Almost three months after the mass shooting on the Strip, employers and policymakers are still working to address the shortage of resources for counseling needs of victims and their loved ones, eyewitnesses, first responders and other members of the community.
Given the national dearth of mental health care providers — a scarcity which is acute in Nevada — this concern was particularly daunting. But immediate, temporary relief was available to some residents in the form of increased access to employee assistance programs (EAPs), according to Yeraldin Deavila, public information officer for the Nevada Division of Insurance.
“Nevada employers, particularly many of the casino-resorts, offer employee assistance programs, which provide certain free, limited benefits to address issues that may affect employees at their jobs,” Deavila said.
Under Nevada law, the number of counseling sessions under an EAP was limited to no more than three within a six-month period.
“Due to increased demand for counseling services after the Oct. 1 shooting, employers indicated that three counseling sessions may not be sufficient while employees transition to counseling under their insurance plans,” Deavila said.
To that end, the Nevada Division of Insurance proposed an emergency regulation that allows employees to access up to six sessions of counseling through their EAP within a six-month period. This emergency measure was approved by Gov. Brian Sandoval and adopted Oct. 6.
“This emergency regulation will provide help sooner to restore health and functionality of employees and family members in Las Vegas,” said Barbara Richardson, commissioner of insurance with the Nevada Division of Insurance. “It will allow EAPs to provide more frequent interventions to help employees and family members heal from pain inflicted by this most disturbing and despicable assault on our community.”
In a memo to Sandoval, Richardson said additional mental health services were needed to ensure employees and family members could receive the support they need until they are able to transition into mental health care, if necessary, through their insurance plan.
Michael Dillon Jr., a health care reform expert and employee benefits broker with Dillon Health, said this use of resources would help get the community through this crisis, and recommended that employers consider adding EAPs to their overall benefits package in the future.
“These are usually inexpensive, and some primary and ancillary carriers offer this group health insurance product,” Dillon said. “Employees can receive expert support services to assist them and their families with a variety of life issues such as family care, stress, depression or addiction.
“Not only would employers be providing a program that employees appreciate, they would also be helping to ensure a productive workplace. In today’s environment, addressing work-life balance issues is more important than ever.”
In terms of counseling services covered by insurance companies, Dillon said that under the essential health benefits provisions of the Affordable Care Act, mental health benefits were usually clearly defined.
“The key is to finding out how your insurance plan covers counseling,” he said. “Typically, outpatient hospital programs, residential treatment programs and inpatient services for mental health will require prior authorization from the insurance provider. Mental health office visits that are not part of a mental health treatment program may not require prior authorization.
“There are many preventive coverages and wonderful benefits that can come with working with your provider,” he added. “Insurance companies and the health care industry want to reach out and hopefully provide services that can address issues that can be handled in a fashion that will be a benefit to the employee and their families, instead of it turning into a situation that becomes much worse for all affected.”
This includes first responders, who face the risk of developing post-traumatic stress disorder and other disorders, although Dillon said most public-sector employees have excellent employee benefit programs.
“In addition, there have been several state laws passed over the years that provide specific benefits above and beyond benefits to certain first responders due to the things they may have been exposed to on the job,” Dillon said.
Nicole McGee, executive director of the nonprofit National Alliance on Mental Illness of Southern Nevada, said mental health conditions do not discriminate, and can include PTSD, anxiety, depression and substance abuse.
“Individuals who suffer from PTSD as a result of similar or other gun-related violence are probably at the greatest risk, aside from those directly and indirectly involved,” McGee said.
“For many people with behavioral health problems, the most effective approach often involves a combination of counseling, medication and support, but there is no one-size-fits-all treatment. Even people with the same diagnosis will have different experiences, needs, goals and objectives,” McGee said.
The mass shooting has also raised concerns about availability of mental health care in Nevada, given that the state placed 51st — dead last — in Mental Health America’s 2017 state rankings (which included Washington, D.C.).
A low overall score indicates a higher prevalence of mental illness and lower rates to access of care. The combined scores of 15 measures comprise the overall ranking. Nevada also faces a severe shortage of mental health care providers, ranking at or near the bottom in terms of the number of licensed providers per 100,000 population.
“Nevada is ranked 51st in the nation with the highest need for mental health care and the least amount of access, according to Mental Health America,” McGee said. “The mental health infrastructure is insufficient to say the least, and more resources are needed to provide vital services and advocacy to an underrepresented population.”