What can mayors do to address mental health?

Reno Mayor Hillary Schieve talks mental health, homelessness and the challenges facing cities.
A photograph showing Reno Mayor Hillary Schieve, along with several other mayors, sitting at a long table, with House Speaker Kevin McCarthy at the head
Reno Mayor Hillary Schieve, and other mayors from around the country, met in Washington, D.C. to advocate for stronger federal support to address mental health in cities. Photo courtesy United States Conference of Mayors

Reno Mayor Hillary Schieve was in Washington D.C. earlier this year, as part of the United States Conference of Mayors, to advocate for stronger federal support to address mental health in American cities. But, what can mayors really do to address the issue?

Executive Editor Noah Glick recently caught up with Schieve to talk about how to increase access to mental health care, especially among those experiencing homelessness.

Interview Transcript

Noah Glick: Let’s talk about the United States Conference of Mayors. The [annual conference] event happened a [few] months ago, back in the first weekend of June. What is this conference all about? What did you guys talk about? What are some of the ideas and solutions that you’re hoping to bring back to Reno?

Reno Mayor Hilary Schieve: We really talked about obviously what’s happening in all of our cities, what’s working in our cities, what isn’t working in our cities. It’s a very special time, because mayors from across the country get to convene, and come up with solutions and platforms for getting onto the Hill [Congress], and working with our federal delegations. But also, just collaboration across the country, so we’re all on the same page. It’s one of the reasons why mayors are typically very strong, because we do band together.

And what we do find out (I don’t know if this will surprise people) is it doesn’t matter the size of your city, we’re all dealing with the exact same issues typically – whether it’s infrastructure, public health, housing, crime, all those things. Like I said, it doesn’t matter how big or small the city is. Every mayor has the same exact issues.

So, when we get together, it’s really an important time to collaborate and figure out what’s working, what isn’t working and the vision as we move forward. Mayors, we’re at the ground level, our jobs can be incredibly exhilarating, but incredibly difficult to at the same time. I think we have a different perspective, being local government. And cities are 24/7, no disrespect to counties, but counties are, they’re a little bit more 9-to-5. They don’t like it when I say that, but I think it’s just a different aspect of local government.

So, I think in the pandemic, a lot of people saw mayors sort of the ‘go to’s’, in different cities and states, so leading the way across the nation. So, it’s important for mayors to convene and collaborate.

What were some of the big themes, what were some of the big issues? And were there any sort of solutions or ideas you’re hoping to bring back?

Yes, so infrastructure is always a big one. Obviously, with the ARPA [American Rescue Plan Act] dollars, it’s really critical to figure out what is the best way to spend that money, because it’s got a lot of stipulations with it. For me, it’s mental health. As the president of the Conference of Mayors, I think it’s the No. 1 issue in America: mental health and addiction. I think we’re probably 30-40 years behind, but I see it as the No. 1 crisis in our country.

And if you really think about it, if you don’t have your mental health, what do you have? You have nothing. You don’t have education, you don’t have infrastructure, you don’t have strong public infrastructure, public health infrastructure. So many things depend on strong mental health.

This country is really, really struggling and the policies that we put in place have completely failed. So, we need to admit that and take a completely different approach if we’re truly going to get serious about how we tackle this massive, massive crisis. Obviously, infrastructure, climate change, public safety, all of those are top tier topics at the Conference of Mayors.

I do want to ask you about mental health. I know that it’s not fair to necessarily lump Reno in all of this, because all of Nevada’s counties are federally designated mental health provider shortage areas. The state of Nevada actually ranks last in mental health metrics, like access to care, high prevalence of mental illness. And that’s all just to sort of set the stage of the challenge we’re facing here.

I know that the city of Reno and you have been advocates to try to get more access to mental health. I’m thinking of the contract during the pandemic to give folks 13 and over free counseling via Talkspace. The critics of that would say, ‘Well, that’s an out-of-state, corporate thing that could have gone to locals, and it’s a one-year contract.’

That was one idea. What can the city of Reno do moving forward to help address mental health and mental health access?

Well, first of all, I do want to say it’s important to always have your local providers at the table, more challenging in a pandemic because a lot of people were not comfortable going in person, right? Or there’s other issues of why someone might not want to go seek therapy in person, right? The stigma, there’s a huge stigma. I would say part of that technology also really was where you can have local providers actually; they just have to sign up on the platform, which is really good, right? And also, you have to be licensed in that state, and so there are requirements. So, I thought it was best of both worlds.

