WMH 10: Mental Health Policy and Legislation in Nevada

This is a transcript of WMH 10: Mental Health Policy and Legislation in Nevada with Trey Delap which you can watch and listen to here:

Katie Waecther: Hi, world, and welcome to another episode of Watching Mental Health. I'm really excited for this one because I think we are going to get into some important topics around Nevada mental health policy, legislation, why we can't get from the bottom. And I think that the person that I'm bringing on has the skillset to bring us through what's going on, what we can do. And so I'm going to jump into his bio trade DAP advocates for accessible healthcare, particularly in addiction recovery and mental health.

And that's how I met him is through working with NAMI Southern Nevada together. Since 1998, he has developed expertise in politics, professional and occupational licensing, coupled with legislative advocacy, addressing gaps in Nevada's healthcare system of which there are many and is focused on dismantling stigma. He strives to enhance mental health services, reduce barriers and foster resilient communities. And I have seen this work that he puts in firsthand. And on this episode, we are going to talk about all things mental health policy legislation, and I'm really excited to bring on Trey Dap. So without further ado, please welcome to the show. Trey.

Trey Delap: Hello Katie. Thank you so much for inviting me. I'm really excited about this effort you're doing to spread the word.

Katie:Thank you. Yeah, it's all about just breaking down stigma within conversations and I think action. And I like because I like what you do because you really bring action to the table as well as important conversations around mental health. So with that, tell us in your own words a little bit about who you are and what you do.

Trey: Well. Sure. I'm a middle-aged man. I'm born in the year of the horse. I like soft level walks. So I've been in Nevada forever. I moved here when I was 10. And what I do basically is there's a core principle I operate off of. And I think this is where the genesis of all the work I've done is I appreciate the discussion about healthcare access and things like that. And that was really my first exposure to the system when I worked at the hospital in Boulder City as a junior volunteer as a kid. And I would say that the general principal I'm working off of is justice, and there's a through line for that looking at healthcare from a rural hospital. I mean, we had people come in with mental health concerns. And at the time I was more focused on the medicine side of it and then just to see how that process worked.

But at the core of everything is the barrier is equity and justice goes back. I did some research and I got a master's in ethics. So lots of philosophy and justice really means balance and fairness. And that's where I think Nevada is, or the system is unbalanced where people who have medical conditions get care or people with mental health concerns get jail or something. So if I had to summarize myself, I feel like I'm a teacher, and to be a teacher you got to be a communicator. And I learn a lot from experiential learning. And so that's translated into my company, group six Partners, which is a consulting firm. And we've been active in the legislative sessions ever every session since 2017. And what I endeavored to do is elevate the voice of organizations that are on the ground doing the work. And that's why there's a natural connection with NAMI at the state level and then at the affiliate level. So if anything, I hope to elevate the profile of people who really needed to hear their voice, have their voice heard.

Katie:Yeah, I think that's really important, especially here in Nevada. And you touched on this a little bit, but why healthcare? There are I think a lot of things that you can be fighting for justice for in this country, but if you do it all, you probably aren't going to get anything done. So why did you decide to zero in on healthcare and mental health?

Trey: Healthcare in a weird twist, that early experience when I was an eighth grader and worked in the hospital, it was my first love. People describe their first love and you never forget your first love. And of reflecting on that, why am I not a doctor today? That was my mission because science, ooh, chemistry, that's hard because math. But I loved it because there was something you can do. So I didn't have the best, most comfortable home life and it was better to be in the emergency room than at my house just respective, at least there was something we could do about it. And I saw the effects of people who were continuously came into the emergency room and we knew 'em and they just had unaddressed issues. It was a acute patch up and go on with their day.

I had such an early exposure to healthcare. I carried that with me. And then when I got into college, I shifted into political science and then I worked on a campaign. My first campaign was 98 and that was a congressional race. And then the winner of that race, Shelly Berkeley, took two staff onto her staff. And I was the one who worked in the district office because of my care, I was assigned the constituency that deals with seniors, healthcare, healthcare. And so you can't undo the experience. So I can navigate the lingo. And then from there, that's where I got introduced to the osteopathic medical board where I was deputy executive director. And that chunk was basically protecting the public from problem physicians. And during that work I dealt a lot with impaired physicians and to see the resources that are deployed on an impaired physician, oh my gosh, if that was the standard, then we would be in a much better place. And that's also where I got my administrative chops and really got exposed to the structure of government in Nevada.

