This week on Nevada Week we examine how well Nevada has implemented a new national hotline for Suicide Prevention, plus how a grant is helping law enforcement in rural Nevada respond to mental health crises.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt.

Welcome to Nevada Week.

I'm Amber Renee Dixon.

July 16th is when the National Suicide Prevention Lifeline transitioned to the simpler and easier to remember three-digit number, 9-8-8.

The Substance Abuse and Mental Health Services Administration says it sees 9-8-8 as, quote, a first step towards a transformed crisis care system in America, end quote; however, local experts acknowledge the system is not perfect.

Joining us to talk about Nevada's 9-8-8 rollout is Misty Vaughan Allen, Suicide Prevention Coordinator with the Nevada Department of Health and Human Services.

Misty, thank you for joining us.

-Thank you so much for having me during Suicide Prevention Awareness Week.

-So the number is certainly easier to remember, but what is different about this than the Suicide Prevention Lifeline prior?

-I think the main difference really is that when someone's in a mental health crisis or having thoughts of suicide, they're overwhelmed.

And having three simple digits to remember, with 9-8-8, will really relieve some of that extra stress and encourage people to reach out for help.

-It is a national hotline, yet when we're talking about Nevada implementing it, how much responsibility is in the state's hands to implement this?

-We've been working for years in preparation of this.

So it's definitely with great leadership from from the state.

But partnerships from Crisis Support Services of Nevada, who's been answering the calls since the 1960s-- so over 50 years --and then you need law enforcement participation and community providers.

So they have been working on every different aspect of implementation for years.

So it's definitely a team effort.

-And how much is it on the state to implement it, as opposed to the federal government telling you this is what you have to do?

-The state met with stakeholders to come up with implementation plans.

We need to hear the concerns from our partners, especially those in communities of color in our more rural communities, law enforcement, to make sure we iron out any concerns as this continues to develop.

-All right.

From what I understand, each state is in different levels of readiness to implement this.

Would you agree with that?

-Absolutely.

The federal government did support the planning and implementation for states.

Almost every state did apply for that.

But now it's in our responsibility to sustain the funding and the planning.

It's not just 9-8-8.

That is the first response and part of a crisis response system.

But now we continue to build out the other pieces of a very comprehensive crisis response system.

-While we're on that topic, what is that buildout?

What does it look like, and what's the ultimate purpose?

-The ultimate purpose is to make sure that when someone is reaching out for support, or a loved one is seeking help for their person they're worried about, that there is a person to pick up that call and de-escalate the crisis; that there is 24/7 mobile crisis response if a higher level of care might be needed.

And then, ultimately, there should be crisis stabilization units to de-escalate, again, in a very trauma-informed, peer-supported system.

That makes help seeking safer, less traumatic, and more supportive for everyone.

It's really important to have that ongoing follow-up and connection to care.

-The crisis stabilization centers, that would operate similar to an emergency room but for mental healthcare needs.

Where does Nevada stand in having one of those or several?

-They're in the process of building.

The State has a new crisis unit, where we have people focused on 9-8-8 implementation.

We have other people focused on crisis stabilization centers.

And then further teams focused on that mobile crisis response.

And then that unit is working together overall.

So there has been incredible funding supported by the governor to work with building up the mobile crisis response, because that does need to be 24/7 and across the state to really be effective in supporting those that reach out to 9-8-8.

So we're in different levels of the development.

It's going to be a long time in the making, because these are huge paradigm shifts for our state.

-Could you put a timeline on when there may be that crisis stabilization center that people could really actually physically go to?

-I do not have the details of a timeline.

I could get that for you to follow up.

But currently, we have a Community Behavioral Health Centers that can serve purposes of de-escalating someone in crisis.

The wonderful thing about 9-8-8, these are well-trained crisis counselors who are able to de-escalate the vast majority of crises or suicide situations just by listening.

They are well trained to listen, de-escalate about 80 to 90% of those calls.

That leaves more space for those that might have a higher level of need that can then be transported to the community care that's out there.

-And I do want to get back to the training aspect you mentioned.

But when this was launched on July 16th, the National Alliance on Mental Illness-- No.

Excuse me.

The substance abuse that I had mentioned earlier, they had listed that there was a 45% increase in need of people seeking help after the first week of the launch.

What has Nevada experienced as far as need or increase in need?

-I think nationally, they were seeing about a 30% increase in in-call volume.

And they have been able to respond to 90% of those really rapidly, within 14 seconds, which is remarkable.

Nevada has seen that uptick initially, but then it slowed down.

So it definitely is in waves here in Nevada, with probably 15 to 20% increase because of the ease in access.

