WMH Season 2 Ep 10: From Colorado to Las Vegas, Mental Health Treatment and Access

This is a transcript of Watching Mental Health Season 2, Episode 10 which you can watch and listen to here:

Katie Waechter: Hi everyone. Welcome to another episode of Watching Mental Health. And this is a really exciting episode because we are going to really dive more into I think, the differences in mental health access and treatment in various states and I think get some good questions answered. And so I'm really excited to introduce this guest. I first met her out networking here in Las Vegas at a local mental health networking group. Her name is Melissa Riggins and she grew up outside of Cleveland, Ohio before she began her journey out west.

And like many of us in mental health, she comes from a family where substance use and undiagnosed mental health issues were present. So she grew up and really experienced that. And then she grew her profession in Colorado living with her husband for eight years before they decided to then move out to Las Vegas where she ultimately launched her private practice. And today we're going to talk about what she's seen as a mental health professional both in Colorado and in Nevada, and her perspective on how we can make a difference, I think here in mental health treatment and access from a provider's perspective. So I think this is going to be really powerful. So let's bring on Melissa Riggins and welcome to the show.

Melissa Riggins: Hi Katie. Thank you for having me.

Katie: Thank you so much for being here, and I'm just really excited, like I said, to see you and to talk to you. I remember when we first met, I just jumped right in asking you all sorts of questions about your thoughts on treatment here in Nevada and where you've come from. And so before we get into all of that though, I want you to tell me a little bit more about who you are in your own words.

Melissa: Yeah, absolutely. So as you had shared, I'm married. So my husband and I, we have a three and a half year old son and we have two dogs who we love dearly. We're very active as a family. We really enjoy getting out in nature and hiking and just really connecting with others. One thing that I'm very passionate about is really fostering relationships that I have with people that are meaningful in my life and creating safe places for them and safe spaces for 'em. So outside of being a therapist and that being my job is to create safe places and spaces for people, I do that with all my friends and loved ones in my life as well.

Katie: That's beautiful. I love that. I have always said that I think it takes a really special person to be a therapist. When I grew up and went to college and was a BA in psychology was a major in psychology, I learned that I didn't think that I was able to really do that because it is a hard job and you do really need to hold these safe spaces for other people and it's really important to do that. I think valuable. It's authentic, it needs to be authentic, and so I just always commend the therapists of our world. Thank you. Definitely. So I did mention in your bio that that's kind of been the background. You had a family with substance use and potential mental health challenges. So with that, can you tell me a little bit more? Was it that made you get involved in mental health or what was it that really made you decide to say, I'm going to go ahead and pursue this path?

Melissa: Absolutely. I always knew that I wanted to be in some sort of helping profession. At first I thought maybe it was within the medical field and I explored possibility of going into nursing or becoming a doctor of sort. And so then moving out and started college, I started on that nursing path and very quickly realized that I was way more passionate about psychology and helping people and connecting with them on a real personal level.

So it was pretty early on in my college career that I determined this is the path of mental health that I would really like to do. And through my own history and my family history and background, I also knew that I wanted to really specialize in family systems and dynamics as well as specializing within the substance use arena. For so long it's been stigmatized that substance use is a singular person problem, but we know that that's not the case. We have an identified user or person that is actively using the substance, but it is a systems. So based off of my experience and my growing up that childhood, I knew that I wanted to help people within that regard and help families with loved ones that had substance use in there to really create a different life for everybody involved so that no child had to repeat the history that my brother and I went through.

Katie: Yeah, yeah, definitely. And what brought you out to Colorado to start your career in this area?

Melissa: Absolutely. It was a coincidence that we moved to Colorado. I did my undergrad and my graduate program in Arizona up in Flagstaff. I met my husband at Northern Arizona University and as he was completing his degree, he had to do an internship and there were a couple of different options there, which ultimately led him to, it's called Walking Mountain Science Center. It's a naturalist resource outdoor thing in Vail area in Colorado. So it's a happenstance that we moved there. So we moved there for him. I got really lucky and found a community mental health agency that was hiring that I was able to work at as well as complete my internship for therapy for. We moved there for him and we stayed for me and I spanned everything in there. I started as a case manager and intern. And when I ultimately left that agency after eight years when I moved here, I was in that position of a program director. So I really did kind of everything within that agency.

Katie: Yeah, that's cool and pretty awesome that you wound up in Colorado because you all love the outdoors and Colorado's a great state for that.

