Nevada typically does not rank well when it comes to available mental health services in the state.
Mental Health America compiles an annual, comprehensive list of how well each state handles mental health challenges, primarily through access to care and percentage of people with unmet care.
Last year, Nevada ranked last on that list.
Lack of housing, substance abuse and low numbers of licensed professionals don’t help the matter. Now, many Nevadans are facing either a loss of insurance or a loss of Medicaid with health care on the federal chopping block.
The situation seems grim, but there are some working to turn it around.
"In the years I've been here, things have certainly gotten better," said Lesley Dickson, explaining that UNLV's new medical school has helped land psychiatry residents in Las Vegas. "...but we're still playing a lot of catch up."
There are seven psychiatrists per 100,000 residents in Nevada. For comparison, Massachusetts has 30 per 100,000. But the situation isn't necessarily unique to Nevada.
"Most of the states out here in the West have a real problem," Dickson said.
The problem is twofold. One, Dickson said, is the stigma that still is associated with mental illness, making it an unpopular field. Two is the reimbursement and pay for professionals, which is relatively low in Nevada compared to other states.
The Nevada Psychiatric Association is a professional organization, one that pushed back against Governor Brian Sandoval's budget proposal during the legislative session for proposing cuts to mental health services.
"A lot of the legislators heard the message and they did restore some of the cuts to the budget," Dickson said.
If Medicaid coverage is scaled back, however, it could mean a dire situation for those seeking care for their mental illnesses.
Can the state pick up the slack if the federal dollars are pulled?
"It's not looking good," Dickson said.
Lesley Dickson, executive director, Nevada Psychiatric Association; medical director, Center for Behavioral Health