeralda Counties are southwestern border counties connecting with California.

Southern Regional Behavioral Health Resource Guide (2023-2024) Online Version

Demographics and Geography

County	Seat	Population	Area
Esmeralda	Goldfield	744	3,589 sq mi
Mineral	Hawthorne	4,586	3,757 sq mi
Nye – northern	Tonopah	6,000 approx.	9,737 sq mi approx.
Lincoln	Pioche	4,525	10,635 sq mi

Board Overview and Members / Roles and Responsibilities

Members serving on the Southern Regional Behavioral Health Policy Board are community leaders, law enforcement, healthcare and treatment providers, family and peer advocates, and more. They bring diverse perspectives to the Board and are passionate about collaborating to improve the behavioral health system in the Southern Region. The board resumed meeting in June of 2023. The Board along with regional stakeholders and county behavioral health task groups and coalitions continue to develop a shared understanding of the behavioral health issues facing the region. The Southern Regional BH Policy Board has begun to learn more about the roles and responsibilities in addition to the connection to the Coordinator role and work. Shared goals are emerging in conjunction with local, regional, and state partners to identify and align priorities and solutions whenever possible. Through ongoing discussion and work, the SRBHPB members, shown below, will continue to examine the needs (gaps and barriers) and strengths and highlights to establish priorities and recommendations for the coming year(s).

Board Members

Chair: Dr. Kevin Osten-Garner, PsyD, Executive Director and Chief Psychologist, Adler Community Health Services
Vice Chair: Stacy Smith, CEO, NyE Communities Coalition
Boonn Hem, Certified Peer Recovery Support Specialist, Substance Misuse Specialist, CHW-I, Nye Communities Coalition
Assemblyman Gregory Hafen II, Legislator/ District 36
Missie Rowe, CEO/Administrator, Grover C. Dils Medical Center
Scott Lewis, Director of Nye County Emergency Management; Fire Chief, Pahrump Fire & Rescue
Sarah Dillard, Rural Program Director, Community Chest Inc.
Whitney Koch Owens, PsyD, Owner, The Evidence Based Practice of Nevada, PLLC
Coleen Lawrence, MSSL, EJD, President-Executive Director, Moxy Up
Brenda O’Neil, Health Manager, Duckwater Shoshone Tribe
Jaren Stanton, District Attorney, Mineral County
Lt. Harry Williams, Nye County Sheriff’s Office

Positions to Fill

Representative of law enforcement, with knowledge & experience with persons needing behavioral health services. Senate Majority Leader. Section 3, subsection (4)
Representative of residential treatment facility, transitional housing or other housing program serving persons with mental illness or who abuse alcohol or drugs. Section 3, subsection 8(b).

Overview of Board Role/Function/Duties

Advise the State on Needs, Issues, Gaps, and Priorities
Note Issues with Laws and Regulations and Make Recommendations
Information, Resources, and Service Delivery
Coordination and Improvements in Behavioral Health
Track-Compile Data and Outcomes / Reporting and Repository
Reporting to the State and Commission
Bill Draft Request and Legislation