Katie: And the structure of government in Nevada is I think a little bit different than many other states. We're one of only a handful that has a legislative session every other year, which I'm not sure how many people know that. So tell us a little bit more about what makes Nevada special or different when it comes to our government structure and what are the pros and cons to that? Why is that good or bad?

Trey: It goes back to 1864. The genesis of all this is get off my lawn kind of thing. So Nevada, it built itself has a very limited government state. And just as an example, if anyone comes with a proposal from California or New York or something, a big state, it's dead before it makes it in the room because even Democrats who might be presumed liberal and more in favor of expansive government are not. And also I think, and this is cool though, Nevada's legislature is small, 63 legislators and they're the most accessible in the country. And I mentioned working as an aide to a member of Congress, she had 14 staff in two cities and that's support. An individual member of Congress had assemblymen or a senator in this state has aid during the session only and they're on their own. So that's very compelling. And our legislature only meets, it's just part of the theory of limited government because if the gang at 63, that's what they call 'em, is in session, everyone hold onto your hair because something crazy is going to happen.

But the challenge with that is it doesn't really follow a state that's growing so fast. Between 2000 and 2020, we got two more congressional seats. Back in the day, it was two congressional districts and then we now have four. So we've had some serious growth and the network of providers in all areas has not kept pace. And so there's a cultural historical thing. There's been lots of discussion about having annual sessions or expanding staff resources to legislators and they just die. It's a heavy lift. So that's really part of it. And the advantage is the people have a lot of connection. The disadvantages services are very shoddy. And when major health issues like pandemics and stuff kick in, you have the city and the county declaring war on each other and you don't have an inherent structure of, okay, who's in charge. Everyone's really piecemealing it.

Also, I think it's important to recognize the complete difference between southern Nevada and everywhere else. And I didn't appreciate that until I schlep up the Carson City. And there you have more Nevada families that have long roots and Las Vegas with two and a half million people versus Reno that is 250,000 if that. I mean, Henderson's bigger than Reno. So southern Nevada is just this behemoth and the state is unbalanced in that way. But we do have all those other counties. So I think that's why Nevada is unique and that is some of the disadvantages of our system.

Katie: Yeah, absolutely. Yeah, a couple points there. I think that southern Nevada is what keeps our state purple. So southern Nevada is our blue edge and then the rest of the state is pretty red leaning. Is that still true in Washoe County? I know that it's really grown there, but I feel like it's still very much conservative leaning up north

Trey: In the last few cycles. And so generally speaking, a political cycle is four years. It attracts with the presidential election and then an off cycle is the midyear stuff. So just as a note, all of our constitutional officers are up off cycle, so we'll be having a presidential election this cycle in 2024. And there's actually an advantage to that. That means our governor's chosen when the president isn't. So it changes the dynamic a little bit. But Governor Lombardo was one of the first governors to ever win statewide without carrying Clark County. So that means he didn't get a majority of Clark County or Washoe County. And if anything, Washoe County was more conservative and now they're more purple. So that's been a change in politics in central Nevada and everywhere else it's extremely rural and they're just more conservative and limited government. We can't put 'em in a category at the core. Nevada voters are very independent.

Katie: Yeah, absolutely. And I think that that's true even here. I was born and raised in Las Vegas, but I feel that kind of inbred sense of Nevada independence and we do our own thing and I don't know. So it's kind of funny even though in some areas I do lean more liberal with my surrounding area. But I always found that interesting, and I think you touched it perfectly, which is that on the pro side, our legislators are extremely accessible. I didn't realize how accessible until I went up to Carson City for my very first time, this in 2023, and I mean you could just go knocking on doors. It's so easy to talk to people if you really wanted to. But then on the other side of that things, I think change is slow. And I think that that has been reflected, especially in healthcare, especially down here because we are growing so quickly and it's our healthcare systems not only mental health, but just in general, healthcare across the board just can't keep up. And it seems like we're just continuing to kind of battle this uphill climb. And sometimes it feels disheartening. I've talked to other doctors who have been here for a long time who we're disheartened by the results of the latest legislative session. So tell me more from your perspective, out of the latest stuff that's happened, are you disheartened, do you think there was some good stuff? What has been in the last legislative session? What happened and in the last couple years, are we going to get better? What do you think?

