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As the first week of school comes to a close with a shortage of nearly 3,000 teachers in the state, Nevada faces another staffing shortage in its education system — mental health professionals. 

The state would need 35 times as many school social workers, 3.7 times as many school psychologists and twice as many school counselors to be at the recommended ratio for the student population, according to a report on improving access to behavioral health care from the Department of Health and Human Services to a legislative joint interim committee in July. 

The staff shortage is a problem in schools nationally — no states meet the recommended ratio of social workers to students, for instance, and the ratio in Nevada is comparable to that in Iowa, Idaho, Oregon, and Utah, according to the Hopeful Futures Campaign’s School Mental Health Report Card. But in Connecticut, Illinois, Maine, Minnesota, New Jersey, New Mexico, New York, North Dakota, Rhode Island, and Wyoming, the number of students per social worker is less than 1,000.

Mental health staffing shortages limit schools to reacting to behavioral health crises and not preventing them, said Christy McGill, the director for the Office for a Safe and Respectful Learning Environment at Nevada Department of Education. 

“Really what you want is a system that does prevention and intervention,” she said. “When you do those two things together you are reducing the amount of required services at school.”

Nevada struggles with two issues that cause a shortage of mental and behavioral health care professionals: a lack of qualified licensed providers, and barriers to access to the providers that do exist because of affordability, according to the Division of Child and Family Services. 

‘You can’t build a workforce is you don’t have a budget’

The COVID-19 pandemic exacerbated the need for mental health professionals in schools in a state that, according to the nonprofit Mental Health America’s annual rankings, is dead last in the nation for youth mental health. The rankings are based on the state’s higher prevalence of mental illness among youth, and lower rates of access to care.

“We’re in the mental health component of the pandemic right now and we need to deal with that immediately by getting more hands into the district,” said McGill. 

Efforts were underway in the state to build a better crisis response continuum prior to the pandemic, but the increased need allowed the state to leverage American Rescue Plan Act (ARPA) funding to implement new best practices. 

More than $45 million in proposals to support the state’s child system of health care will be reviewed in the legislative Interim Finance Committee’s meeting on Aug. 17, including $3.4 million to the Division of Child and Family Services Mobile Crisis Response Teams. The mobile teams allow youth and their families in urgent need of care to be stabilized. The funding would allow the teams to support Clark County and Washoe County school districts and the Nevada Department of Education after school hours, when school-based mental health professionals are not available.  

While the proposal will help with the immediate needs of students in crisis, it won’t address the larger issue at hand — Clark County School District (CCSD), the fifth largest in the nation, has about 185 school psychologists, 700 school counselors and 195 social workers to support approximately 305,000 students.

The Nevada State Board of Education adopted recommended ratios based on national best standards in April 2020 — those ratios are one school psychologist per 500 students, one school counselor per 250 students, and one school social worker per 250 students. 

CCSD currently has one psychologist per 1,649 students, one school counselor per 436 students and one school social worker per 1,538 students, based on data provided by the district. 

Building a system of care to prevent crises from happening in schools will take years and an increase in funding for mental health systems and infrastructure, while simultaneously creating a pipeline to move Nevadans interested in behavioral health care professions into the workforce, said McGill.

“You can’t build a workforce if you don’t have a budget, so it feels like an overwhelming issue, but there are some bright points,” McGill said. “One of those bright points is that Nevada is poised to start billing Medicaid for these services.” 

Two years ago, Nevada expanded their state plan amendment allowing Medicaid funding to unfold, but the state has to build the infrastructure to get parental consent, write care plans and monitor the progress of care for the students. 

The initiative is still in its infancy, but in the meantime, CCSD plans to pilot a program to bill Medicaid for behavioral health this year, said McGill.  

The pilot program will allow the state to bill for behavioral health services in schools that are eligible, instead of relying on just normal education funding streams. 

Districts would then be able to use freed up education funds to hire more school counselors and other mental health professionals and and come closer to meeting recommended staffing ratios, McGill said. 

“It will take several years, but there’s hope. There’s a lot of federal support for the billing of Medicaid in schools and increasing school based health,” she said. “If kids can’t get to school because of their debates or their mental health or something of that sort and we don’t have the proper providers and support in schools, it becomes an inequitable system.” 

Small state equals big opportunity?

To combat the other piece of the workforce shortage — getting enough people into the profession — the Nevada Department of Education contracts with institutions like University of Nevada Las Vegas and Nevada State College and the high school districts among others  to “grow your own” workforce, McGill said. 

The districts are using dual credits for the students interested in behavioral and mental health service professions to create a pipeline from Nevada high schools into Nevada universities. The universities and colleges offer paid internships, respecialization plans and more. “We will start building the workforce to meet the needs of the schools,” she said. “We’ve got a long way to go but I think we are a small enough state that I think we can start to make differences if we start to close those gaps.”