A Decade Lost: Nevada Teens and a Mental Health System That Can’t Keep Them Home
Nevada ranked last in the nation for youth mental health in 2015. A decade later, in 2025, the ranking remains unchanged. How is it that after ten years, we are no better off? In fact, in many ways, the crisis has only deepened, particularly as access to properly managed adolescent residential treatment remains limited or unavailable for many families who need it most.
In the neighborhoods of Northern and Southern Nevada, psychiatric residential treatment homes are increasingly operating without licensure or regulation, yet Nevada teens are still being shipped across state lines for psychiatric treatment. Adolescent residential placements are needed to provide intensive, specialized care for teens with severe mental health, behavioral, or substance abuse issues. The ability to treat adolescents in the community is essential. Types of Placements include:
Residential Treatment Centers (RTCs): Facilities for severe mental health needs, offering 24/7 care, school, and therapy for high acuity patients.
Therapeutic Boarding Schools: Combine therapy, schooling, and life skills in a structured setting designed to improve behavioral issues.
Group Homes: A supportive, communal setting for teens unable to live at home, focusing on daily living skills.
Substance Abuse Treatment Programs: Specialized residential care for adolescents struggling with addiction.
Co-occurring Disorders Programs: Treats both mental health and substance use issues simultaneously.
Michael Spindler, LCSW, became involved in residential treatment for children in 1968 and spent the last 50 years in the business of providing a full range of psychiatric services for children before moving to Henderson, NV in 2016. Over his 50+ year career, he’s found that the level of acuity, suicidal ideation, and cycle pathology among youth and adolescents has exponentially increased, stating, “this is a national problem and the country has to come to grips with the fact that we have a mental health crisis among our young people and a gross lack of services in most states to address this need.”
Here in Nevada, access is low, which means many families and patients are desperate to find housing and/or adequate treatment options. As was previously reported, “the Nevada Current found that, 'Beds in state-run psychiatric facilities for Nevada’s children are empty because of a staffing shortage, and inpatient treatment has plunged by 60 percent since 2015.” The good news is that the state is taking steps to revoke several homes with psychiatric patients where the operator is unable or unwilling to properly manage the patients. The bad news is that little is being done to fix the system or provide oversight for state-fun facilities, the state is constantly playing catch-up on complaints, and Nevada teens are still being sent over state lines for treatment.
In-State Residential Treatment Struggles
Since 2022, Nevada has been in trouble with the Department of Justice for violating the ADA and unnecessarily segregating children with behavioral health disabilities in institutional settings like hospitals and residential treatment facilities. When little was done to address the problem, the DOJ filed a new complaint in 2025 and came to a settlement agreement with the state to “allow Nevada’s children with behavioral health disabilities to access the services they need without being forced to leave their homes, schools, and communities.” Progress has been slow, even with the DOJ checking in. Despite repeated audits, media investigations, and federal intervention, Nevada lacks a centralized system to track, inspect, and enforce compliance among residential group homes operating outside licensure.
The most recent media investigation came in December 2025, when News 8 reported on one Las Vegas residential treatment facility, stating that “Neighbors provided video of screaming teens, emergency vehicles, and other activity in their cul-de-sac,” with one neighbor hearing a teen girl scream, “I’m not safe!” as workers tried to restrain her. After months of problems, the state showed up at that same adolescent residential treatment facility, and things escalated to the point where a “standoff occurred between state workers and staff,” proving that the state can take action when necessary.
Neighbors of these types of homes across the state are left dealing with nightly police and emt visits, runaways trespassing their backyards, fights, and illegal activities. Without proper regulation, PBS found that, according to a 2024 Senate investigation, “children in residential treatment facilities are sometimes subjected to abuse and neglect.” In 2022, The Nevada Independent reported that “Nevada has routinely failed to provide adequate treatment and services to youth with behavioral health disabilities, instead over-relying on institutional settings such as hospitals or residential treatment facilities to a degree that likely violates federal law.”
The ADA and FHA (Fair Housing Act) protect patients' rights to be allowed to be in residential areas, and prevent discrimination against those with disabilities—ensuring that everyone has a right to live in good neighborhoods. The state that licenses these homes can shut them down if the operators are unable to properly manage the patients. But that would require regulation, oversight, and accountability that the state doesn’t seem to have the resources to support.
What Happens When Kids are Sent out of State?
To combat the limited adolescent mental health treatment options and shortage of psychiatric residential treatment beds, many Nevada youth needing psychiatric residential treatment are being placed out of state and far away from their homes and communities. According to state policy, a child may only be placed in an out-of-state facility if they have been denied placements in Nevada or if the state does not offer adequate services to meet their needs. Here in Nevada, many youth are taken to Texas, Utah, or Arizona, and some are sent as far as Florida.
