The Subcommittee on Health and Human Services was called to order at 1:30 p.m., on Friday, May 7, 1999. Co-Chairman Sheila Leslie presided in Room 3138 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All Exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Ms. Sheila Leslie, Co-Chairman

Mr. Mark Manendo, Co-Chairman

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Co-chairman Leslie announced the meeting was called to discuss a potential amendment to S.C.R. 11.

Nora Brashear, administrative coordinator, Crisis Call Center, explained the center was founded in 1966 in response to the high suicide rates in Nevada. The official name was "Suicide Prevention and Crisis Call Center, Inc.," and it was the longest continuously operating call center in the nation. She provided the following information:

• Crisis Call Center was the only 24 hour suicide prevention crisis line in the area.

• There were five full time staff members, one part time.

• 65 active volunteers who worked the crisis lines. They received over 55 hours training before taking a call.

• They handled 14,000 to 15,000 calls a year; of those about 4,500 were people threatening harm to themselves or others. Approximately 2,000 to 2,400 were suicide-related. Those might be family members calling about someone who was depressed, not necessarily someone threatening suicide themselves.

• The center had a youth outreach program in Carson City, Washoe County, and high schools in Douglas County. They talked to over 4,000 high school students yearly about the issue of suicide, how to identify when a young person was depressed, how to seek help for that person or for themselves.

• A Survivors of Suicide Loss Support group for family, friends, and other loved ones of people who had committed suicide. It was the only such group in the area.

• The center taught a class at the University of Nevada, Reno, every semester in crisis intervention for the School of Social Work.

Co-chairman Leslie asked if they provided the suicide hotline for all of northern Nevada, or everywhere but Clark County. Ms. Brashear said "yes," and they received a lot of Clark County calls as well. If the calls from Clark County were other than suicide related they referred those calls to the appropriate numbers in Clark County. If the calls were suicide related they were handled just as they would a call from Washoe County or the rural areas.

Co-chairman Manendo was surprised people from Clark County actually called a northern Nevada hotline and wondered how they knew about the number. Ms. Brashear said they distributed literature all over the state. A number of services were provided through the hotline, such as the Senior Connections Service. They recently distributed by mail about 4,000 pieces of material with the "800" number to 32 senior centers throughout the entire state, including Clark County.

Also the center's number was published in statewide and national guides. The 800 number could be dialed throughout the State of Nevada and four neighboring northern California counties.

Mr. Manendo related he had been involved in getting a new Whitney Senior Center in his district and consequently he was there quite often but had not seen that information. Ms. Brashear said she would see the center received information.

Ms. Leslie noted the feeling of the committee at the time of the hearing was the state should have a role in helping to fund the basic hotline. She asked Ms. Brashear to explain the state funding the center currently received. Ms. Brashear said they had no ongoing funding except a few thousand dollars the center itself raised. They received pass-through dollars from a number of grant-administered funds, some money from Title XX, and also from Children's Trust Fund. The Washoe County Consortium consisted of county and city dollars. Also there was some Victims of Crime Act (VOCA) money but that was for child abuse, neglect, and sexual assault, not for suicide prevention. United Way also funded every year, but the amount had been reduced every year because there were so many groups needing funding. She added they competed in competitive process for every cent received every year. Ms. Brashear stated further they needed more guaranteed funding, because they were "right to the penny" every year and if one of the grants should decide not to fund 1 year they would lose a staff position.

Ms. Leslie asked if that had happened in the past where they had good years and bad years. Ms. Brashear said it had happened, where a funding source on whom they had relied chose not to fund. Often it depended upon who was on the funding allocation committee; their priorities changed, and sometimes suicide prevention was not a priority for a particular group. There was a lot of money available currently for family violence prevention; the definition being what one person did to another. The Crisis Center believed suicide was an act of family violence and had struggled to make a case for that, to no avail.

Ms. Leslie queried if money was appropriated for a statewide hotline, or one for the north and one for the south, what would that appropriation replace. Would such an appropriation jeopardize existing funding, and/or could existing funding be used for more prevention. Ms. Brashear did not feel current funding would be jeopardized, and they could do more prevention. The Washoe County School District recently asked the Crisis Center to develop a suicide prevention curriculum for the fifth and sixth grades, and school counseling staff had agreed to work with the Crisis Center to make it developmentally appropriate. The Crisis Center currently had one half-time person who performed suicide prevention outreach with young people, and Ms. Brashear said they were eager to expand that program.