Melissa: Absolutely. And prior to moving there, I had never been there before. We moved there in May of 2015 and we had first visited, or I had first visited in April to find a place to live. So it was a big move all at once, and I dove right into really addressing mental health in a resort rural community. So very small town that did not have a lot of resources.

Katie: Wow. Wow, that's really interesting. So I know that the statistics tend to go that where you do your internship or your apprenticeship is where you wind up practicing. And it sounds like you did do that for eight years. I think that that's really interesting. You wound up in a rural area because rural mental health and how you treat that is different than urban because the resources are so more lacking, I think, in that rural environment. So tell me more about what the system was like when you came in and was it good, was it bad? Was there room for improvement from a rural setting? Because I think as in Nevada, that's a big problem is our rural settings. And so I'd love to just see what you saw in Colorado in a rural place.

Melissa: Yeah, absolutely. So as I was stepping into these roles and positions, the agency that I was at was already in the process of building a lot of these relationships. They already had fabulous relationships with DHS and the local probation and juvenile probation. So we already had these pieces in place. We were working with the schools to really provide those services as well. So as I transitioned in there, it was still building those relationships and building programs with them.

So I came into a place that was already developing, so speak, and throughout my tenure there, I sat in regularly on child protection team meetings and being able to check in on that side of things and how we can support clients and families that are going through that process. We were actively involved with the probation, both adult and juvenile. We ran the agency that I was at myself as well, ran a DUI therapy group. So we had a lot of those pieces, but inevitably it also became too much because at that point we were the only agency that was really doing all of these things. So throughout that piece, there was marijuana tax dollars that came in that was now funded or funneled to fund mental health, which then allowed for other programs to be created so that the agency I was at was not the sole person providing all of these things. That was also crisis response. We were in the schools, we were responding to hospital settings if somebody was in a mental health crisis. So throughout that, I also watched and helped navigate through responding to suicides in the school. There was a co response model between mental health and law enforcement, so that if there was a mental health emergency, we were able to go out with them and provide them with the support that they needed, the individual with the support that they needed rather than getting a legal charge for having a mental illness.

Katie: Wow, that's cool.

Melissa: And then just also being part of different work groups, and there was a really heavy emphasis on getting as many people trained as possible in mental health first aid. So being a mental health first aid trainer and going to different agencies and schools and just within the community, being able to provide that. So yes, it's a small community, but we were trying to bring all these resources there and it worked quite beautifully with everybody working together towards a shared cause rather than people competing for one thing, everybody was just working together and it was a really cohesive model. And even when other agencies came in or new programs came in, we would shift and we would all work together. We're all there serving the greater good. Even in the small resort community, rural community, there's enough clients to go around. There's enough people that you don't have to fight each other, that you can work together.

Katie: Yeah. Wow. You touched on a few really amazing points, but it sounds to me really what you had was a budget, a little bit of a budget when the marijuana tax dollars came through, which is unfortunate because here in Nevada, they promised that that money would go to the schools and us locals are all like, that didn't happen. We don't think that happened. That money went somewhere else. But then you also had collaboration and partnerships,

You were bringing together not only resources that require dollars, but then also free resources that people could use. Mental health first aid to get trained in that is a big deal. Wow. Okay. So you do all of this, you see this build. I mean, you were in a place with a foundation and then you move out even further west, southwest to Las Vegas. So before we get into what the differences are there, first, what brought you out to Las Vegas?

Melissa: Again, another move that had to do with my husband, he kind of made a career switch and we moved out here again for him. Funny enough, he had never been here prior to us moving, but I had been here just a couple of times. Touristy thinks,

Katie: Yeah, it's fun, right? A little fun Las Vegas, but never as a local. You probably had never seen outside of the strip or downtown or the big Texas. Yeah.

Melissa: Yeah. That's so interesting. Culture shock. When we moved here as well, coming from a really small rural area into Las Vegas where the sun goes down, you can't see the stars anymore. Very different. That's

Katie: True. And traffic all times, day and night. And the traffic's just gotten worse. Worse. I'm sure it's so different from the rural Colorado traffic. Yes. Our traffic jams are caused by elk. Right. But what I will say, actually, before I jump into the mental health stuff, is a lot of people don't realize how much outdoorsy opportunities we have here in southern Nevada too. Have you found that? Have you noticed that? Have you been able to tap into some of that?