Regional Assets, Strengths, and Highlights

There are two hospitals in this rural region that are significant partners and resources for the counties and the Mt. Grant General Hospital in Hawthorne provides primary care and emergency medical services in Mineral County for the surrounding area. The facility also provides inpatient care, emergency services, and diagnostic services, according to their website. They also run a skilled nursing facility and have local clinics nearby. Grover C. Dils Medical Center in Caliente (Lincoln County) also serves the region. They provide healthcare services and list a clinic in Alamo as well. They provide primary and emergency care with long-term care and there are health clinics nearby.
Tonopah has a free-standing health clinic run by a private provider. Although there is a “hospital group” meeting in Tonopah, there is currently no hospital in northern Nye County. Esmeralda County has no medical providers other than EMS and First Responders and periodic immunization clinics.
Desert View Hospital in Pahrump is outside the southern rural region but in southern Nye County and serves part of the region.
Mineral County has restarted the behavioral health task group with significant work on outlining goals around adults and seniors as well as youth and families. A summary of that planning can be found at https://nvbh.org/pdf-preview?id=5129. A survey of strengths and needs in individual counties has also been conducted. Mineral County also has several agencies doing significant local and regional work. This coordinator is integral and active in the mental and behavioral health work groups and committees in three of the four counties. Community Chest and Rural Clinics are key stakeholders in Mineral County.
The Southern Behavioral Health Region has significant strengths in the resolute and creative work of the individuals, coalitions, and other agencies that have a positive impact on the region. Nye County has a very robust coalition that is not only doing significant work in that county, but also outreaching to Lincoln and Esmeralda Counties. The Lincoln County Coalition is supported directly by Nye Communities Coalition (NyECC) with staff and board members on the ground in Lincoln. The region also has robust partners —- providers and agencies —– doing great work across the southern region and in counties outside the region.
Esmeralda County does not currently have significant resources or an official behavioral health work group; however, a year-long collaboration between and among local, regional, and state stakeholders and partners produced the Opioid Plan and Community Needs Assessment in addition to working on an emerging Specialty Court Project and a Rural Jail MOUD and Community Continuation of Care Initiative that is underway.
Three of the four counties have completed the Opioid Plan and Community Need Assessments, and Lincoln County is currently exploring that possibility.
Deflection and diversion programs are a high priority for the grant deliverables and this coordinator. This coordinator recently met with the Attorney General’s Office who requested a letter of support for the Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) national grant application for Nevada. We also discussed expanding the deflection and diversion work in the southern rural region.
FASTT and MOST Teams in Nye County – community-based justice and behavioral intervention along with Multi-Disciplinary Teams working in deflection and Lincoln County has begun to implement a Most Team. Three of the four counties have either implemented or started the process for the Virtual Community Care (VCC) Program (Avel Tablet Program) for crisis-related telehealth and support.
The presence of NAMI and other non-profits, agencies, and providers support the region virtually through telehealth and with in-person services such as rural clinics and other services.
Crisis Intervention Teams (CIT) and training continue to be a need for the region, and this aligns with state deliverables for the grant and coordinator. Earlier work has been completed in the counties laying the groundwork for continued training.
Regional Specialty Courts in the region are mostly adult drug Nye and Esmeralda both fall in the 5^th Judicial District which has one specialty court. Mineral County falls under the Western Region Specialty Court which manages a few of the rural areas. Lincoln County falls under the 7^th JD which has one specialty court. The southern region does not have any mental health courts.
Several tribes run health clinics and behavioral health work in the region, Moapa Paiute Tribe in Moapa, Nevada and Walker River Paiute Tribe in Schurz, Nevada. The Duckwater Shoshone Tribe also runs a health clinic among other behavioral health services.
This coordinator started a regional networking and support monthly group for peers, prevention substance use-misuse specialists, community health workers, and other staff to meet for support around their work in the region. A major focus has been supporting peers in health and wellness, stress and burnout, and self-care.
There are two harm reduction vending machines in the region that set a precedent in the state, especially for rural areas.

Opportunities and Needs (Gaps and Barriers)

Significant Regional Needs: Barriers and Gaps

Notable general lack of services for both youth and elder populations, especially awareness or knowledge of state programs across entire region. The work of 2023 included the development of the first behavioral health resource guide for the region which also included a comprehensive This guide and the distribution to over 100 stakeholders has been instrumental in meeting those needs and filling those gaps to help reduce the barriers.
Obviously, citizens in the southern region also utilize agencies and resources in the more urban areas of Clark and Washoe and surrounding counties and states as needed and when travel and transportation are available and feasible, yet the scarcity of resources and providers create a need to travel out of the region to access specialists in healthcare, more intensive behavioral health, crisis support and stabilization, and other services. Transportation complexities and scarcities around accessing medical and healthcare and mental health crisis transport all create major barriers.
Coordinated behavioral health crisis response and stabilization are ongoing needs. Although some parts of the region have a more developed response in this area, training and crisis planning needs continual development, coordination, and training that can support the region including supportive telehealth options. Some rural areas are also facing shortages of volunteer emergency personnel and first responders.
Although some areas have more fully implemented deflection and diversion, there is a need for developing and enhancing these community-and-jail-based initiatives around multi-disciplinary sectors; however, barriers with workforce, buy-in, resources, funding, and collaboration make this more challenging.
Although increased services around telehealth crisis and healthcare have broken down some barriers, there is still a need to connect these services with continuity of in-person care and continued development of on-the-ground care and services for those who have more serious ongoing needs and for transition to and from telehealth.
Lack of behavioral health workforce across southern region as well as recruitment, retention, and training of professionals also creates major concerns.
Need for improved access to behavioral health supportive housing and in-patient (residential) treatment for Serious Mental Illness (SMI), Opioid Use Disorder (OUD), and substance use disorder (SUD). Long waits for evaluations and intensive residential care are barriers to access. Sometimes patients must stay in local rural hospitals who are not equipped for behavior health support while the patients wait for evaluation and admission to other facilities outside the region.
Substance use-misuse and the need for increased prevention, educational programs, treatment and coordinated Some counties (schools and coalitions) do have grants, funding, and agency programming around these areas, but more is needed in other counties and sustainability in other areas. The extension office and other youth serving agencies do have a significant presence in the region, but these services are often not enough.
Need for increased harm reduction and resources around opioid misuse and preventing death and overdose. Some county coalitions and agencies are doing training on opioids including Narcan and Naloxone distribution. Deliverable for this grant seek to support and enhance these efforts.
Increased education and training around stigma, harm reduction, crisis intervention (CIT), emergency services, and other behavioral health areas are ongoing needs.