Ms. Leslie posed the idea of allocating funds to a state agency who in turn would do a competitive process to decide with whom to contract. Ms. Brashear had mixed feelings about that, stating "We like what we do so much we don't want any competition." On the other hand, she would certainly be willing to write for the money; they were good grant writers and felt confident they would prevail. She remarked that Crisis Center was the only suicide hotline in town, although there were a couple other specialty hotlines for social problems. Most people were unaware of what it took to operate a 24 hour hotline. Crisis Center paid their graveyard shift (midnight to 8 a.m.) $7 an hour, because they had so much difficulty keeping volunteers working that shift 7 days a week. It was one of the best things they had ever done; however, it cost $23,000 a year, and now it was time, after 3 years, to give those people a raise. Several people on that shift had been with Crisis Center since the beginning.

Ms. Leslie then asked if the Crisis Center had any connection with southern Nevada. Ms. Brashear said she had recently spoken with Dorothy Bryant at the Las Vegas hotline and would be sending materials to her. That hotline was a 100 per cent volunteer organization operating out of their own homes. Ms. Brashear was looking forward to helping further develop the Las Vegas hotline.

Ms. Leslie cited NRS 389.063, an educational statute, that stated "the state board shall establish a program of instruction regarding the prevention of suicide and instruction must be provided to each pupil by the completion of grade 12." She then asked if any funding was received from the Department of Education. Ms. Brashear said "No." Currently she was assisting the Washoe County School District write a multi-million grant for a 3 year period and hoping to obtain some funding, but it was a competitive process. The school district had on occasion helped with some in-kind support such as publishing handout materials.

Co-chairman Manendo asked about the graveyard shift that, according to his calculations, would cost approximately $18,800 a year for a 7 days per week staff, not $23,000. Ms. Brashear said they took deductions for Social Security and Medicare, and the difference might be attributed to a match.

Mr. Manendo then asked how the Clark County hotline was funded. Ms. Brashear was not certain, but understood they did fundraisers. The woman who coordinated the hotline said she received no payment for her work, nor did the 20 to 25 volunteers who rotated on call from their homes with pagers and cell phones. They used a professional answering service to answer the calls, and as soon as the call is identified it was quickly patched through to the person on call. Ms. Brashear believed they also had a board of directors. It was Ms. Brashear's understanding the Clark County line handled only suicide related calls.

Mr. Manendo was perplexed why Clark County did not compete for any grants. He expressed disappointment because they had not. He suggested Ms. Bryant get assistance from Ms. Brashear in grant writing, because any funding they could get would clearly be beneficial.

In view of the fact the Crisis Call Center accepted calls regarding sexual assault, and child abuse, Ms. Leslie asked if Ms. Brashear received state funds besides the competitive Title XX funds. Ms. Brashear said "No." Ms. Leslie believed it was required by statute that the state provided that basic service. Ms. Brashear said that was correct, and they had received funding for child abuse and neglect from VOCA and from Children's Trust Fund money, both of which came from the Division of Child and Family Services. However, the center had never been a hard-line item on anyone's budget. The center also did off-hours elder abuse and neglect reports for the Division of Aging Services, and they received no funding from the state for that either. They wrote grants for that money, and grantors had been understanding so far. However, grantors did question them every year as to why the state was not giving the center any money.

Ms. Leslie expressed concern about the Clark County hotline, because the county had a tremendous suicide problem and she was disheartened to know there was not a well-organized professional organization there to provide suicide prevention.

Ms. Brashear noted the rural areas had the highest rate of suicide in the state. Washoe County was second in its rate of suicide per numbers of population, and Clark County was third. However, Clark County had three or four times more the actual number of suicide deaths per year but was prorated based on the population, the rural areas had the highest rates.

Ms. Leslie asked her if she knew the reason for that. Ms. Brashear said they did not know why; they talked with the coroner and others about it, and the one point that continued to surface was isolation. The top 10 states in the nation were western states; places with large rural areas. Many people, she said, jump to the conclusion that gambling or 24 hour drugs and alcohol access, but she believed that was not the core of the problem. Although, for certain individuals those things might contribute to the problem.

Next to speak was Liz Breshears, family programs officer, Division of Child and Family Services (DCFS). She provided information on the role played by the Crisis Call Center for DCFS and the fund sources and their stability. The Crisis Call Center provided a legislative mandate. NRS 432 (b).200 required a toll-free telephone number for reports of abuse or neglect. Subsequently there had never been a state appropriation to fund that particular requirement. Historically, some funds were provided through Title XX and through VOCA. The parameters for VOCA funding stated no funds could be used for perpetrators. With suicide, the individual was both victim and perpetrator. Ms. Breshears researched other states to determine if they were funding anything in the area of suicide prevention or if they had found an interpretation that would be accepted federally. There was nothing in either category. However, suicide fit in with the child abuse reporting piece provided by the Crisis Call Center. That was funded in the current year for $15,830.

