Community Counseling Center has been in a tailspin over the last several weeks.

Last month, the Southern Nevada mental health care nonprofit learned that it could no longer apply to a U.S. Department of Education grant program that helps sustain the group’s adolescent treatment program, which serves more than 350 people at a time. 

It also recently found out about steep cuts to its share of a federal grant program that will result in it ending its psychosocial support and peer navigation programs for people living with HIV, a population that the nonprofit has provided treatment for since its inception in 1990. It’s unclear who made the decision for the cuts.

And at the same time, the nonprofit is also fearing potential federal changes or cuts to Medicaid, which supplies 70 percent of its revenue.

“That's our number one fear right now — is what happens if Medicaid is impacted,” said Executive Director Patick Bozarth. “It would be absolutely devastating.”

Nevada has long ranked near the bottom in nationwide mental health care amid a lack of sustainable funding. But the handful of mental health groups that do exist are facing an unprecedented sense of uncertainty ever since President Donald Trump took office nearly two months ago and set off to reduce the size of government. 

There’s widespread unease as Elon Musk’s Department of Government Efficiency (DOGE) has relentlessly sought to slash federal expenditures while the Trump administration has sought to pause wide swaths of federal spending. Congressional Republicans are also moving forward on a stripped down budget framework that experts say would be impossible to achieve without cuts to Medicaid,  despite statements from GOP officials that they aren't touching the government-funded health insurance program.

A loss in federal funding would particularly harm nonprofits, which rely on grant funding to survive. A recent survey of 160 nonprofits by the United Way of Southern Nevada found that 80 percent of respondents believed their funding was at risk, including 58 percent of health care and education groups.

“The nonprofits in this state are the ones that have held social services together over decades. They have filled in the gaps of services that haven't been there — and there hasn't been money to be there,” said Robin Reedy, the executive director of the National Alliance on Mental Illness Nevada (NAMI). “If we don't have that, people will have nothing.”

Although these moves have not had long-lasting effects yet — no Medicaid programs have been slashed — leaders from six Nevada nonprofits that provide mental health care said it’s resulted in a shift in priority from growth to survival.

One nonprofit applied for nearly 20 non-federal grant programs in the past month in an effort to diversify its funding. Another decided to not pursue a federal grant at all because of the uncertainty. And a third is painstakingly going through how it words applications amid concerns that even the smallest item that does not align with the administration’s priorities might result in a rejection.

“It’s kind of this little gremlin in the back, staring us down,” said Wendy Madson, the executive director of Healthy Communities Coalition, a group that provides mental health services in Lyon and Storey counties.

The potential of funding cuts in the mental health sector has gotten the attention of state political leaders, too. Gov. Joe Lombado, a Republican, urged congressional Republicans last month to not indiscriminately cut Medicaid, writing in a letter that the money has allowed the state to make “significant progress in enhancing behavioral health care for both children and adults.”

The funding uncertainty comes at a precarious time for mental health care nonprofits. 

Demand for their services has exploded in recent years — one group’s non-crisis phone line receives about 7,000 calls monthly, compared with about 200 before the pandemic — driven by the heightened need for mental health care during the pandemic, and some pandemic-era funding from the American Rescue Plan Act (ARP) is due to expire in short order.

Some leaders estimated that their nonprofits wouldn’t survive for more than a few months if federal or Medicaid funding dries up.

“We don't have enough funding already — the idea of cutting is unacceptable,” Madson said. “Our people deserve better. We just can't accept it.”

‘It would kill me’

The Trump administration has specifically targeted diversity, equity and inclusion (DEI) initiatives — and one nonprofit in Reno is worried that it could affect or lose its federal funding.

Step2 provides long-term substance use disorder and mental health treatment to women, particularly pregnant women and those with children. It will be writing new grant applications this summer, said CEO Mari Hutchinson, who is concerned that the nonprofit’s areas of coverage could inadvertently be the victim of DOGE’s funding cuts.

“That doesn't technically fall under DEI, but I guess it could be considered under DEI,” Hutchinson said. “I don't feel like our funding is safe.”

Nonprofit leaders interviewed by The Indy warned of large cuts to their programs if federal grant or Medicaid dollars dry up, exacerbating the mental health care void that exists across the state.

“I believe if there are sweeping cuts, you're going to lose your nonprofits,” Madson said. “And I don't think anybody could understand the impact of that until seeing it because every nonprofit I know goes way beyond their scope and their funding.”

Step2’s full suite of wraparound services — which include transportation to appointments, courses on personal finance and nutrition and workforce development programs — are fully funded by federal dollars.