Trey: Well, always, and this is also how I grew up. I didn't come from a wealthy family or a power broker family, so I learned young if it was to be, it's up to me kind of thing. And I think that's what brought me into politics as well, because I've always understood that the civic responsibilities we have, the citizenship that we exercise is the power at the end of the day, popular sovereignty is the source of all power. For some of the issues that you mentioned with regard to changes in legislation or whatever, the people in Nevada have initiative petition. I mean the people can make law themselves, and that's based in a philosophy or a theory that you can't trust the government all the time. And because there's been numerous case examples at the core of all this is we do not have a stable revenue stream for taxation. That's another piece. You just cannot rely on stuff. When we look at how we generate most of our revenue for a lot of things, it is on the backs of tourism. So during the shutdown when, I mean it's never happened, the Las Vegas stripers literally closed

Katie: The Congress.

Trey: It was fascinating. Economists, they couldn't set their little graphs to go to zero. So it was like, how do we deal with no revenue?

And I basically lay all that track to say, if you want it to be different, you got to organize and make it different because we have the most accessible legislature, but they don't exist in a vacuum. So just for scale, there's 63 legislators and 1100 lobbyists, and the most valuable commodity in legislation is information. And if you're not providing it, someone is, there is no nothing. So that's where it falls on the backs of the people themselves. Nevada has chosen not to invest in these services for whatever reason. But I think as cultural things change and more knowledge about mental health, addiction, recovery, et cetera, that is innovative and comes with some innovation, we are just behind and we don't have a structure that can enhance that.

Katie: Yeah, and it feels like now is the time that more people are kind of talking about this, and so hopefully change can be made. I know that 9 88 was an example that, so I recently had Robin, which is the executive director of NAMI Nevada come on, who mentioned that 9 88 was passed in a way that there's a tax revenue for it. So that feels encouraging. Do you imagine these kinds of things happening for other mental health services or healthcare services in general?

Trey: Yes, but the motivation is interesting. So 9 88 important, and it was, we're all paying the tax that goes into that. It's collected by the telephone companies, cell phones, so it's like modeled after the 9 1 1 tax. So we're all paying to support 9 1 1. So there's always the taxpayer, which is the industry, the telecom industry, in that case, they always have a complaint about taxation. So there's that. But the thing that exists if we don't do anything is what happened with the Department of Justice finding Nevada in civil non-compliance with the A DA because of a critical lack of youth mental health services. So when we're sending youth out of state to get services disconnected from the community, that's just terrible. So the remedy to that was a, so-called provider tax. So hospitals got together and they're going to be imposing a services tax on the services hospital provide it's estimated to generate 875 million in revenue.

And that revenue is supposed to be dedicated to the build out of more youth mental health services. And I'll say I have a real soft spot for youth mental health because when I took Mental Health First Aid, when I had Youth Mental Health First Aid, I just thought, wow, if adults had this knowledge, my life would've been so much easier. It's just such an awareness thing. So I think the sadness is in addition to just that example where the Department of Justice has to find us in violation of the A DA and that triggers or motivates a tax remedy as a bummer, we do that ourselves.

Katie: Couldn't we have just done that without getting in trouble first?

Trey: Exactly.

Katie: And we are at the bottom of a lot of these lists for youth mental health, for just mental health in general access. And I know that one of the big things that came out of this last legislative session, one of the big pushes from NAMI Nevada was a housing bill that actually included a taxation of sorts. And the governor who was a Republican and who was new at this time, had put down his foot and said, no more taxes. But then that led to that dying. Now I feel like something like that is going to come back in the next legislative session. Can you talk, because we still have a severe housing crisis for people who are struggling both with mental health, but then also just other disabil. So it's not just people around mental health, but disabilities in general housing for these folks. So can you talk more on if you think a bill like that would come back and any other bills that you are thinking might come around during the next legislative session, even though we're really way in advance right now?