Melissa: We have, and one of the things that we recognized is we really just had to switch our seasons for everything that we're doing. Where summer, we would be out hiking in Colorado and really enjoying that, but go hiking here in the summer. No, thank you. So we've just had to shift our seasons.

Katie: Right, exactly. And map Charleston's a little Cool. But I mean, yeah, dead of summer, August, we don't need to be outside. We don't know that. So you moved here and I'm sure it was a big culture shock, but also a big professional culture shock because Nevada, we are one of the worst states as far as mental health access goes. I think part of that, a big part of that is our rules, but I think also in general, I have noticed in the mental health field that we work in silos that there's a lot of competition where there doesn't need to be because there are a lot of people who need help. But I just want to get your perspective coming from that Colorado rural town here to Nevada. What are the differences that you've seen? And yeah, just tell me more about that.

Melissa: Yeah, I think you hit the nail right on the head. It was coming out here, I had this idea that it's a bigger city. There's going to be more resources, there's going to be more, be more robust. And when I had first moved out here, I still had some remote work with my last agency as I was transitioning out, and I had some part-time work here at an agency. It was very siloed competition. That was one of the first things that they had told me was this is our competition in referring to other agencies that were providing a very similar resource. So that was like, that's a little bit weird that there are plenty of people that can benefit from this. We don't have to be in competition.

And then I transitioned into another role with a different agency and very much the same thing of it's competition. It's siloed. And even within that agency, while there was multiple clinicians, probably about between 16 and 20 clinicians, and they were serving the schools, the clinicians in the agency were siloed from each other. Despite my best efforts to try and bring 'em together, they were just siloed and really didn't want a whole lot to do with that, which I found very shocking and interesting. Being in a people profession, you would want to connect with those around you. You want to have somebody to debrief with so that even in the agency settings that I was at, they were lacking in that supervision, that just case consultation, providing that support for the clinicians that they so desperately need so that they can continue to serve the population in a way that is ethical. So that for me was a really big shock. And also what led to me taking a step back from that agency and both of those agencies that I worked very hard for my licensure that I was not going to jeopardize it for unethical practices that I was seeing.

Katie: For sure.

Melissa: Some of the other things that I saw here was looking for resources, things that I thought would be present are not here, where are they? Yeah, I was disillusioned to my own thinking when I moved here. So that was very shocking to me of just seeing all these different resources that within this really small town of Colorado that we had, I just assumed that they would be here. They're not. And that was really disheartening for me. So also recognizing, shifting into private practice. My passion is to provide quality mental health treatment to those that need it. And really putting out into the community. I'm not in competition with anybody. Yes, of course, for me to be successful, I need clients, but I also recognize that if somebody's coming to me and they're outside of my area of expertise, I'm going to refer them to somebody else. I don't need to keep them just to be in competition with somebody else to spread the love. So that was also very interesting to me. Just that competition feeling of within those agencies where they're there as a safety net, but they're really not providing that safety.

Katie: They're not doing that. Yeah. So is that what led you to then create your own practice? You were kind of disenfranchised or disenchanted, like you were saying, buy it, and so you're like, I'm going to step back and step into my own. Is that what led you that direction?

Melissa: Yeah, absolutely. That the experiences that I had at the last agency that I was at here were just so, they broke my spirit in a way, and I really had to take a step back and question, is this what I want to do? And it took some introspection. I love helping people within the work that I do outside of the work that I do. I just love helping people. I love being there for people. And it was a really, really sad realization that I had allowed somebody to take that away from me for that time that I lived there. So being able to regain that and just putting back out into the community of I know that I'm going to help those that I can and I'm going to connect with them and I'm going to give them the time that they deserve. I'm not going to rush them through cattle or try to fill up as many spaces as I can because that's doing a disservice to the community.

Katie: Yeah, definitely. And I think it's really important that you're here. You came into a place that doesn't really have a foundation, but still really needs a lot of help. And so I think it's valuable that you were able to refine your love so you could continue practicing and continue helping others through their journey. And so you were talking to me a little earlier off camera about this. So you have clients both in Nevada and Colorado right now, right?

Melissa: Yeah, that is correct.

Katie: Yeah. So what is that difference between treating your clients in Nevada versus in Colorado? Are there any technical differences or are maybe the things that you're talking about with your Colorado clients different than your Nevada clients? Are there any differences there at all

Melissa: As far as presenting issues and things that we're focusing on technical pieces? Not a whole lot of difference there, but one of the things that I did share was the inequity of how my caseload is balanced. Where about 85, 90% of my caseload is individuals from Colorado, and I really only have about 10 to 15% of my clients who are here in Nevada.