Transportation and Transport

Individuals and families travel long distances for work or more specialized care.
Taking time off for work and school, if it is even possible, creates issues.
Agency (law enforcement/EMS) transport residents to access general medical care, specialized services, and mental health crisis or residential/inpatient treatment.
Traveling long distances (out-of-county) requires personnel to be out-of-service or unavailable, understaffed, or paid overtime.
Two of four counties and some smaller communities and tribes have no hospital, emergency, and/or shopping/groceries nearby (50 plus miles).
Travelling long distances to urban areas for shopping and services also creates issues with financial concerns, time off work and school.

Youth and Family Opportunities

Local supports for guardianship process, adult and child protection, and foster care.
Increased parental engagement and family support.
Increased need for prevention programs, youth development, and school-based programs including licensed childcare and daycare centers and community-and-home-based services for all ages.
Increased use, transportation, and access to programs, services, and facilities.
Support for seniors and those with disabilities including community-home health
Support for tribal communities and veterans

Emerging Issues and Priorities

The Southern Regional Behavioral Health Policy Board resumed operations in June 2023. The following information aligns with current state and regional goals and objectives as well as information taken from the 2022-2023 Annual Reports. The coordinator and the board continue working together and with local and regional stakeholders to develop initiatives around local and regional needs and priorities. The SRBHPB will begin reviewing these and/or developing other priorities and initiatives in the coming year(s).

Three of the primary content areas the board will be working on are as follows: substance use/misuse prevention; mental health; and opioid response.

Overview of Priorities and Strategies

Continue understanding local and regional highlights and strengths, opportunities, and needs (gaps and barriers).
Continuing to develop strategies, priorities, and initiatives as they relate to the southern rural and frontier region and statewide behavioral health.
Implementing a direct impact and sustainable culture of concrete action and communication leading to tangible results (effective execution and follow-up).
Tiered Process based upon demographics (population thresholds) and nearby infrastructure in relation to various parts of the region
Developing and implementing outreach and education for the public and stakeholders.

Outreach and Education (inform/educate board/public)

Involving “public voice” and community stakeholders and partners.
Reducing barriers to public input and involvement.
Value-added benefit of a policy board for the public
More accessibility – social media to collect feedback to inform and educate the public.
Earning public trust and communications to demonstrate how board makes a difference.
Ways to remove barriers and increasing presence in the communities.
Provided updates at behavioral health and other community groups about policy board.
Examen historical context, communication, trust, and feedback issues, and impact in communities before moving into policy.

Emerging Issues

Transportation and Transport: Medical, Behavioral or Crisis

Resources and funding for rural outreach – infrastructure – creative options
Factors: reducing barriers of high caseloads, short staffing, large geographic distance in regions, and scarce services and limited resources and allocation; safety as a factor.
Availability of facilities issues in relation to transport – priority levels dictate urgency / access to hospitals, residential services, and facilities.
Summary of Process: “Medical necessity” – sheriff-EMS transport variables – lack of consistency in transport services – different protocols and procedures for each county- driven by medical necessity that drives reimbursement and levels of services – physical-medical treatment vs. emotional and behavioral health issue or both / fee for service and other payment issues and barriers – reimbursement and payment as restrictions or avenues to service and transport. Depends on where patient is originating from, and issue of mental health crisis holds (3-day) – decision for transport – responsibility for payment and sheriff or ambulance transport
Workforce and Staffing (hospitals, law enforcement, EMS, clinical, peers, CHWs): ,
Boomerang effect: high utilizing patients that continually cycle through the system

Crisis Response and Stabilization: rural and frontier – hospitals, facilities, and community.

Improve the capacity of local hospitals – addressing reimbursement services – noted overlap in transportation and transport above. Different options for transport.
Barriers and access to services – high risk factors
Discharge and transition planning and services – movement between levels
Stabilization and Treatment: establishing more outpatient care
Some areas do not have hospitals: telehealth and limited onsite services
Partnerships and creative collaboration are essential: local, regional resources & agencies.

