Last year, eight-year-old Reno resident Tyler Richard had an IQ of 38 and spoke only two words. On Thursday, he read a testimony aloud to legislators:
"I can tell my mom I love her. I can now tell you thank you for helping me and others," read Richard, diagnosed with autism and 13 other biomedical disorders. "Please don't stop."
Richard's mother Toni attributes her son's success to assistance through Nevada's Self-Directed Autism Program, which serves 174 children and faces an uncertain future as the governor's proposed budget shifts the program to cash-strapped counties.
The autism program was one of several painful cuts and drastic changes discussed Thursday at a budget subcommittee hearing for Nevada's Mental Health and Developmental Services Division.
"We had to make some pretty hard choices to make sure our residential and adult services could remain intact," said Deputy Division Administrator Jane Grunter.
Parents cried at the witness stand as they told legislators their children's conditions would regress -and cost more in the long run - without services from the state.
"A group home or an institution is not OK for my child," said Shannon Springer, mother of 11-year-old Joy, who has autism.
Times are changing throughout the division, which is facing major cuts and restructuring along with other state agencies.
Officials on Thursday discussed their plan to privatize the medical operations for the Southern Nevada arm of the Mental Health Division and the Department of Corrections. The effort would not necessarily save money, but would alleviate a chronic recruiting problem and improve efficiency after a recent internal audit showed productivity was low.
Division Administrator Harold Cook said 22 of the state's 59 psychiatrist positions are vacant and have been supplemented by temporary, contractual employees. Recruitment is notoriously difficult and time-consuming, and turnover is sky-high among medical directors, many who stay only a few weeks and one who only stayed two days.
"There are very few medical students that start their career with a goal of becoming a state employee," Cook said. "And our salary schedule has fallen behind."
But legislators scrutinized the decision to give up some state control of the mental health operations, saying privatization could lead to runaway costs and the large contract - involving about 40 employees - could be difficult to manage.
The chronic hiring problem could also be a symptom of other problems, legislators suggested, including poor conditions at the inpatient Rawson Neal Hospital and in four outpatient mental health clinics.
"The information I'm getting is there isn't enough support," said Sen. Steven Horsford, D-Las Vegas. "The staff you do have are under-resourced and overworked."
Cook described Rawson Neal, built in 2006, as "state of the art" and said he disagreed that the system lacked resources.
Horsford also questioned the constitutionality of the privatization effort, which is unprecedented in Nevada but common elsewhere, according to Cook.
Article 13 of the Nevada Constitution specifies that "Institutions for the benefit of the insane, blind and deaf and dumb, and such other benevolent institutions as the public good may require, shall be fostered and supported by the State."
Whether the provision allows for state-funded, privatized medical services for people with mental illness is a matter of interpretation.