Katie: So why do you think that is?

Melissa: I think that at a state level in Colorado, there's a larger push for mental health that they're putting in behavioral health authorities. You have so many different things in place. And while within my small community, yes, mental health first aid was a push there, but even at the state level, mental health first aid was a really big push. So they're decreasing the stigma

Within the state of Colorado. They're talking about it. It's not this, oh, you are crazy, you need to go to therapy. It's that idea of you are a whole person. You need to take care of your mental health as much as you do your physical health. And I've found here that whether it's, there's stigma attached to it or just unaware of the resources that are available. I'm not seeing as many individuals from Nevada. But interestingly, the clients I do serve in Nevada, maybe about three or four of them are here in Las Vegas. And the rest of my Nevada clients are up in Reno, Carson City, Tahoe. They're up in northern Nevada where it might just even be culturally a little bit different up there.

Katie: Yeah, that's interesting that you touched on that actually. I was speaking with someone recently who mentioned that Northern Nevada's mental health system is a little bit more put together than Southern Nevada's. And it seems like, yeah, there's more communication and that communication helps to break down stigma. And so that is interesting that that's how that's kind of shaken out. And I think that you're also right. There's people who are struggling and they don't know how to reach out. They don't know where the resources are. We really don't have a place where we bring all the resources together. Nevada two, one exists, but it's completely outdated and people get, I even

Melissa: Had a hard time navigating that. And I like to think of myself as fairly high functioning,

Katie: Right? You have a master, you've done stuff. So just imagine if you're in a crisis, and I think that's something that we talk about, we would say, oh, there are some resources here, but how accessible are they really for people who are in a crisis and for the people who are trying to help them. It's such a big challenge.

Melissa: Another stark difference that I noticed too, especially being suicide prevention and awareness month, that where I was previously there would be posters and signage and all of these different things about suicide prevention. And it wasn't 9 88 yet, but the numbers that you can call and who you can contact if you're experiencing suicidal ideation, just driving around, I haven't seen anything of that sort here.

Katie: No,

Melissa: And that's so important that if somebody's experiencing suicidal ideation, they're having that crisis. It's good to know who to call

Katie: Because

Melissa: Nine one one's not always the option there.

Katie: Exactly. And nine, eight eight's been around for over, I think a little over two years now.

Yeah, I mean I talk about it all the time, so I think that we all know it, but I regularly running into people, professionals, even in the mental health space that are like, oh, I've never heard of 9 88 before. And it's like, what are we doing? And I know here in Las Vegas, I think we have an extra stigma on suicide. Our casinos don't like to talk about suicide. We do have a lot of people who come to the state and unfortunately attempt that on their lives, and we just don't talk about it as a community. Suicide in general, I think we're getting better at talking about substance use, but it is a slow, slow moving giant here in Nevada.

Melissa: And that brings up a really excellent point. So again, within the state of Colorado where I was the I 70 corridor and historically, and there's a couple articles around that, that it's known as the suicide belt, that there disproportionately is a higher number of suicides in that stretch of the country. There's a lot more isolation there, lack of resources, all of these different things. And so it's something that's really prevalent, but as a community, we talk about it or they talk about it. It's at the forefront of everything. When there is a crisis, you have mental health responders there. If there's whatever it is, you have those resources present.

There's also very regular parent educationals, if you will. So I think once a month you have a professional come in and you talk about a topic, whether it's social media or suicide or just being a connected parent, that those are pieces that were there. They're talked about. They're not ashamed. We don't need to brush it under the rug. This is the time for us to really bring it out and talk about it and bring it into the light because we know that it's happening. And so if we talk about it, it shows that other person that it's okay that I'm a safe place that you can come to and talk about this with. And I'm not going to shame you. I'm not going to tell you that this is a bad thing. I'm going to help you through it.