Intake and assessment – earlier intervention – levels of care determined.
Local options – community-based options and short-term stabilization
Communication – utilization of local resources – meeting individuals where they are
Homelessness issue and difficulty with date and reporting
Prevention level services – upstream funding and programs

Access to Care and Services: barriers to insurance and care and other related issues

Any willing provider, paneling of providers / access issue – inaccuracy, not accepting patients, barriers – contributes to scarcity of providers.
Telehealth (virtual): limited or short-term solution vs. value of in-person care.

Training and education: crisis response, mental health, substance use-misuse, opioids, naloxone, Narcan, first responder-EMS, law enforcement. This relates to and supports other issues.

Youth, parenting support, family systems, and engagement: residential and community support and transition. Service complexities with guardianship concerns and funding.

Workforce Development (GOED): Community Health Workers, Peer Specialists, Clinical Staff, Certifications, and Licensing. This issue is related to barriers and access to care, transport, and crisis.

Courts and justice: specialty courts, mental health, deflection, and diversion

Data assessment and collection as a guiding focus: collection and reporting – issues, availability, barriers, and complexity. This issue is related to all other issues and cuts across lines.

Strategies and Recommendations

The coordinator and the board will work together in the coming year to collaborate with local and regional stakeholders and state partners to develop strategies and recommendations around local and regional needs and priorities. Initial strategies and recommendations are as follows:

General Recommendations and Strategies

Regular updates and distribution of the Southern Regional Behavioral Health Resource Guide (2023-2024). Increasing knowledge and support around statewide and community programs and resources which includes updating local and regional behavioral health resource guides keeping up with local providers and resources that connect with regional and statewide support.
Networking and building relationships with NRHP, board, hospitals, and local/regional/state/ tribal stakeholders.
Increase in data and resource review and collection to support reporting.
Ongoing review of strengths, needs, opportunities, barriers, and gaps.
Strategies, priorities, and recommendations on evidence-based models using action planning and collaborative systems.
Ongoing support of coalitions, behavioral health task and other groups.
Support and advocacy for increased funding, resources, staffing, and technical assistance for the southern region.
Continued improvement as a liaison between the community, board, and state.
Ongoing enhancement of behavioral health coordination in the southern region including mental health, opioid response, and substance use-misuse prevention.

Regional/Statewide Recommendations and Priorities

Increasing access to care and reducing barriers at all treatment levels
Renewing the need for a focus on transportation including decreasing barriers to accessing long distance care by building upon local resources, using existing and creative intervention as well as finding funding for necessary transportation and crisis transport around behavioral health.
Review the concerns and needs of the behavioral health workforce and work with local, regional, and state individuals and entities around retention, training, and support if
Support the development and implementation of effective and efficient use of telehealth and virtual services by supporting and connecting in-person, on-the-ground services in the region.
Examine the roles of community health workers and peer specialists and enhance the workforce and development in those sectors.
Continue advocating for supportive housing as well as state and national models around housing and homelessness in rural areas. This will include a review of social determinants of health and how they relate to housing and homeless needs and concerns.
Review, survey, and examine how supportive housing can be aligned with best practices for residents with behavioral health issues in the region.
Review existing regional crisis response systems including the need and support of developing or expanding those services and training in the region.
Review existing crisis intervention, response, and stabilization in other regions and states and bring new strategies for southern rural, frontier, and tribal areas
Continue evaluating existing and emerging deflection and diversion and programs like MOST and FASST and support funding and expansion for counties in the southern region.
Continue building relationships with behavioral health agencies, local and regional law enforcement, courts, and judicial staff including specialty courts.
Aid communities by providing resources, training, and technical
Increased harm reduction strategies and resources around opioid misuse, preventing death and overdose.
Supporting coalitions and agencies with training on Narcan as well as Naloxone distribution.

