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Mental health shortages are among the worst in healthcare, and governments all over the US are trying to "do something" about it.
There's just one thing. When you tell professionals who may do what, and how, where, and when to do it, all the kings horses and all the kings men can't make them want to.
First Nevada, then Iowa.
Nevada Hit With $447K Fine for Continued Delays in Mental Health Care for Defendants
Nevada is set to pay $447,000 in fines for delays in providing mental health care to criminal defendants in Clark County
Associated Press | Feb. 10, 2026
Nevada will pay $447,000 in court-ordered fines for continued delays in providing mental health care to criminal defendants in Clark County, the latest sign of its struggles to quickly provide treatment.
Defendants deemed unfit for trial are supposed to be transferred to a mental health facility within seven days of a court order, but the state has consistently failed to meet this deadline amid a shortage of mental health facilities.
Last year, a Clark County judge held the state in contempt and placed sanctions of $500 for each day a transfer is delayed. Since then, there have been 32 orders when sanctions applied, adding up to the $447,000 penalty.
The state has been assessed $1.4 million in fines related to delays in mental health care over the past two years, with more than half coming last year via a $753,500 penalty in Washoe County.
Tuesday’s approval from the Board of Examiners — a panel consisting of the governor, attorney general and secretary of state — came with no discussion. The state’s Division of Public and Behavioral Health, which is responsible for connecting defendants with treatment, did not respond to a request for comment.
It needs one more final approval from the state’s Interim Finance Committee (IFC), a group of lawmakers that makes financial decisions when the Legislature is not in session. The money will go to Mojave Mental Health, a clinic affiliated with UNLV.
The continued payouts reflect the struggles facing the state in providing care to defendants deemed unfit to stand trial.
The issue dates back to 2005, when a man sued the department after never being transported to a treatment center. The state previously sued to stop the fines, arguing the seven-day timeline would be “impossible” to meet and that consistent fines would put the agency “on a debt treadmill,” but the Nevada Supreme Court upheld them in 2023.
In a December Clark County court hearing, attorneys representing the public health agency argued that it could not legally pay for the fees because its budget does not account for these payments. The agency can go to IFC for extra funding when the Legislature is not in session.
“It is unclear to the court why the division failed to address this issue prior to the end of the last legislative session or during the special session, or at other interim IFC meetings,” District Court Judge Christy Craig said at the hearing, according to a transcript.
Craig said she was concerned about the frequency of the delays, even if the agency is making efforts to lower wait times.
These efforts include placing certain individuals into nursing facilities, bringing on staff to divert defendants who might be better served outside of hospitals, renovating a mental health building to increase capacity and starting mental health programming in detention centers, where defendants are held prior to receiving treatment.
The agency’s latest budget also allocates $17.6 million for 21 additional beds for Southern Nevada patients and 53 new positions related to care for criminal defendants. The state is also planning to build a new mental health treatment facility in Southern Nevada, set to open in 2029.
“It seems as if it’s just become a kind of a cost of doing business — that sanctions are going to be imposed and that the division is going to pay them,” Craig said. “I recognize that the division is attempting to do things to try to ameliorate the problem of the failure to promptly transport, but it has been 20 years of these issues.”
As of last February, the treatment wait times were decreasing. The agency did not respond to a request for more recent wait time data.
Craig also noted that these delays can have negative downstream effects, referring to one recent case where a man — detained at a county jail while awaiting mental health treatment — picked up an additional battery charge while in custody.
“Incapacitated criminal defendants suffer from various harms while they languish in facilities that are not equipped to treat them while awaiting transport,” Craig said. “These harms include worsening of their mental illness, bodily harm, and even death.”
Law can fine, mandate, restrict, and shut down services. But it can't create people dedicated to caring for others.
The Des Moines Register reports. Note the list of related headlines halfway through.
Iowa bills look to improve subacute mental health services
Marissa Payne | Feb. 11, 2026
Iowa lawmakers are considering two bills to improve access to subacute mental health care.
The proposed legislation aims to remove barriers like treatment time limits.
Advocates say the changes will help Iowans who need more support than outpatient care but do not require hospitalization.
Mary Neubauer had to send her son out of state for mental health care because Iowa lacked the services he desperately needed.She and her husband sent their son Sergei to Wisconsin and Arizona to try to get him help for major depression, anxiety and post-traumatic stress disorder he dealt with after a "tumultuous" childhood in Russia. They adopted him in 2009.