And they are responding with in-state calls about 80% of the time, because Crisis Support Services is a regional backup center.

They do get calls from all over the nation, but they definitely have the focus of Nevada callers and Nevadans who call in.

And that response is within 15 to 16 seconds, which is outstanding.

That shows the workforce has been built up properly to meet the demand.

-The organization that I was mentioning, the Substance Abuse and Mental Health Services Administration.

That was what I was referring to.

-Yes.

-Okay.

So then there is an increase-- There was an increase in demand, and how well do you think Nevada has been prepared to respond to that?

-I think Nevada is one of the states leading the way.

We are well prepared to respond.

As I mentioned, we had been preparing for years for this implementation.

So they had build up of staff, paid staff, a build up of volunteers, they are able to train remotely.

COVID enabled us to get very creative with training our call responders so they can have call responders across the state.

And I think you can call 9-8-8, text, or chat.

And all of those options are really meant to meet that person in crisis where they're at, what is most comfortable for them.

And I think the speed with 15 to 16 seconds is really telling that we were prepared, well prepared.

-And that would certainly be an increase from what you listed in your grant proposal to the federal government, which was 35 seconds.

That was your average response time.

And you had also mentioned in that grant proposal that your answer rates were 74 1/2%.

Did you say they're now at 80%?

-They're now at 80%.

And that's with the initial rollout.

So know that that's just going to keep improving as we continue to build that staff and resources and then the whole system, as I mentioned, as a whole will continue to improve that answer rate.

-What happens when a call is not answered, that other 20% of the time?

-The network for 9-8-8, it is a network of centers who are all staffed by well-trained crisis counselors.

So it would roll-- It is designed to roll to that next center that might not be as busy.

That was the intention, and Crisis Support Services of Nevada is one of a handful of centers across the nation that does serve as that backup center.

-Okay.

So then-- -So there would be another well-trained person to answer that call.

-And would that person be in Nevada, or perhaps out of state?

-Not necessarily.

And one of the challenges with 9-8-8 is, it routes you to the center, according to your zip code-- I'm sorry.

According to your area code.

And so many people keep their cell phone area code no matter where they live.

So if you are from New York living in Nevada, it's going to route you to a New York Center.

And vice versa, if a Nevadan is somewhere else but they have their 7-7-5, it would route to Nevada's centers.

Again, these responders are well trained to de-escalate the crisis.

They are able to utilize internet for resources and referrals.

So that system will still help the person in need.

-When we spoke with Sheldon Jacobs, he's vice president on the National Alliance on Mental Illness, Southern Nevada Board of Directors, he had mentioned, one of the concerns he's hearing is that these are not always licensed counselors or therapists who are answering the phone calls.

And so they may not be responding in the most appropriate manner.

But have you heard any of those concerns?

-That is correct.

I started my career answering and training the volunteers on the hotline.

They are not intended to be clinical support; they are intended to be crisis response personnel.

So they are trained in over 70 to 80 hours of crisis training, referral, and information across a broad spectrum of issues from child abuse, elder abuse, substance abuse.

So they are multifaceted, but they also know that crisis de-escalation model.

Then their real skills are listening, hearing what has brought that person to crisis and to the pain, and then developing a safety plan with that person to connect them not only to keep themselves safe, but also to whatever next steps for support they might need, be it a community referral or a clinical resource.

-Have you heard any of those concerns, though, about how they are responding?

-I have not.

I think 9-8-8 has really prepared people, well trained.

Again, state by state, it could be very different.

Each responder can be very unique, but I feel people come to the work because of their lived experience.

And that's really powerful when you're listening to someone else who might be going through a challenging time or having that crisis of suicide.

-Very much so.

Some of the other concerns have been that a police officer might show up, law enforcement might show up, or an involuntary hospitalization.

How often is that happening in Nevada when someone calls 9-8-8?

-I will tell you 80 to 90%, as I mentioned, are de-escalated just by that process of well-skilled listening, and then they're connected to referrals and resources.

And you don't have to be a person in crisis to reach out.

You can be that family member or friend who wants to help their loved one, which is really a powerful connection.

Then you have another group that might need more support.

And we would say, Would you like to be connected to resources for help as far as emergency, you might need a higher level of care.

About 1 to 2% are at that place where the hotline needs to connect them to law enforcement or first responders.

That is only when we don't see any other way to keep them from harming themselves or others; 1 to 2% of all calls might need that care.

And a welfare check doesn't necessarily mean anything involuntarily.

It could be they're just checking up to make sure that they are safe and they have a plan to get safe.

So that would be emergency services.