Regarding the stability of funding, Ms. Breshears would like to see a multi-year funding cycle. She acknowledged the fact that Crisis Call Center had met a state mandate, were doing it very well, and were the only one providing that service. She hoped to balance that by ensuring all of the federal accountability that tracked with those funds in reporting, and so on. They were in a competitive situation in terms of how their grant was reviewed. It was precarious to juggle a number of fund sources and provide payroll for the next year.

Ms. Leslie asked if the division could simply decide to do that, or was anything required from the legislature to encourage the division to act favorably. Ms. Breshears said anything the legislature could provide to encourage that would be beneficial. Unless they looked at the entire system that way, it would be treating one grantee with preference as a recipient. However, she also believed if was justified because Crisis Call Center was the only recipient meeting a specific legislative mandate.

Ms. Leslie asked if there would be a problem with the Federal Government if Ms. Breshears did multi-year funding. Ms. Breshears explained the funding was always done with a rider that stated the funding would be received if the money was there. Ms. Leslie followed up asking what Ms. Breshears had been thinking in regard to multi-year. Ms. Breshears said probably biennial.

Mr. Manendo asked about 432 (b).200, the toll-free number mandate, and asked if the state provided the $15,000 of which Ms. Brashear, of the Crisis Call Center, spoke earlier. Ms. Breshears said the state did not provide it, so DCFS had looked to federal fund sources to meet the mandate. Mr. Manendo wondered how they were able to operate on $15,000.

Misty Allen, who oversaw the crisis lines for the Crisis Call Center, said the $15,000 was for after-hours calls and covered training plus the graveyard shift. In addition, they received other funding for the graveyard shift, so it was not a large chunk of their budget. She explained they answered child abuse and neglect calls, but the after hour reporting was weekends, holidays, 5 a.m. to 8 a.m. They did not ask for funding because they had volunteers for that other period of time.

Ms. Breshears explained during regular work hours the child protective service agencies were open, in addition people could call local sheriffs. But, if someone saw something occurring on Friday or Saturday nights when the agencies were not open, it was important to have an easily accessible 800 line. She added the other VOCA grant was in the area of sexual assault, providing services and counseling for victims, and that was $61,703. The Children's Trust Fund also had parameters and its intent was prevention of child abuse. The Crisis Call Center received $9,000 grant targeted primarily toward providing resources for parents as opposed to reporting a parent. In that scenario the parent might say "My child is driving me crazy, can you help me?" Finally, there was some Title XX funding; one portion was to help provide the student suicide prevention and education in the schools, the other was targeted toward seniors. The amounts were $11,957 and $11,500.

Ms. Leslie had some questions for Dr. Brandenburg, administrator, Department of Mental Health and Developmental Services. She asked for his thoughts on the state providing funding for a hotline to reach all parts of the state. Also she asked him to address the Las Vegas hotline where attention was needed.

Dr. Brandenburg explained for the last 4 years in Las Vegas the Psychiatric Emergency Service (PES) center on the campus had been the de facto crisis call for Clark County. The way it had evolved was when volunteers were not available for the crisis line for Clark County, they turned a switch and the numbers automatically rotated to PES. PES did not know that was going to happen until they started receiving calls. Dr. Brandenburg then had Dr. Jim Northrup meet with Dorothy Bryant to find out what was happening, because he felt it was an inappropriate use of PES staff and resources. The PES had been trying to provide a psychiatric emergency service and Dr. Brandenburg's staff was spending considerable time dealing with suicide, sexual assault, and other calls that were beyond their scope. Based on the testimony previously given, it was strictly a volunteer network in Clark County. However, he believed United Way in Clark County had offered Dorothy Bryant funding to do the crisis call line, in the same way it was funding the Crisis Call Center in Reno. He believed, however, that Ms. Bryant refused the United Way funding, because they insisted upon accountability and outcome measures. Most nonprofits now wanted indicators and wanted to know the results of their monetary support. Dr. Brandenburg was told Ms. Bryant had not felt she should have to justify or make her programs accountable. For those reasons, it appeared the Department of Mental Health and Developmental Services had become the de facto crisis center, and he reiterated it was an inappropriate use of his staff and services. Moreover, if his staff received a call from someone threatening suicide, what were they to do other than call the police who could bring them in for an evaluation.

In terms of whether the state should be providing funds, Dr. Brandenburg felt it was an extremely important service. He related as a student in the clinical psychology graduate program at the University of Nevada, Reno, he had to do a rotation on the crisis hotline. The resource was definitely needed, and there was constant competition for federal dollars which were rapidly vanishing. In view of the fact Nevada was number one in suicide rate, twice the national average for the general population, as well as the highest rate for adolescents and teens, and the highest for the elder population. He echoed Mr. Manendo's earlier belief that a resolution might look good and feel good, but unless it had some teeth it was impotent.