And of course, I think anything you do, you’re going to get criticized. That’s especially so if you’re in government. Everything that we do, we get criticized, and that’s okay. Sometimes that’s how you get better. That’s how you expand. It’s also how you bring in more people. I’ve really connected with a lot of the therapists and psychiatrists in our community, whenever we did that.

And also in the pandemic, we were so used to dealing with our public safety experts. We’re so used to fires and floods and things like that. Never before did we work with physicians and epidemiologists or had them at the table. That was a major shift and I think it opened a lot of our eyes to see the lack of public health and the infrastructure. It’s one of the reasons why it was so hard to tackle a pandemic, right? So, I think it teaches you a lot, even though it might not be perfect, but it’s okay for people to criticize. I think that’s how you get better.

As far as mental health goes, everyone should have access and I think every school should have walk-in therapists, like we have emergency ERs [emergency rooms]. Why don’t we have emergency mental health facilities or programs where you literally can walk in off the street? That is not the way that it is. Right now, we continue to treat some of our sickest patients dealing with mental illness and addiction in our jails and in our hospitals. I always talk about our hospitals are where they fix broken bones, not broken brains. It’s a very, very complex problem, and it’s one of the reasons why I think a lot of people have not wanted to even touch it for so many levels.

One size doesn’t fit all. You can’t just say, ‘Hey, we’re going to build a homeless shelter right here and that’s going to going to take care of everyone.’ I think you have to holistically diagnose each individual. Not everyone suffers from the same ailment – whether it’s schizophrenia, bipolar, depression, those kinds of things.

Or, when we talk about homelessness, you cannot say that everyone is homeless for the same reason. There are a lot of seniors that we see that can fall right into homelessness, because they’re living on such tight, fixed incomes. So, to me, yes, it’s going to be very intensive. It’s going to be incredibly expensive to diagnose each individual, but that’s really the only way that we’re going to be able to comprehensively figure out what services they need, where they need to be and how to treat and diagnose the problem.

Well, I guess I’m curious then… what can the city of Reno, or cities in general, do to incentivize more mental health providers, or to help create more access for mental health? I know it’s not an easy solution. Is the answer just more money?

No, actually. Everyone’s like, ‘We need more money.’ Well, yeah ok. That depends on what you’re looking at, right? You need more money obviously, if you’re going to build infrastructure. The other thing I don’t think people realize, is that when the federal government gives that money, it goes to the state. It never hardly ever comes into the city. And remember the city is where we are dealing with these issues at ground zero. So, we need to figure out a much better way to allocate it.

I’ll just give you an example. I’ve been working on a 24/7 crisis mental health center for six years, and that money has been sitting at the state for six years. It’s just taking way too long to get it into the hands of where we need it to go, where we can act fast and frequent. And then also typically, the funds will go to the county, they don’t go to the city, and we need to address that as well. Because it needs to be equitable. That way, again, we can take on these initiatives, because we know it’s there, but the way that it’s allocated, it isn’t helping our cities in the way that we need it to.

You talk about providers, right? How do we incentivize more people to go into mental health? There [are] a few ways. I think you have to get to these students and incentivize them and say, ‘Hey, we would like to help you with your tuition. How can we incentivize you to go into this space?’ We’re already going to lose a lot of care providers already. So, I think we have to incentivize them and work with our universities. And honestly, look at how we can give them access to credits and things like that, that can help in exchange. Our push is going to be for 100,000 providers in mental health.

There’s another thing that’s interesting that we learned in the pandemic, something that we didn’t know (but we did waive it at the time, and it should be long term), and that was bringing in providers and specialists from outside our state. So, if we want to make it easier for people to go into healthcare or for physicians to come into our state, then we need to get rid of the red tape, that they need to have, this licensing. There should be a license across the board now more than ever, when we see the shortages.

I’ll add just because I I’ve got some experience and I’ve talked to folks in this realm. This isn’t necessarily a local issue, but nationwide. There’s an issue with Medicaid as well, where providers who take Medicaid clients, if those clients don’t show up, the providers don’t get paid. And so, a lot of providers are not interested in accepting Medicaid clients. That goes back to a lot of the folks who may be on the streets or [are] low income.

That’s why I was saying when we started out how complex this is. It isn’t one single issue. It’s a lot of different issues that have this sort of combination effect, this perfect storm. And to your point, this affects all of the country. This is why we collaborate with mayors to find out what are the issues they’re seeing. They’re seeing the exact same thing.