Sergei, an Urbandale High School graduate, ultimately died by suicide in 2017. His parents openly shared his mental health struggles in his obituary, where they implored policymakers "everywhere to recognize the toll that mental health struggles and addictions are taking on our society, particularly our young people."
Neubauer has since testified to lawmakers in a plea to ensure other families don't lose their loved ones to the same fate because of Iowa's mental health service gaps.
"I can tell you as a family member, it's excruciating because you're trying your best to support this person and when they're halfway across the country, it's really hard to do and I think it makes it that much harder for the patient as well because they're starting over in a new place and they don't have their family member with them," Neubauer said. "So if we can build this level of care in Iowa and make it successful, I think we'll be doing a great thing for the families who need that care."
Neubauer, a former Iowa Lottery spokesperson who lives in Clive, is pushing lawmakers to expand subacute mental health programs, a type of care that officials say is scarce and hard to access in Iowa. Subacute mental health programs serve people who do not need emergency hospitalization but need more intensive support than is available through outpatient care.
State lawmakers have advanced two measures that would make comprehensive changes in subacute mental health care in Iowa and aim to remove barriers to treatment.
The House proposal, House File 2220, advanced in a subcommittee hearing Tuesday, Feb. 10. The Senate's bill, Senate File 2202, passed out of committee on Feb. 5 and is eligible for the full Senate's consideration.
What would the bills do?
Under the House bill, a mental health facility would be required to draft a treatment plan within 24 hours of a resident's admission.The proposal removes a 10-day limit on the length a person can receive subacute care and prevents managed care organizations from discharging patients until the mental health professional supervising their treatment determines proper supports are in place. That's intended to curb the risk of a person harming themselves or others after being discharged.
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Iowa reaches final settlement in lawsuit alleging state hasn't provided adequate mental health care for kidsThe Senate bill also eliminates the 10-day cap and allows the Iowa Department of Health and Human Services to adopt a rule permitting longer stays.
The House bill requires Iowa HHS to develop a system to track available beds at psychiatric medical institutions for children.
And it limits requirements for prior authorization — the submission of clinical documentation justifying their treatment — for the first 15 days of a patient's stay. A managed care organization couldn't review the medical necessity of a person's stay until the 45th day of treatment.
The Senate bill instead outlines a timeline that MCOs must follow to grant prior authorization based on the urgency of an individual's case ranging from 48 hours to 10 days after a mental health provider submits a request.
Neubauer said the House bill was more comprehensive but she would welcome the changes outlined in either proposal.
Mental health advocates support provision lifting treatment barriers
Lynh Patterson, representing Wellpoint Iowa, which is one of the MCOs, said Wellpoint was concerned about limiting prior authorization language and did not see that as a barrier to accessing subacute services as lawmakers considered the House bill Tuesday morning.She said Wellpoint approved all prior authorization requests in 2025. Wellpoint's data show subacute stays are eight days long on average, so she questioned the need to extend the length of time.
But Neubauer said other states allow longer windows of treatment and Iowa's average may result from Iowa's 10-day cap on subacute care. She supported removing the statutory limit to allow patients time to put treatment techniques into practice and for professionals to monitor and adjust their prescribed medications.
Neubauer said if a health provider recommends this level of care and an analysis shows the patient should receive this level of care, insurance providers should not require the sometimes lengthy prior authorization process.
The wait for prior authorization, which varies but can sometimes take 15 days, means a patient doesn't know whether their services will be covered or they're made to wait until approved, Neubauer said. She told lawmakers "15 days from now is really no help at all" to someone in crisis.
Patterson said subacute care is meant to stabilize a patient and then find the correct level of care for them elsewhere.
Rep. Rob Johnson, D-Des Moines, said 45 days may be enough time to stabilize someone and insufficient subacute care has placed too much of a burden on law enforcement and taken up emergency room resources.
As a minister who does funeral services, Johnson said he has done too many for people who couldn't access the mental health care they needed.
“Too many families are left with an empty chair at the dinner table and that’s why I believe we have to move this forward," Johnson said.
Rep. Craig Johnson, R-Independence, said loved ones in his own life have struggled to get timely and adequate mental health care.
“I think all of us at one point or another in our lives have had family members, friends or someone that we know and love subjected to maybe not the care and services that we would've liked to (have) seen," he said.
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