Katie: Right, exactly. And I think you touched on another big challenge that we have here in southern Nevada in particular with such a large school district, it's hard to get into the schools, it's hard to get access to the parents. It's hard to get training for the students. It's hard to get mental health first aid going consistently. And lots of groups try, because I know I talk to them, and Clark County is notoriously difficult I think to again, make change. So I think as Nevada, we are a slow moving state because we are a little bit of a smaller state, and our legislative session is every other year, but there are still people who are here trying to make a difference. And so I am glad that you're here doing the hard work. I think that it'll be valuable to continue to talk to providers like you because seen a system works, and I think that that's important. We don't need to reinvent the wheel. We need to find what works for us as Nevada. I know that we can't just take from another state, but we need to also not just do it from scratch, get that foundation,

Melissa: And of course there's going to be pain points,

Katie: But

Melissa: It's really putting the community first. You're serving this community, whether at a political level, these are your constituents. Let's serve them. Let's make sure that they have what they need to really be their best selves.

Katie: Absolutely. Well, we're right at time, but before I end, I do want to ask you one more question and then also lead you into talking a little bit more about how people can reach out to you if they're searching for help for themselves or a loved one. But talk a little bit about reimbursement rates. Did you experience reimbursement rates in Colorado when you were with facilities? And you don't have to say too much if you don't want. I know it can be a touchy subject. So do you know the difference of reimbursement rates between Colorado and Nevada, and is that what led you to ultimately, if you did decide to go cash basis as many of our therapists, was that a part of that decision? So just talk a little bit about that as we wrap up.

Melissa: Yeah. As far as an agency setting, I was not privy to what those reimbursement rates were, but currently in my private practice as I do provide services in both Colorado and Nevada, I do have cash pay options, but I am also credentialed with a number of different insurances and the reimbursement rates. While they're not the greatest, because we know that for mental health reimbursement rates are relatively low comparatively, but the reimbursement rates are the same between Nevada and Colorado. So that is good to know. Other states definitely fluctuates with where you are within the country, the insurance providers that you're credentialed with and how that all shakes out. But as far as currently, those reimbursement rates look about the same.

Katie: That's really interesting. Thank you for opening with that. I know not everyone likes to talk about reimbursement rates, but it is a challenge and I know that they're not as much as they should be. So it sounds like, and I think that's wonderful because a lot of therapists here in Nevada have wound up going only cash basis because it has been difficult for them to work with the reimbursement rates and to make a living. So it sounds like you do both, and I think that that's really wonderful that you do.

Melissa: And I do both because not all insurances provide mental health benefit.

Katie: Yeah, exactly.

Melissa: Being able to diversify. And as a licensed marriage and family therapist, not all insurance covers couples therapy either,

Katie: Right?

Melissa: Wow. Not all benefits are created equally.

Katie: Yeah, that's true. Well, this was so insightful for anyone who's listening who may be struggling or who has a loved one and would love to get connected with you, and to learn more about your services, tell us the best way to get ahold of you, what your specialties are and what insurances you accept, and just, yeah, so someone knows how to reach out if they need to.

Melissa: Absolutely. Best way to get ahold of me. So go to my website, which is melissarigginscounseling.com. There is a link on there where you can email me. I believe my phone number's on there as well. So you can just reach out to me from there. And then as far as my areas of specialty or my niche, if you will. So as I mentioned, I am a licensed marriage and family therapist, so I do specialize in working with couples who really run the gamut of whether it's a communication issue or concern too. I've worked with infidelity and have training around that piece as well for individuals. I specialize in depression, anxiety, mood disorders. I have some significant training and trauma as well. And part of my licensure as well. I'm also a licensed clinical alcohol and drug counselor, or a licensed addiction counselor in Colorado, as they call it. So I do specialize in substance use as well. With that, if there is substance use on board, there's likely going to be some additional treatment that you're receiving outside of just traditional outpatient.

Katie: Yes, yes. Yeah, that's as we've discovered, substance use usually comes with other problems. So I think that's really great. I love the direction that we're going as a culture. I know that it's slow moving, but it's valuable. You offer teletherapy services, which is amazing. I know a lot of people can maybe only utilize that, especially in our rural, right? So again, thinking about our rules that isolation, I think a big reason why Nevada suicide numbers are so high is the rules. So it's a big deal, all that isolation. So I just really appreciate your time for just allowing me to get in there and really ask you all these questions. I've been so looking forward to this conversation, so I am really grateful that you joined me.

Melissa: Likewise. Thank you so much for having me. I appreciate it.

Katie: Of course, of course. And then for anyone who's listening, we are live here every first and third Wednesday, but you can always check out our episodes at www.katierosewaechter.com  as well, and on my YouTube and Spotify. So thanks so much and we will see you all next time. Bye everyone.