Resources, Services, and Data

A Southern Regional Behavioral Health Resource Guide (2023-2024) is in process to print and will be officially published and distributed both hard copy and electronically in August-September of 2023. A preliminary version of the guide can be found below and on the Publications and Reports section of this website on the following page

Southern Regional Behavioral Health Resource Guide (2023-2024) – Online Version

Southern Regional Resource Appendix: https://nvbh.org/pdf-preview?id=4963

Nevada Opioid Center of Excellence: Overdose Data to Action Program (OD2A) – https://nvopioidresponse.org/initiatives/od2a/

Regional Resources

Community Chest: https://communitychestnevada.net/

Nye County

Nye County Communities Coalition: https://nyecc.org/

Resource Directory – 2022-2024 (see Southern Region Documents and Publications)

Food Pantry List – 2023 (see Southern Region Documents and Publications)

Lincoln County

Lincoln County Coalition: https://lccoalition.org/

Lincoln County Resource Guide: https://drive.google.com/file/d/1808JQg1epwnyx0-3GKZ9YkfwsJpsWpt0/view?usp=sharing

Mineral County

Mineral County Resources – see Southern Region Documents and Publications

Esmeralda County

Senior Transportation (Goldfield)

Director Maureen Glennen
Email: mglennen@esmeraldacountynv.org
Clerk Email: ncolunga@esmeraldacountynv.org
Address: 403 W. Crook Ave, Courthouse, 2nd Floor; Goldfield, NV 89013 / Phone: 775-485-3406
Website: https://www.accessesmeralda.com/county_offices/senior_transportation.php

Commodities

This resource in Esmeralda County is a joint effort with 3 Square of Las Vegas. The resource includes two deliveries of food including frozen and fresh: fruits, vegetables, meats, canned & boxed goods. This food is distributed to volunteers of the other unincorporated towns (Gold Point, Silver Peak, and Fish Lake Valley, and then the food is delivered to local families. The distribution happens the first Wednesday and third Monday (barring holidays). Anyone who meets the income requirements may contact the Commissioner’s Office for an application and times for distribution in their area.

Pickup Locations

Goldfield: Commodities Barn on Euclid across from the Fire Barn (Noon-1:00 pm)
Fish Lake Valley: Community Center (2:15 to 3:15 pm)
Silver Peak: Library (11:00 to 12:00 pm)
Gold Point: Delivers to the 6 residents there as soon as she gets back to Gold Point (10-10:30 am)

State and National Resources and Data

Regional Behavioral Health Policy Board data dashboard at https://nvbh.org/dashboard//.
Behavioral Health Wellness and Prevention 2022 Epidemiologic Profile: Southern Region – April 2023
Nevada Youth Risk Behavior Surveillance System: https://www.unr.edu/public-health/research-activities/nevada-youth-risk-behavior-survey (2021 High School and Middle School Reports)
Nevada Rural and Frontier Health Data Book: https://med.unr.edu/statewide/reports-and-publications/nevada-rural-and-frontier-health-data-book
Nevada Overdose Data to Action Program (Opioids): https://nvopioidresponse.org/initiatives/od2a/
State Unintentional Drug Overdose Reporting System (Infographic Washoe, Clark, and Statewide for 2022). Available at the following link.
Drug Overdose Surveillance Epidemiology (DOSE) reports that include data on emergency department visits related to overdose in Nevada at the following link: https://nvopioidresponse.org/initiatives/od2a/. Statewide and regional reports for 2020-2023 will be listed when and if available. Contacts: ernst@health.nv.gov and (tlensch@unr.edu).

Nevada 211: https://www.nevada211.org/

https://988lifeline.org/

Nevada Recovery Resource Hub: https://forrecovery.org/resources/

https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-dashboards/?State=Nevada

NAMI

Warmline: https://namiwesternnevada.org/resources/nevada-warmline/

Tee Peer Support Text Line: https://namiwesternnevada.org/resources/nevada-teen-peer-support-text-line/

Caring Contacts: https://namiwesternnevada.org/resources/nevada-caring-contacts/

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Nevada Statewide

Rural Behavioral
Health Region

Washoe Behavioral
Health Region

Northern Behavioral
Health Region

Southern Behavioral
Health Region

Clark Behavioral
Health Region

CALENDAR OF EVENTS

december, 2024

Publications and Reports

Group	Name	Region	Date	Download
Board Meeting	Southern Regional Behavioral Health Policy Board Agenda – 010825	Southern	12/20/2024	Preview Download
Data	Youth Experiencing Homelessness Project – Preliminary Statewide System Map, 2024	Southern	12/09/2024	Preview Download
Legislation	AB31 Overview Presentation – December 2024	Southern	12/09/2024	Preview Download
Resources	Report on Safer Social Media and Online Platform Use for Youth	Southern	12/05/2024	Preview Download
Data	Nevada Hospital Surveillance Overdose Report – Q3 2024	Southern	12/03/2024	Preview Download
Resources	Guide to Resource Mapping and Assessing Community Needs – November 2024	National, Southern	11/21/2024	Preview Download
Resources	Foundational Public Health Services in Nevada	Nevada Statewide, Southern	11/21/2024	Preview Download