“We would lose all of the wraparound services that help these women stay clean and successful in our community,” Hutchinson said.

Hutchinson added that the nonprofit’s role in reuniting children in the foster care system with their mothers saves more money than any federal funding cuts would — and she condemned any suggestion that nonprofits receiving federal funds are rife with waste.

“We have to have a very substantial financial audit each year by an external accounting firm that comes in and looks at every aspect of our financial records,” she said. “I don't understand how anybody could be frauding, specifically in our state.”

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"We’ve generally had an upward track record of growth. It would just be heartbreaking to have to take steps back."

Erik Schoen, CEO of Community Chest

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Bozarth, from Southern Nevada’s Community Counseling Center, is particularly concerned about its services to people with HIV and those who are transgender.

The counseling center was founded in 1990 to provide support for people living with or affected by AIDS, as other health groups refused to treat AIDS patients. It offers free and confidential HIV testing and wellness counseling for people living with HIV. In 2023, 14,000 people in Nevada were HIV positive, including 12,000 in Clark County, according to a state report.

With cuts to the organization’s HIV grant funding — called the Ryan White program, which is awarded to Clark County then funneled to other groups — the organization’s support services for people with HIV will decrease significantly.

“It does take away a major part of the organization,” Bozarth said.

The organization also started the state’s first affirmative therapy program — a type of counseling focused on supporting people’s identities —  for the LGBTQ+ community, funded by a mix of Medicaid and grant dollars. He’s concerned about the future of programs to support transgender people, a frequent target of the Trump administration.

“It is heartbreaking to see that a lot of the clients that I know personally are really living in fear right now with what could happen, what has been happening,” Bozarth said.

Community Chest, which provides a wide array of mental health services across several rural Nevada counties, is about half funded by the federal government, CEO Erik Schoen said. Its mental health and addiction counseling programs, as well as in-home services to families with children under 5, are most reliant on federal dollars.

He said the long-term outlook would likely become clearer in the next 18 months, but any cut in services would mean scaling back efforts in rural Nevada — such as revitalizing a historic Art Deco building to serve as a hub for community services in Hawthorne  — an area that already has a severe shortage of mental health care. 

In 2022, there were only nine licensed psychologists in rural Nevada, according to a report from UNR.

The organization has been around for more than 30 years, and it has only had to lay off one part-time employee for funding purposes in its history, Schoen said.

“It would kill me,” Schoen said. “We’ve generally had an upward track record of growth. It would just be heartbreaking to have to take steps back.”

NAMI Western Nevada is heavily reliant on the federal Community Mental Health Services Block Grant to run its programs, which include a teen support text line that exchanged more than 63,000 messages with clients last year.

The organization is already going to have to cut services when its ARP funds run out this month, but further federal funding cuts would require shuttering other programs, which have seen exponential growth since the pandemic.

There hasn’t been any clarity on the future of its funding.

“There’s nothing definitive coming out,” said Laura Yanez, the group’s executive director. “I think that makes it even scarier.”

‘Don’t spend any more money’

Reedy, the executive director of NAMI Nevada, awoke to news of the blanket federal funding freeze on an early Tuesday morning in late January — and her message was clear to anyone who asked.

“I said, ‘Don't spend any more money at all … Don't have an expectation of getting reimbursed from anyone … And we're probably gonna have to be laying everyone off because we can't accrue debt,’” she said.

Though the freeze was rescinded amid widespread outcry, officials with the mental health nonprofits described a similar sense of chaos.

The United Way survey showed in the days following the announcement, 38 percent of nonprofits reported a temporary shutdown of their reimbursement portal and a freeze in their funding.

Immediately following the announcement, the Healthy Communities Coalition, the group servicing Lyon and Storey counties, immediately canceled one contractor and reached out to its landlord to see if it could receive three months of free rent, Madson said.

Meanwhile, Step2 has never experienced such a sudden threat to its funding, Hutchinson said.

“We can't provide the services without the funding. It's just a simple reality,” Hutchinson said. “So when it got cut overnight, I was in a tough spot. Do I lay off staff? Do I release women from our housing and send them to shelters?”

Amid the uncertainty, Yanez from NAMI Western Nevada said there has been a newfound camaraderie between nonprofits to ensure service gaps are filled, despite the groups often being in competition for funding opportunities.

“We're definitely having a lot of conversations between ourselves of, ‘OK, what services do you have? What services do I have? How can we combine those so we can stay and provide this safety net?’” Yanez said.