You touched on Medicaid. The other issue is they pay some of the lowest rates, so a lot of people don’t want to accept it and that becomes extremely problematic. So again, there’s a lot of inequity in mental health care, and until we bring that equitable, it’s going to be very, very challenging. But that’s what mayors are doing on the Hill, we’re advocating as much as we possibly can. Again, I think it’s [mental health] the No. 1 crisis and I don’t see right now at this point, it getting better. If you just walk on a city street in any city, you can see people that are seriously struggling and need help. And to me, to allow to leave them on the street is incredibly inhumane.

I want to ask about that because you did talk about that in a MSNBC appearance back in June. And actually, I rewatched it today… I want to read this this statement that you made during that that speech.

You said, “The policies we’re using today are very, very broken. Treating our mental illness in our jails is absolutely not working and quite honestly leaving people on the streets. The way that we see our cities right now is very, very cruel, inhumane and we need to do something completely different.”

Reno Mayor Hillary Schieve discussing mental health, homelessness and the challenges facing mayors in a June appearance on MSNBC.

So, I have maybe a more policy wonk-ish kind of question. What can we do moving forward? Because when I when I think of homelessness in the city of Reno, I look at some of the decisions being made – whether it was the removal of the benches from the downtown bus station or the demolition of weekly motels throughout the city. I’m just curious to know, what is the city of Reno doing to try to address homelessness? And what kind of policies would you advocate for?

Well, again, it’s not just one thing. I mean, looking at low paying jobs, and then not being able to afford housing. You know what I mean? It’s very, very complex. So, it’s not just one thing, so there are a lot of issues.

I would say, first of all, we have got to build more transitional housing. We do not have the infrastructure in place, and as a country, we are not allocating the infrastructure that we need to address this problem. And one, is to make sure, again, having access to treatment. The drugs today are so incredibly strong. We talk about it all the time: one pill kills, and it can kill hundreds of thousands of people. That’s a weapon of mass destruction. We don’t treat it as such.

And there is a narrative out there. Let’s talk about the motels. Those were built on a 40-year shelf life. I’ve been in them. They were horrific. That is not a way for people to live. I don’t want everyone to think that everyone is a bad motel owner. They’re not. But what we saw was these people [landlords] taking advantage of some of our most vulnerable, charging them $400 a week. Do the math. That is crazy. With bedbugs, 30-year-old bedding, conditions that can make someone so incredibly sick, because they don’t have the money to do so.

You cannot continue to have dilapidated infrastructure and then talk about you know, health reasons, right? And then, we talked about housing, and people will say, ‘Mayor Schieve, we need more affordable housing.’ Absolutely we do. But what people don’t also realize is that you need housing of all types. It’s about economics 101, which is supply and demand. Because if you only have a certain type of supply, the people that can afford that supply will dominate that supply, because they can afford to do so. So, do you see why it’s important to have housing of all types? Because then people get upset about, ‘Oh, you’re building higher-end housing?’ Well, again, those people that can afford that housing, they’re dominating the other housing, the lower-level housing, that other people could afford to be in when you don’t have enough supply and demand. So, housing becomes a very big issue.

And then lower wages like we talked about, right? I’m really impressed with some of the work that EDAWN [Economic Development Authority of Western Nevada] is really dedicated, saying to companies, ‘We are not going to incentivize you to come to Nevada if you don’t pay a certain wage.’ I think the system is very broken. We’ve got to start incentivizing people. What I see happening, there are a lot of people that are working but they make too much money to qualify for a subsidy, and they would never make enough money to qualify for a mortgage. So, all of this is very, very complex.

But I would say we’ve got to start addressing transitional housing, because we, in this country, most cities have adopted the housing-first model. I’ve seen it first hand, it doesn’t work – not for everyone. Some people it works great for. That goes back to my point, diagnosing everyone to figure out what it is that they need. And there’s this big, huge gap of care and long-term care and providers that are going to bring in case management. There are people that need medications so that they can stay stable.

You have to look at the individual, and that’s what we’re not doing. I think we’re really lumping everyone into one box and saying this is what it looks like. Again, it’s going to take a lot of resources. It’s going to be very expensive. But it’s something that we desperately need if we truly want to change the way that mental health, homelessness and addiction really play a part in this country.

I want to just talk about housing for a second. Obviously, you don’t have control over the grand economic scheme of things here. You don’t set prices or anything. You’re not the one who’s in charge of rising house prices.

You mentioned that we need housing of all types, and you’ve got folks who can afford it dominating the market, as you say. But this area is also growing. And so, I’m curious, if we’re focusing or building more of the higher-end or market-rate housing, isn’t that incentivizing essentially more people to come here that can afford it? And it just kind of further exacerbates the problem?