And that's only when it's absolutely necessary.

-In the future, you're hoping it would not be emergency services, but the mobile crisis response unit, correct?

-Ideally, that would be the goal, but sometimes a mental health crisis is a health crisis.

And so an ambulance response, EMT, is the most appropriate response, especially maybe someone has already taken steps to attempt suicide.

That would be the mandatory choice we would have to make, but the vast majority of those, we want to empower them to be able to de-escalate and keep themselves safe.

That's the goal.

-Lastly, for anyone who may be on the fence about calling 9-8-8, what would your message to them be?

-It is an absolutely effective method for getting yourself support and keeping safe.

We often don't feel seen and heard, and here you have an anonymous and confidential person willing to listen and really help you figure out what are the next best steps for you to keep safe.

I think 9-8-8 separates from the 9-1-1 response.

That was an important intention.

And so if you are worried about a friend, a loved one, or yourself, it is such a great opportunity to be heard and to be connected to the appropriate resources.

-Misty Vaughan Allen, with the Nevada Department of Health and Human Services, thank you so much for your time.

-Thank you for having me.

Take care.

-And that department recently learned it would receive a $3.8 million grant to launch a South Dakota pilot program here in Nevada.

The virtual Crisis Care Program will provide 11 law enforcement agencies in Nevada's rural areas with tablets which officers will then use to connect someone experiencing a mental health crisis to a behavioral health professional.

The Helmsley Charitable Trust is behind the grant; and one of its trustees, Walter Panzirer, a former police officer in South Dakota, spoke with Nevada Week about the need behind the Virtual Crisis Care program.

(Walter Panzirer) Every day, sheriff's departments across the state come in contact with people experiencing extreme mental crises.

And what this Virtual Crisis Care program does, it gives the sheriff's departments tools to better handle the individuals and de-escalate the situation and make the right choices out in the field.

-So what does it look like?

Sheriff's or someone with the Police Department will go out, come in contact with someone who's in a mental health crisis, and what happens after that?

-What happens, typically the Sheriff's Department and the City Police Departments are given these iPads that are loaded up immediately to a trained team of interventionalists.

These people have different qualifications; some are psychologists, some are other trained folks in the mental health field.

And at a touch of a button, after the situation is de-escalated, they give the iPad to the individual; and the mental health team then interacts face-to-face with the individual on scene at their own home sometimes, sometimes at a police station, wherever the crisis is occurring.

And the mental health team can talk with the individuals and come up with a plan.

Sometimes that plan might be taking the person to a mental health care facility.

Sometimes it's more de-escalations and tying them into care within the community.

So it's a great tool for the Police Department where traditionally, the decision whether you go to a mental health institution, voluntary or involuntary, was made by the Police Department.

Now the Police Department has a tool to use, trained individuals who are experts in mental health to help make those decisions.

-You have been a police officer yourself.

In your opinion, is that a decision a police officer should be making, whether to take someone to a mental health institution?

-Well, it's not necessarily a decision that they should be making; they have to make that decision because it's a life safety issue.

And at two o'clock in the morning, there are no other services, especially when you even get into rural areas.

Sometimes during the day, there isn't any services.

But the police officers-- and I can say, because I was one of them --don't always have all the training and the knowledge to make those split second decisions, but they have to make it.

So they tend to err on the side of safety and generally transport people to these facilities where they might not need it.

-And where were you a police officer?

-I was a police officer in Sturgis, South Dakota and Mitchell, South Dakota for about 10 years.

-And so you were working in rural areas, mostly?

-Yeah, very rural areas.

Sturgis, South Dakota was about 6,000 people.

Mitchell was a hair bigger.

And we had contact with people having mental crisises back then, almost on every shift.

-And I bring that up because this program focuses on rural areas only.

And when you announced this $3.8 million grant from the Helmsley Charitable Trust, there were a couple of Nevada law enforcement officials who spoke about the need for a program like this, what they're currently facing.

Let's take a listen.

(Kerry Lee) Our problem-- And just a little bit about Lincoln County is we're almost 11,000 square miles.

So we're three hours from Las Vegas, seven hours from Reno.

So if we're going to go get any services-- and that's one direction, that's one-way.

If we're gonna go get any services, I mean, you can see that it's huge for us.

And right now, if we have a person that is L2K'd for a mental evaluation, I could be taking my one and only patrol officer off the street to do a six- to eight- to 10-hour transport.

That's if there's no issues at the hospital.

We've been turned away before.

(Ty Trouten) Because we don't have a full spectrum of resources available, a lot of times it's the lowest common denominator.