Trey: Well, we may be way in advance, but this is the time to have the conversation during the interim, the off years, the legislative committees, the interim committees still meet, and this is when, basically when committee bills are crafted. So the discussions will happen this year about what will be presented to the legislature next year. So just being aware of the discussion doesn't have to only happen during session. This is sort of a different thing with regard to housing. If you look at anything, any recovery of any kind, housing destroys it. So if someone has a heart attack, diabetes, stroke, anything, if they're unhoused, there's no chance of recovery. I mean, it just, it's a terrible thing. The bigger issue with mental health and poverty and no housing is that there's tons of research and you can get into details about how housing first models have been successful, where it's like, okay, we understand you're in the first year of your recovery from opioid use disorder.

We're going to house you for a year so you don't have to worry about it. And there's tons of data that says that is a valuable model to invest in. So now with regard to legislation and housing, Kenny Gwen, when Governor Kenny Gwen was the no new taxes person, and that was the first time I was in the legislature as a wheel ad in 2001. And at that time, what I was proposing did have a revenue increase, and the committee said, the governor said, no more taxes. So this is again, classic Nevada. So we walked across the street to have lunch, and Kenny Gwen, the governor, was sitting there all by himself having lunch, walked up to him and I said, Hey, hi. Here's the people I'm with. We were across the street, but they said, you wouldn't support taxes. He is like, well, does the industry support it? Yes. Well, good. Done. Done. So that's the magic of Nevada.

Katie: That's that accessibility of Nevada. Yeah, that's amazing. What a cool story. Well, maybe we could do that too. I actually ran into Lombardo in a coffee shop when he was running because they are so accessible. So that's really cool. What a cool story. Well, so I like what you said earlier about this is the time to have these conversations, and I think that a lot of nevadans maybe don't. We think, oh, okay, our sessions every other year, so we're just not going to do anything right now. Nothing's going to get done. But I don't think that's true. It feels like you're saying that these are, when these meetings are happening, these are when people are putting research together, it feels like this is when maybe the cities or the counties or potentially putting things together. So why is it so important to talk about this stuff now during the interim when a session isn't about to happen?

Trey: Well, it's the only real time where the 120 days to do two years worth of lawmaking, two years worth of budgeting. It's a really backward system. Also, no dollars can be spent until education is funded. So the last days of the session are when you have torn up exhausted lawmakers making the most important decisions of the whole session. Every session begins with some goofy bill that's like la, la, la. And then towards the end, they suspend the rules and it just literally chaos. One bill died because a printer failed in the Senate and they couldn't get it to the assembly fast enough. And they had to call a special session. My God, there's just so many. And then if you get a chance to talk with someone who's been around, because term limits have had a major impact. So when I talk about 2000 or whatever, there's no one in the current legislature that was in the legislature then except lobbyists.

So one of the details about term limits is that it benefits lobbyists and the bureaucracy, and that's a critical detail, but this is the time for two reasons. One, it's the interim and longer conversations can happen at policy committee meetings. This is where a lot of bills were hashed out. And then when they arrive at the legislature, you already know who the opposition is, what the issues are. Also, there's an election, every assembly person is running for reelection. And in this process, I call it poor man's leverage with the tightening and the tiny margins between the parties, every seat is not guaranteed. So all that's just very present in our one. That's the trending of politics. But definitely Nevada, how that's realized in the interim, you have more opportunity to have longer conversations, and you also have the leverage of voting. Yeah,

Katie: Exactly. And you mentioned it is an election year, and it is an election year. I personally like that our president and our governor elections are not in the same year. I agree with you. I think that would really change the dynamic of things. I think it's going to be another really heavy hitting election year. I think it's already been kind of a shit show. So what can we expect as this election year starts to ramp up? Who would we be voting for here in Nevada besides the president? If the governor isn't up for reelection, who are we voting for these days or this year?