Nevada DHHS used to publicly report on out-of-state residential treatment centers. As of September 2023, the average monthly out-of-state patient count was 86, and the average monthly out-of-state spend for the previous 11 months was $1,076,371. But the State has since stopped publishing these reports, and cumulative information about the total number of children in residential treatment facilities is no longer publicly available. According to a legislative audit report, as of June 2024, the total number of children in out-of-state facilities was 59. The audit also noted “concerns at 18 facilities related to fire safety, 11 facilities related to denial of rights reporting, 7 facilities related to mandatory reporting requirements, and 6 facilities related to fingerprint submission documentation.” However, the Nevada Citizens Portal noted that “the audit also reviewed 2,039 complaints forwarded by facilities during the fiscal year, finding inconsistent complaint reporting and recordkeeping practices among facility types.”
Regardless of the exact number of placements, the fact that Nevada’s overall ranking for youth mental health is still dead last is telling. Every out-of-state placement:
Removes jobs from the State
Fosters needed Skills outside of Nevada
Moves Medicaid and Insurance payments out of the State
Separates children from family and support systems
Often retraumatizes already vulnerable youth
Spindler states, “The notion of sending kids hundreds of miles away from their home is completely antithetical to quality care for kids - why? Because it retraumatizes children.”
Changing The Approach
When treating youth mental health, the Nevada Independent’s investigation found that, “Children served in the community typically experience a decrease in clinical symptoms, an increase in emotional strengths, better school outcomes and fewer suicide attempts… On the flip side, [poorly run] residential care is associated with “significant harms,” including higher rates of abuse, delayed development and emotional attachment disorders.”
Spindler finds that many of the new residential treatment facilities in Nevada run as for-profit businesses that prioritize profit over safety. Residential care is a particular challenge because organizations are working with the most seriously challenged young people who were just in a hospital and getting reimbursed at a fraction of the rate.
“The goal should always be keeping kids in the community with family,” Spindler explains, “but there will always be some youth whose level of acuity requires a period of care out of home. That care should still be in the community when possible.” To provide the best care possible, Spindler believes in the sanctuary model of care, developed by Dr. Sandra Bloom, designed to create a healing, safe, and therapeutic community, and utilizes trauma-informed and evidence-based approaches to treat patients.
Maral Saccoyan, the Regional Director of Business Development at Thrive Behavioral Hospital, who has seen adolescents in crisis daily, explains that “having resources like the psychiatric residential treatment facility (PRTF) that offers comprehensive services is essential. When parents don't know what to do with a child who may be suicidal, if they need that intensive care, where are they supposed to go? It needs to be kid-friendly. The hospitals are often not kid-friendly. The institutions are not kid-friendly. And there is no continuity of care.” Thrive is one of the few PRTF options available for adolescents in Las Vegas. While they offer structured programming, academic support, and family resources, the public and charter schools students attend often have no support at all.
What’s Next for Adolescent Psychiatric Treatment in Nevada
In January 2025, Governor Joe Lombardo announced the launch of the Nevada Health Authority as part of a reorganization of the state’s health agencies. Stacie Weeks, Director of the Nevada Health Authority, and state lawmakers have begun making changes to funding and policy for youth residential mental health services. By July 2025, oversight of Medicaid and licensing was streamlined under the Nevada Health Authority through the Bureau of Health Care Quality and Compliance (HCQC). The Nevada Medicaid Fraud Unit has already reported improvements.
In Reno, 2 News announced that “Molina Healthcare of Nevada gave $50,000 to Thrive Wellness of Reno to support their innovative behavioral health services for adolescents and adults experiencing OCD, anxiety, and eating disorders. The grant will help fund the development of a 24-hour residential treatment center, scheduled to open in early 2026.” Molina explained that by providing such comprehensive care, the facility will enable Nevada residents to stay local while obtaining treatment. Spindler feels the same, saying, “One stop shopping, that’s what we need in Nevada.”
The Las Vegas Review-Journal announced that “Nevada lawmakers approved nearly $485,000 in funding to regulate an operator of youth residential mental health facilities in Las Vegas.” Still, enforcement continues to lag behind the number of complaints. Unlicensed homes remain open. And placing oversight of state-run facilities within the same agency that regulates them raises serious conflict-of-interest concerns.
Nevadans have stepped up to make these problems publicly known so action and accountability can happen. The Nevada Citizens For Public Health Oversight and the soon-to-launch Four Horseman Media Group are designed to increase oversight and promote health and wellness across Nevada. As these stories continue to come to light, so will the need for oversight, accountability, and the change that Nevada desperately needs.
If Nevada wants lasting change, next steps might include:
A mandatory public registry of all licensed residential facilities
Cross-reporting requirements between hospitals, ADSD, and CPS
An outside entity to check the facilities that do not have a conflict of interest.
Increased funding for inspectors and unannounced site visits
Penalties for hospitals and referral sources that discharge patients into unlicensed homes
A task force that is tasked with building a youth mental health infrastructure, including a full continuum of care, in Nevada
Nevada can protect patients, keep adolescents in the state, and comply with federal law. But it will take consistent enforcement, transparency, and the political will to fix a system that has been failing quietly for far too long. Reform requires laws with teeth, enough inspectors to enforce them, shared data across agencies, and accountability for everyone involved—not just the facilities, but the systems feeding them clients. Together, we can transform youth mental health in Nevada and ensure that by 2035, our youth mental health ranking finally sees real improvement.
