The U.S. Department of Justice (DOJ) has concluded that the State of Nevada is violating the civil rights of children with behavioral health disabilities. After a lengthy investigation, the DOJ found that the Nevada children’s mental health system fails to provide adequate community-based services, leading to unnecessary institutionalization. This practice violates Title II of the Americans with Disabilities Act (ADA), which requires that people with disabilities be served in the most integrated and appropriate settings.
DOJ Investigation Reveals Systemic Failures
The DOJ’s findings paint a troubling picture of how the Nevada children’s mental health system is structured. Because of limited resources and poor administration, children are too often placed in institutional facilities instead of being supported at home, in schools, or within their communities. According to the DOJ’s report, Nevada relies heavily on segregated settings to manage children who could otherwise thrive in less restrictive environments.
“Because of deficiencies in its community-based service array and the manner in which the state administers its children’s behavioral health system, the state relies on segregated settings to serve children with behavioral health disabilities who could be served in their homes and communities,” the DOJ noted.
Long Institutional Placements and Out-of-State Care
The investigation highlighted the severe overuse of institutional placements. Of the 480 children in residential treatment, stays lasted between nine and 12 months on average, with 27% of children remaining for over a year. In many cases, the Nevada children’s mental health system sent children to facilities out of state, pulling them away from their families and support networks. From July 2019 to February 2021, Nevada funded the out-of-state placement of roughly 250 children.
Hospitals have also become a fallback option when community services are unavailable. In fiscal year 2020, more than 1,700 Nevada children were admitted to hospitals for psychiatric care — evidence of how underdeveloped the state’s community-based supports truly are.
Civil Rights Violations Under the ADA
Assistant Attorney General Kristen Clarke of the DOJ’s Civil Rights Division emphasized that the Nevada children’s mental health system is not meeting federal legal requirements. In her letter to Nevada Attorney General Aaron Ford, Clarke wrote: “After carefully reviewing the evidence, we conclude that there is reasonable cause to believe that the State of Nevada violates Title II of the ADA by failing to provide services to children with behavioral health disabilities in the most integrated setting appropriate to their needs.”
The ADA requires states to ensure children have opportunities to grow up in environments that encourage inclusion, family connection, and community integration. Instead, Nevada’s reliance on institutions isolates children and undermines their long-term development.
Nevada’s Ongoing Struggles
What makes the DOJ’s findings more concerning is that state leaders already acknowledge the issues. According to the report, Nevada officials admit that many institutional placements could be avoided if the behavioral health system functioned effectively. Despite this awareness, the Nevada children’s mental health system has consistently been ranked among the worst in the nation. Since 2015, Mental Health America has placed Nevada near the bottom of its youth mental health rankings every year.
This persistent ranking demonstrates a pattern of neglect that places children at risk of long-term harm. For families, the lack of resources has meant watching their children struggle without sufficient support or being forced to send them away for care.
National Pattern of DOJ Oversight
The situation in Nevada is not unique. In June, the DOJ released similar findings in Maine, concluding that children with mental health and developmental disabilities were unnecessarily institutionalized in healthcare facilities and even in juvenile detention centers. In May, the DOJ launched a civil rights investigation in Kentucky over concerns about the institutionalization of individuals with serious mental illnesses in the Louisville/Jefferson County area.
These cases reveal a national pattern where states fail to develop robust community services, leading to widespread reliance on institutional placements. The Nevada children’s mental health system is now part of this broader scrutiny, placing added pressure on the state to implement meaningful reforms.
Next Steps and Potential Legal Action
The DOJ made clear that if Nevada does not address the issues, it could face a lawsuit. Clarke, however, expressed the department’s preference for cooperation: “We would like to work with the state to achieve a consensual resolution of the issues raised in this report. We anticipate that these negotiations will, as in most of our cases, result in an agreement to resolve these issues.”
If negotiations fail, Nevada risks significant legal and financial consequences. Beyond compliance with the law, however, the Nevada children’s mental health system will need to evolve if the state hopes to meet the needs of its children and families.
Broader DOJ Oversight of Mental Health
The Nevada case is part of a larger enforcement push. The DOJ is investigating several states and organizations, including the controversial mental health startup Cerebral Inc., for potential violations in mental health care delivery. These investigations show that the federal government is paying close attention to whether states are meeting ADA requirements and providing individuals — particularly children — with access to integrated, community-based care.
Moving Toward Reform
The DOJ’s report on Nevada underscores the urgent need for reform. Children deserve access to support in the least restrictive settings, where they can maintain family ties and participate fully in their communities. Transforming the Nevada children’s mental health system will require investment in outpatient programs, school-based mental health services, crisis intervention, and home-based supports.
By shifting resources away from institutionalization and toward community solutions, Nevada could not only come into compliance with federal law but also improve outcomes for thousands of children. This transformation would allow families to remain together, prevent long-term trauma, and build stronger community systems of care.
Conclusion
The DOJ’s investigation reveals that the Nevada children’s mental health system is failing its most vulnerable populations by unnecessarily institutionalizing children with behavioral health disabilities. While state leaders recognize the problems, action has been slow, and families continue to bear the burden.
With federal oversight and potential legal consequences looming, Nevada must act quickly to expand community-based services and align with ADA standards. Doing so would not only resolve compliance issues but also give children the chance to grow, heal, and thrive in supportive, integrated environments where they belong.
