Cornhuskers embrace community-based care

Nebraska is moving from an overreliance on acute psychiatric inpatient care to having more community-based services and more consumer choices than ever before. In 2004, then Gov. Mike Johanns and state Sen. Jim Jensen joined together to restructure the state's fragmented mental health system. Their shared vision of better services and consumer outcomes, reflected in LB 1083, is resulting in more appropriate care for people with mental illnesses.

LB 1083 authorized redirecting $25 million annually from two of the state's three inpatient regional centers (psychiatric hospitals) to community services, as well as $6 million in one-time transitional funding, $2.5 million annually for emergency protective custody services, and $2 million in new funding annually for housing for people with serious mental illnesses. In addition, the state is on target to capture $9 million in Medicaid matching funds through expansion of Medicaid-eligible services. Since 2004, service capacity has been expanded for services such as crisis response teams, psychiatric residential rehabilitation, short-term residential, emergency community support, medication management, dual disorder residential, mental health and substance abuse community support, and day rehabilitation.

The legislation provided for reducing or eliminating capacity for adult acute inpatient care at two of the regional centers, replacing it with community-based care. Between FY 2002 and FY 2006, the number of consumers committed to the regional centers by local mental health boards dropped from 871 to 490. Between June 2004 and December 2006, the number of people served by the following community-based services increased by 44%: The number of people served by Assertive Community Treatment increased by 116%, community support/mental health services by 56%, community support/substance abuse services by 41%, day rehabilitation services by 19%, dual disorder residential services by 160%, psychiatric residential rehabilitation services by 54%, and short-term residential services by 24%. Between September 2005 and September 2006, 227 people with serious mental illness and extremely low incomes received housing-related assistance.

LB 1083 gave consumers a greater voice, requiring a consumer to be the administrator for the new Office of Consumer Affairs, which includes two consumer liaisons. The hotline in the Office of Consumer Affairs is answered by people who understand our behavioral health system. The Nebraska Department of Health and Human Services sponsors an annual conference to provide leadership and advocacy training for consumers so they can speak up at the national, state, and local levels, advocating on their own and on the system's behalf. A state-sponsored e-mail listserv lets consumers and the public discuss reforms. Each of the six local behavioral health regions now have a full-time consumer position, who is part of the management team and serves as a liaison to local consumers.
Nebraska has been innovative in developing rural behavioral health emergency programs, including local crisis response teams that help people needing emergency intervention locate immediate resources in their communities. These services have been expanded to all six regions. In nearly 80% of the teams' encounters, there is no need for emergency protective custody and other coercive measures. Follow-up services are provided for 90 days after a crisis, ensuring linkages with behavioral health services, housing, and other resources. The teams focus especially on consumers placed in emergency protective custody or committed for treatment to prevent further crises.

In addition to these reforms, a public-private partnership of community leaders, local healthcare providers, and government entities is creating the 64-bed Lasting Hope Recovery Center, which will open in December in Omaha, Nebraska's largest city. Private donors committed $17.5 million toward the Center and other community services, with the state committing $5 million a year. The Center will provide acute, subacute, and crisis services, as well as promote wellness and recovery. The Center also will serve as a statewide resource for training behavioral health professionals.

As you can see, Nebraska is moving away from coercive treatment and institutions. We're shifting from control by providers and government agencies to consumer empowerment. More than ever, consumers and providers are working together to achieve the goal of self-determination. Consumers have more choices and more responsibility for their own life plan. Treatment objectives are more likely to be centered around housing, education, and employment rather than symptom reduction and compliance. While there is still much work to be done, progress is being made and is changing the culture of behavioral healthcare in Nebraska.

Christine Z. Peterson is CEO of the Nebraska Health and Human Services System.