Nevada’s mental health care system was already in dire straits. The carnage in Las Vegas will strain it more

LAS VEGAS — The volunteer psychologists and counselors have been pouring into this grieving city, so fast that a state official says the supply far exceeds the demand for crisis counseling.

But a worrisome question looms: What happens when the volunteers go home?

Nevada’s mental health system was already overstretched before the carnage on Sunday night at a country music festival here. Now, thousands of victims, survivors, and their loved ones — as well as first responders and local workers who witnessed the horror — are expected to need mental health services in the coming weeks and months.

“It’s certainly going to take us above and beyond what we were already capable of managing before, which was: We were barely making it,” said Michelle Paul, a clinical psychologist who directs a mental health care clinic at the University of Nevada, Las Vegas.

“I hope we have the resources to support the needs of our community,” Paul said. “I can’t say that we will. I just don’t know.”

Nevada ranked last in the U.S. by measures of access to mental health care in a report released last year by the nonprofit group Mental Health America. Mental health professionals in the state said they’re routinely forced to turn patients away or add them to the end of long waiting lists.

The state has fewer psychiatrists per capita than all but three other states. And aside from a few patches of Clark County, everyone in the state lives in an area that’s been federally designated as having a shortage of mental health professionals, according to an analysis released in March by researchers at the University of Nevada, Reno.

“I think this crisis and now this surge in short-term demand for mental health services will place a lot of stress on the pretty thin, poorly resourced system that we have currently,” said Nancy Brune, executive director of the Kenny Guinn Center for Policy Priorities, a think tank that has analyzed the state’s mental health infrastructure and made recommendations about how to address it.

Flying in from Michigan, ready to help

The morning after Stephen Paddock fatally shot 59 people and injured more than 500 in bursts of gunfire from his room on the 32nd floor of the Mandalay Bay Resort and Casino, the mental health response was already beginning on the ground floor.

Tucked in a small room down a corridor in Mandalay Bay’s attached conference center, crisis counselors were on the job, sitting around tables stocked with plenty of tissues.

Those sessions were part of a rapid-response scramble among mental health providers that would play out in the first 48 hours after the shooting.

Also on Monday, Mandalay Bay put out a call asking certified trauma counselors to report to Circus Circus Las Vegas, another MGM-owned resort — before saying a few hours later that enough counselors had answered the call.

Some of the volunteers were local. Others traveled hours to help.

UnitedHealth Group dispatched more than 60 mental health professionals affiliated with its Optum unit to workplaces around Las Vegas, including all of MGM’s properties, a hospital, two fire stations, and Cirque du Soleil — and plans to cover the cost of counseling sessions for some people in crisis.

Jeff Gorter, a licensed master social worker affiliated with Optum, flew to Las Vegas on Monday night and has spent the last few days seeing people affected by the shooting.

“Part of what we’re doing is simply helping them to interpret [their reaction] correctly and identify some self-care and coping skills that they can enact in the short and long term,” said Gorter, who is from Michigan.

The result of all this mobilization? Amy Roukie, a spokeswoman for Nevada’s Division of Public and Behavioral Health, said in an email on Tuesday afternoon that “there are many more volunteers offering their services to address the community needs for mental/ behavioral health needs, [than] there are actual requests for assistance.”

A dire shortage of psychiatrists

Many of the fans attending the concert had traveled from out of state and are expected to seek mental health services near their homes. But many others affected by the shooting are Nevada residents.

Their mental health needs in the coming weeks and months will vary, experts said. Some may do fine with just the support of their loved ones and a restoration of their normal routine. Others may need psychiatric interventions. And those diagnosed with post-traumatic stress disorder will need intensive therapy.

For Nevada to meet their needs, experts say, it’s going to take some creative solutions.

Nevada has just 190 licensed psychiatrists (6 per 100,000 residents, 47th among U.S. states) and just 390 psychologists (13 per 100,000 residents, 38th among U.S. states), according to a count last year.

And many counselors in the area specialize in the trademark Las Vegas vices of alcohol, drugs, and gambling — and are unlikely to be trained in responding to a trauma like the Mandalay Bay shooting.

Budgets for several mental health programs in Nevada were slashed in the years after the recession. And the state has had trouble filling some jobs in mental health services.

But advocates see some positive signs. State lawmakers this year rejected sharp cuts to mental health funding proposed by Gov. Brian Sandoval and restored funding to some programs. They also passed several measures aimed at making it easier for people to access mental health care and smoothing the path for professionals to get licensed.

Those changes could help in the current crisis. It won’t be easy, though. Jordan Soper, a Las Vegas area psychologist who’s the executive board secretary for the Nevada Psychological Association said, “A lot of us are going to be working overtime. I can almost guarantee that.”