The state of Nebraska made the decision more than a decade ago to move away from institutional care for mental and behavioral health services in favor of local programs.
The plan was to close state-run regional centers and shift that money to community-based services addressing the same needs.
However, the second part of that equation has failed to materialize in many parts of the state.
“We were able to save money by closing the regional centers and we didn’t make the necessary commitment on the other end,” said Sen. Paul Schumacher.
That has led to a “real deficiency” in mental health services and workers in Nebraska, the Columbus senator said, particularly in rural areas where it’s hard to recruit and retain trained professionals.
“There’s a real lack of facilities in outstate Nebraska,” Schumacher said.
And that’s created some serious problems.
Those in need of short- and long-term in-patient care for mental health issues can linger on waiting lists for months before a spot becomes available.
“There’s not enough resources for the number of people who need them,” said Deputy Platte County Attorney Elizabeth Lay. “The wait times are indicative of that.”
In cases where emergency protective custody is needed to prevent people from harming themselves or others, Lay said the county can usually find an open bed for them at hospitals in Norfolk, Kearney or Hastings.
However, this can be a time-consuming process for the county attorney’s office and law enforcement personnel, who must line up a spot for the patient and provide transportation.
Schumacher said law enforcement officers are treated as the first line of defense in the mental health crisis, but the onus shouldn’t be on them to solve the problem.
That’s where the community-based services were supposed to surface to address these issues.
“It is not a good system,” Schumacher said. “To fix the system costs money, and we don’t have money. In fact, we’d like a tax cut.”
Schumacher, who served as Platte County attorney for eight years in the late 1970s and '80s, has introduced bills targeting the state’s shortage of mental health services and listened to testimony in the Legislature from law enforcement, county attorneys and others willing to voice their concerns.
State lawmakers have recognized the problems with the mental health system for years, he said, but little has been done to improve it because the Legislature isn’t willing to find the funding.
“We may say it’s a priority, but that doesn’t mean it’s a priority,” Schumacher said.
That’s exactly what Sen. John Stinner, chairman of the budget-writing Appropriations Committee, is saying.
“Mental health has gotten more and more emphasis and traction within the Legislature. It certainly has come out as a priority for us,” the Gering senator said.
Stinner acknowledged that better services are needed, especially in rural Nebraska, to avoid “adverse, long-term” problems, but noted that there’s no funding available to make this happen.
“When you don’t have money, it’s hard to add to a program,” he said, referencing a projected $195 million revenue shortfall for the state’s 2017-19 budget.
“There’s a lot of areas we need to take a look at when revenue comes back,” said Stinner, adding that mental health services will remain “on the radar.”
Lay, who has made several trips to Lincoln to lobby for better mental health services and provide a voice for this vulnerable population, said simply talking about the issue doesn’t cut it at this point.
“I believe that actions speak louder than words,” she said. “If we’re not funding it, then it’s not a priority.”
He said it’s easy for senators to get elected on a platform of reduced spending and tax cuts, but that’s not going to solve the mental health issue.
The Columbus senator also believes there’s a tradeoff when it comes to investing in these services.
With a lack of resources available, Schumacher said many mentally ill people end up in prisons or the state-run Lincoln Regional Center instead of receiving the treatment they need.
“That’s the place where you park people when you have nowhere else to park them,” he said.
This has contributed to overcrowding issues in state prisons and rising costs in the criminal justice system, he contends.
And when mentally ill people don’t get the rehabilitation services they need upon release, “around and around they go,” Schumacher said.
“We’ve got ourselves in a Catch-22 on some of this,” he said.
Lay believes the state needs to rethink the mental health system as a whole, putting an emphasis on individual care instead of an all-encompassing model.
“To say that we’re going to come up with one model that fits everybody is ludicrous,” she said. “That tunnel vision is what got us into this mess.”
Her vision involves a step-down system that allows people to transition from the Lincoln Regional Center or other in-patient facilities to outpatient care followed by local support services.
She loses an ally in Lincoln when Schumacher leaves the Legislature because of term limits following the 2018 session, but said other senators have shown a willingness to help with this fight.
“It’s going to take more than one voice to make change in this particular instance,” Lay said.