Trey: All politics is local, and your assembly person is, if you're talking about state stuff, your assembly person is the first person to go to. So you're represented by an assembly person, a senator, and those are elected officials in the legislative branch, and they don't know what they don't know. And reaching out to them is very valuable. I mean, you might accidentally call, I mean accidentally, they may have their cell phone published. So the most effective thing a person can do when they're going to engage is to have their spiel ready to go. And that's one of the major problem programs that NAMI provides that I think is just brilliant. It's the NAMI Smarts program. It's basically a very intentional way of crafting a two minute speech that is effective. The history of mental health advocacy is it's just free for all. And people would go in and they would tell their story in great detail, and it was scary.

It didn't have a point. It leaves a lot to be interpreted, basically. So if you have your 90 minute speech ready to go, also hearings, they can tap you out at two minutes. So during the specials that were virtual, even lobbyists like me had two minutes. And I used the NAMI Smarts template just to make sure I got all my words out before I got tapped out. So the reason this is so important is you are creating an opportunity for them to support you and what your issue is. So if your issue is that we want to support more housing and you can tell a convincing story, then you're basically presenting a path that they can follow. And the governors have said, and we'll say no new taxes, yada yada governing has to happen. And there's lots of examples of that being sorted out in Nevada history.

Katie: Most definitely. And I like that you brought up the NAMI Smarts. It's one of my favorite programs as well. What I love most about it is mental health can be emotional. And telling your story, something awful has happened to you or your loved one is an emotional experience. And the Smarts program really helps you craft it so you can get out the emotion, but then also get out the ask. And you can get that out within two minutes before they mute you if you're on Zoom or they cut you off. And I've seen them kind of cut people off because they need to keep things moving. And so for me, I think that that is one of the greatest next steps that anybody can take if they're interested in mental health legislation here, or advocacy here in Nevada, is to take this program and then to apply it to what they have going on.

I think that's the beauty to the NAMI Smarts is that it's not just, okay, here's a spiel on what we believe. It's like, no, take the template and apply it to what you believe and what your ask is going to be. And I really just love that. So I think that that's something that people can do to start preparing. Are there any other things that we can do as a people to start getting ready for election season and then for our very next legislative session, which will be just a couple of short months after that?

Trey: Yeah, I think knowing if you're real serious about moving the needle, starting with your person who represents you is the first step, or join an advocacy group like NAMI or any group of people, an organized group of people is the driver of change. In all respects. The legislature isn't really set up to solve problems. So if you go up there with a problem, you're going to not get it solved. But they're confirming solutions. So when an authoritative community organization goes forward with an issue topic and can demonstrate that a lot of people would be affected by this, you're just making it hard not to support it. Because one, like you said earlier, policy is a long game. We've got to look down the road and build the pieces up. So what people should be looking for is their local people, because all this stuff happens at the state level, what their sand is on this. And because of work I've done with breaking down stigma, we've created the space to have that conversation. Everyone says stigma is a barrier. How? Why do we break that open? So that's the power of people telling their stories, and that's what you can do now. And as a form of self-care, do not live and die by the words of the day, the world is collapsing. It's not yet. And that's why I'm even more excited because our system has a process and the process is still intact.

Katie: I love that you ended on that. I love that. Yeah. All politics is local, organized. People are powerful. We want to be coming with not just problems but solutions. And the most important thing is recognize your own self-care. Learn to turn off the TV when doomsday is coming and breathe. And just remember, like you said, it's a long game. And no matter what happens this year with our presidential race here in Nevada, we can still make a difference. We can still do what we want to do to make change. And so thank you so much for your time. I'm going to, going to be bringing you back as we get into the next session. So it'll probably be in between the election and the next session, which is February, 2025 from my understanding. And you'll have, I think, a lot more updates for us. So thank you so much for your time, Trey, this was a great conversation. Thank you. Thank you, thank you.

Trey: You. Well, thank you so much, Katie. It was a great pleasure. I really am grateful for your work you're doing,

Katie: Of course. And we will see you again in a few short months. But in the meantime, we are a couple minutes over, so I'm going to stop it right here. Please tune in every first and third Wednesday at 3:00 PM Pacific time, and I'll see you guys next time.