If we have to take someone to a hospital, it could be an ER room nurse that does an evaluation on someone.

Again, they're busy people, they're not specifically trained in this, and they don't spend the time to kind of build the rapport with these folks, learn about them, and get the true story.

And, unfortunately, we've had people who are taken for evaluation, they're held for a short period of time.

There is an evaluation that occurs, but they're then released from the hospital or another provider, given a single sheet with some other providers here in the area, and told to reach out and schedule an appointment.

And, unfortunately, they will go home and complete a suicide.

-It's such a sad scenario.

And you had talked about the decision whether to take someone to a mental health institution, but there really aren't many of those.

So you often are going to hospitals that are not equipped for this type of issue.

-Exactly.

A lot of times the initial contact may be in the hospital.

The hospitals generally aren't equipped with mental healthcare teams.

Some of them in the larger cities are, but the majority aren't.

So it really puts a strain on the entire community and the patient too, because the individual having the crisis isn't being seen in an adequate time.

-And it can put a strain on the jails as well.

But if someone is committing a crime, they are gonna get arrested, correct?

-Absolutely.

This isn't taking away from people that are committing crimes or anything.

Those people face the Justice System.

I like to say that mental health, if someone's in a mental health crisis, that's the only healthcare condition that you can be arrested for and put in jail.

Just think about that.

You don't go to jail for a heart attack.

You don't go to jail for a stroke.

But a lot of times these people end up incarcerated for just being-- having mental health problems.

-Some of the officers that we heard from and the Sheriff's Office spoke about, the crucial aspect of this is it's not just that initial call.

That initial call, who is answering that on the iPad?

-The initial call, it's a team out of South Dakota.

It's called Avail, they're telemedicine team.

And they are a team of physicians, doctors, nurses, other types of clinicians, psychologists.

Those are the types of people that are answering that.

-So it's in South Dakota; but then the follow-up, that has to be local, right?

-The follow-up is 100% local.

The reason they were selected-- First of all, it was done with an open bid with the state.

But they have the qualifications.

They have run this program in South Dakota, they are one of the largest telemedicine providers in the nation.

-Wow.

And so it's a pilot program in South Dakota.

How well did it do?

has it done?

is it doing?

-It's still ongoing.

It's actually expanded in South Dakota, which is super exciting.

And just to give a little perspective: Out of all the encounters, 80% of the individuals having an encounter-- a mental health encounter --with this iPad program, do not get transported to the hospital.

-Wow.

-They have care found in town.

So that's huge when you're talking about saving resources for the communities, saving the time of a deputy, making many hours of transport.

And the people are getting treated at home, which is huge.

And the follow-up on that, they have seen 50% less recall.

So there's 50% less recidivism calls of the same event, individual getting help, needing help.

So this means it's working.

-And perhaps that's connected to that crucial follow-up aspect.

Last question: How was Nevada so lucky to get this pilot program?

-Well, this has been great for Nevada.

Nevada actually came to the Trust.

Folks from Nevada heard about what was going on in South Dakota and expressed interest, and that's when my team started, and myself started dialoguing with the State.

We started off with, of course, with the governor's office, Governor Sisolak, Chief Justice Hardesty, who expressed very strong interest on this program and even talked on the local areas.

We were very happy that Sheriff Lombardo saw very much of a need for this type of program in the rural areas of Clark County.

Most people don't think Clark County has rural areas.

But you get out towards Mesquite, you get out towards Boulder City and Indian Springs, and stuff like that, it gets very rural very quick.

-So areas that Metro has to oversee?

-Still Metro oversees.

So we got buy-in from across the state.

And that's the key thing: This isn't just a Republican or Democrat thing.

This isn't a small-town, big-town thing.

This is a problem across the state, and everybody's seen that this could be one of the answers to the problem.

This isn't a magic silver bullet that will end mental healthcare problems, but this is something that's going to actually move the needle and make a difference for especially those people who choose to reside in rural Nevada.

-It is a start.

Walter Panzirer, thank you for coming on.

We are going to have you on Nevada Week In Person on September 17th at 6:30 p.m. We'll be talking about the Trust that you oversee, the Helmsley Charitable Trust, which is connected to your infamous grandmother, Leona Helmsley, nicknamed "the Queen of Mean" by the media, but I imagine you have a different perspective.

Look forward to that.

Thank you for your time.

-Thank you.

-And thank you for watching Nevada Week.

If you or someone you know is in crisis, there is help available.

Call or text 9-8-8.

We also have additional resources on our website.

Visit vegaspbs.org/nevadaweek for several links to mental health and suicide prevention services.

And I will see you next week on Nevada Week.

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