Nevada is among a handful of states to add a surcharge to all phone bills intended to help support the state's 988 mental health emergency hotline.

A new report by the mental health advocacy group Inseparable found if the surcharge were to increase from 35 cents to 98 cents, it would generate approximately $3 million annually for the Silver State.

Angela Kimball, chief advocacy officer for Inseparable, said the report is a tool to help policymakers and state leaders develop an equitable and sustainable crisis response system. They found Nevada's in-state answer rate sits at 68%, when it should be above 90%.

"We're still a long way from having the kind of system that everybody expects in every ZIP code, in every part of America," Kimball acknowledged.

Kimball pointed out with the implementation of 988, it also brought about changes in the way local jurisdictions respond to mental health crises. The report highlighted Nevada has convened a workgroup to build response processes for collaboration between 988 and 911. While it is a step in the right direction, the report showed Nevada could improve call center capacity, crisis response as well as system financing.

Nevada has the 39th highest suicide rate in the country and also ranks 50th in the nation for overall mental health, according to the Nevada Division of Public and Behavioral Health.

Kimball stressed the figures need to see improvement. She added not having an effective response system in place can make a difference between life and death for some.

"People going without help, being turned on to the streets, being in jail, being in emergency departments, being hospitalized -- voluntarily or involuntarily -- or, tragically, having their life end," Kimball noted.

Kimball added the report lays out policy examples for each of their policy recommendations which come from red and blue states moving the needle in the right direction. She hopes they can serve as inspiration for other states. If you or someone you know is experiencing a mental-health emergency, do not hesitate to call or text 988.

The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.

Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.

But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.

"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.

Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.

Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.

Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.

"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.

Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.

'Tis the season for celebration and good cheer. However, for many Michiganders, the absence of a loved one - whether through death, divorce or another painful separation - can make this time of year feel almost unbearable. According to the National Alliance on Mental Illness, 64% of people with depression report the holidays just make them feel worse.

Dr. Ibrahim Sablaban, a psychiatrist and addiction medicine physician at Corewell Health, offers a surprising insight: he says sadness is one of the most universal human emotions, and should be embraced.

"The worst thing somebody can do is really try to suppress feeling human - really suppress feeling lonely, feeling sad, feeling a sense of loss," he explained. "It's very easy to say, 'Oh, I need to get my mind off of so-and-so who passed away,' but that's not the healthy way forward."

If you or someone you know is struggling with a mental health crisis, help is available 24/7 - call or text 988, the Suicide and Crisis Lifeline, to connect with someone for free and confidential support.

While many enjoy Michigan's snowy holiday scenes, the state's long winters and reduced daylight can also worsen depression, especially for those with Seasonal Affective Disorder, the aptly-named "SAD." Dr. Sablaban advises sharing emotions with trusted family and friends, and reflecting on happy memories of loved ones.

"To be able to embrace the traditions and the things that you shared with that individual, even if they're not in your presence. To be able to keep those things alive," he continued.

Mental health professionals also emphasize that while family traditions can provide comfort and remembrance, it's okay to let go if they become too painful. Explore new ways to celebrate, and over time, new traditions will naturally evolve.


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On this Election Day, Indiana residents may be feeling the effects of what some are calling election stress disorder, but there are several ways to cope.

If you're suffering with anxiety related to the biggest day of the year for politics, Dr. Jennifer Embree - chief wellness officer and clinical professor at the Indiana University School of Nursing in Indianapolis - encourages taking a moment to pause before reacting to election-related news, especially on social media, and focusing on what you can control.

"When we pause, it's easier to take the emotion out of that situation and then really thinking about what exactly are you afraid of," said Embree. "What's the worst thing that can happen? And then, what issue impacts you the most?"

Deep breathing exercises can lower heart rates and reduce anxiety. One popular technique is known as box breathing: inhale for four seconds, hold for four, exhale for four, and hold again for four.

Medical experts caution against using alcohol or drugs to cope, noting the substances often disrupt sleep and ultimately do little to alleviate stress.

Instead, clinicians prescribe seeking professional help if stress becomes unmanageable.

Embree suggested connecting with supportive people who help keep them calm. For those greatly stressed, she recommended meditation, exercise, or even dancing to manage emotions.

"Think about the people that keep you calm and really are your support peope," said Embree. "Those are the people you need to be connecting with - not people that are going to make you more anxious, more upset, that's one thing - is to keep the calm around you."

While election outcomes are beyond individual control, Embree said maintaining personal well-being is key to victory in navigating this high-stress period and future events.