Well, you are seeing a huge influx of people coming here, we saw that during the pandemic. And that’s the other thing, Reno is what they call a ‘breakout city.’ You know, I see your point, but again, it comes down [to] if you have plenty of supply, what happens? Landlords are forced to come down on rent because they’re sitting vacant, right? So, that’s where you start to see the market shift. Again, it’s all in supply.

And then what’s happened is, a lot of people forget, but in the recession in 2008, a lot of people left here because they needed to go find jobs. We [Nevada] were the highest in foreclosure and unemployment, and a lot of people were in the construction industry. So, we haven’t been able to bring them back. Then in this economy, you’re seeing supplies, the cost of wood, be incredibly expensive. So, we’re still not building nearly the amount of housing that we need to keep up with the demand.

Again, to your point, there’s another demand of people from the outside coming here, and one of the reasons why it is attractive is because Reno can provide a great quality of life. Our air quality is really good. Our backyard playground, I say, is one of the best in the country. We kind of have this lifestyle, like best of both worlds, where in the day I say, ‘We work hard, we play hard,’ but there’s a lot of people that come here for a great quality of life.

We at the [Reno City] Council, it’s very hard for us to be able to predict those market conditions. And you have to remember most of housing comes in on the private side. Then today, we do see a lot of what they call NIMBYs (not in my backyard). So, you get a lot of pushback.

That’s why I did an initiative called 1,000 homes in 100 days within the McCarran ring, to build up and not out to avoid sprawl. There’s still a lot of areas in our city that are dilapidated that we need to build up, right? And then I think working as private-public partnerships to say, ‘Hey, if you build this, will you take vouchers?’ We’re doing that a lot at the city. Usually every project that comes in we say, ‘If this is not affordable, we donate to the Affordable Housing Fund.’ Those [are] types of ways in which we can continue to keep building affordable housing.

And how we’ve done that at the city, because we haven’t had a lot of money, when I got into office, we were $600 million in debt. So, it’s very hard to be a player in the space. But, what we did have was land, and most of our land went to affordable housing. And a lot of that too, was trying to find developers that can build it. Not everyone will build it, which is also really challenging. When there’s a few people in the space that know how to do it. They have to go after tax credits. It can be [an] incredibly laborious initiative for a developer to go after. So, it’s not easy, and it takes a long time to put a shovel in the ground. And as you know, prices have gone up dramatically, and cost of land is very expensive.

I’m just trying to put my developer hat on here. If I have a project where my prices and my costs are rising, I don’t see much incentive to build an affordable housing unit; I would obviously want to build a higher-end or luxury one. So, how do you incentivize developers to do more affordable housing? And then also, what kind of impact have you seen from the affordable housing fund that you have at the City of Reno?

Yeah, that’s why we try to come into a project with land and say, ‘Hey, we have land. Is this something that you can do?’ And it is hard because the cost, to pay workers, to get workers, because there are a lot of people working right. So that’s another issue that we see is trying to get contractors to the space, so that’s difficult as well. It’s not just one issue.

Where the city can play a part is looking at land for housing, and then again you say, ‘Hey, can you dedicate so many units [to affordable housing]?’ Because that’s how you can work with them. Or workforce housing. Again, a lot of those people make too much money to qualify for a subsidy and they don’t make enough for a mortgage, so you want to focus on housing of all types.

That’s where the city I think, has been able to be pretty successful is coming in with some of the land, and then also with the ARPA [American Rescue Plan Act] and Cares Act dollars. We bought a motel so that we could do transitional housing there for veterans. Those types of things, because they’re not long-term housing. We did Sage Street, we bought more units coming in from Sage Street, and that’s a pretty big project. I think there’s 300 units right there alone that the city brought in.

Most of the housing doesn’t come in from the government side, it comes in from the private side, and those are the ones that typically know how to do it. It’s not usually a space that the city is in, other than being at the Housing Authority. They’re looking at a very old dilapidated project that has 100 units, and they’re saying, ‘Hey, the conditions of these units are not where they should be for today’s standard.’ So, we’re redoing the whole project and adding another 100 units. So, now that’ll be 200 units instead of the 100 units. Those are the kinds of ways that we need to think forward and more probably in today’s terms.

Hillary Schieve is the 28th Mayor of the city of Reno, serving in the role since November of 2014.

Editor’s Note: This interview was edited slightly for length and clarity.


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