Dr. Brandenburg noted the state had received the Center for Disease Control grant which would examine the ideology of suicide statewide and he would be making recommendations, but that would be more than 3 years in the future. He added the division stood ready to help with whatever needed to be done.

Dr. Brandenburg's understanding of the proposed amendment was that money would be given to the division who would then send a Request for Proposal (RFP) and work with the providers to develop funding criteria, and to examine accountability measures. If the legislature felt it would be a policy issue, Dr. Brandenburg would be happy to help implement it. He added the hotlines provided a tremendous resource for the Division of Mental Health and Developmental Services and for the Division of Child and Family Services.

Ms. Leslie explained the committee had become involved because of the resolution by Senator O' Connell; however, the committee was convinced it was a serious problem and it was not enough simply to pass a resolution to urge ourselves to do something. She asked for confirmation, based on Dr. Brandenburg's comments, that he would be willing to work with the committee as outlined, and that he represented the department as well. Dr. Brandenburg said he represented the Division of Mental Health and Developmental Services. However, he had spoken to Charlotte Crawford, director of the Department of Human Resources, whose only concern was the liability issue. She did not want the state to be in the position of being the operator of the crisis center. She had no problem with the pass through monies or having the division do RFPs and developing the existing resources.

Ms. Leslie felt it was more appropriate for a community-based function than a state function. Regarding Las Vegas, she asked if he was concerned about finding a provider who was willing to take on the liability and get a crisis call center operating. Dr. Brandenburg was concerned if the information he had received about the current system, in terms of the volunteers and their inability to accept accountability measures, was correct, because he would be asked to provide accountability for the funds passing through his division. However, he was relieved that Nora Brashear was an experienced provider for northern Nevada, and perhaps her role could be expanded to develop a statewide hotline if a provider did not come forward who met the criteria developed. He added he would be happy to develop the criteria with the existing providers and pass it through Ms. Leslie and Mr. Manendo before actually sending out an RFP.

Ms. Leslie asked how soon could the program become effective once the funding was available. Dr. Brandenburg said a realistic date would be October 1, 1999.

Mr. Manendo said he was having difficulty understanding how they would be able to get the southern Nevada people to be accountable for $50,000. He wondered if something could be put in statute. Dr. Brandenburg said it would be built in to the RFP. They had experience in sending RFPs that were very clear in addressing the issue of accountability, both from the fiscal side as well as the demographic and process side; providing data, number of calls, number of staff, and so on. He would probably use what Nora Brashear now had in terms of her accountability measures and build on those. Most of the nonprofits with which he was familiar were attuned to accountability and outcome indicators. Some people found it hard even in state agencies, because change was threatening.

Ms. Leslie pointed out in the potential amendment it stated "the funding may be split equally," and in speaking with Marla Williams, committee research analyst, they asked the language be broad enough so the division could make the best decision. She added that she did not know if Crisis Call Center was interested in handling the Las Vegas area, or perhaps there was someone else, if funding was actually available.

Misty Allen related a few months ago, the Crisis Call Center had been approached by a committee from the Division of Mental Health and Developmental Services. Together with Dr. Northrup they explored the possibility of handling Las Vegas. The center already handled elder neglect for the entire state, and they did take some child abuse and neglect calls because of the volume. Ms. Allen said they thought it might be a good fit. They would have to increase the volunteer recruitment, and thought dollars would be available, but discovered they would be competing for a United Way grant to increase their volume to cover the services. They decided they did not have the energy or manpower to do that.

Ms. Leslie said she felt a northern agency who had been doing it as long and as well as the Crisis Call Center could also do Clark County, if the appropriate resources were there.

Ms. Leslie explained the intention was to go with the potential amendment (Exhibit C), incorporating the "Resolved" sections from Senator O'Connell's resolution S.C.R. 11, changing those to "Whereas" clauses to provide the basis for making the change, and asking for an appropriation of $100,000 for each year of the biennium, or $200,000, to the Division of Mental Health and Developmental Services to fund a statewide suicide prevention hotline. The funding could be split equally between the two most populated areas of the state. The intent was Washoe County and would serve all of rural Nevada. Further, the division would develop funding criteria that included accountability measures, and the funding be awarded for a period of 2 years for the biennium, although the first year would start October 1, 1999.

Ms. Leslie added they would take it back to the committee at the meeting of May 10, 1999, and be placed on the work session agenda.

With no further testimony before the subcommittee, Ms. Leslie adjourned the meeting at 2:45 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin,

Committee Secretary

APPROVED BY:

Assemblywoman Sheila Leslie, Co-Chairman

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