15 Years After Mental Health Care Reform, Nebraskans See Progress – And a Long Way to Go

Fifteen years after significant mental health care reform in Nebraska, advocates say we’ve made a lot of progress. But there’s still a long way to go – and it all comes down to funding.

"There we go!"

On sweltering summer day at a small park in Omaha, Kelsey Leick-Macari is watching her daughters rush by on a hot merry-go-round.

A few years ago, Leick-Macari’s own world was spinning after the traumatic premature birth of her first daughter.

She went to the emergency room a few weeks later with suicidal thoughts. But when she told doctors she didn’t plan to act on those thoughts, they sent her home and told her to see a psychiatrist.

"And the whole process could take upwards of a month," she said. "Which when you're in the position that I was, that felt like an eternity."

Leick-Macari got lucky – one doctor had a last-minute cancellation and could see her right away. She’s been managing PTSD and Bipolar Disorder ever since, and feels pretty good about most of the care she’s gotten.

When former state Sen. Jim Jensen looks back 15 years, he sees a much bleaker picture.

"I had met with fathers and mothers, and kids who were searching for facilities for their loved ones, they were far away, away from home," Jensen said. "So I really felt there had to be something better."

Jensen wasn’t the only one paying attention; then-Governor Mike Johans wanted to completely overhaul Nebraska’s approach to mental health care, so the two worked together to write the Nebraska Behavioral Health Services Act.

The most significant change was to close down or greatly reduce the state’s psychiatric hospitals, called Regional Centers.

In an interview with NET News in 2004, Johans said the reform was long overdue: "It's not the most popular thing that I've probably ever done, but it's very, very necessary."

Johans said the goal was to use our resources more effectively – especially federal funding. Medicaid wouldn’t pay for regional center care, but it would pay for community-based care.

The problem was that community-based care wasn’t available yet.

"It was it was very important, number one, that we would not close a bed and a regional facility if there wasn't a bed available in the community," Jensen said. "And in many cases, we had to develop those facilities within that community."

Nebraska does have far fewer psychiatric beds now than fifteen years ago. The Treatment Advocacy Center estimates there are about 15 beds per 100,000 people in the state – far less than the recommended 50 beds per 100,000 people.

But the number of beds isn’t really a good comparison, because one major goal of community-based care is to reduce the need to institutionalize people – a person who finds the right medication or works regularly with a therapist may never reach that crisis point.

Julie Hebenstreit works with a lot of mental health care providers across the state, as the Executive Director of The Kim Foundation. She says the community-based care model only works if local programs have enough financial support.

"Especially right away, the funding did not follow those pieces," she said. "And so there was, we lost a lot of ground in that transition, as well."

Hebenstreit is a big advocate for community-based care – she says it’s so important for someone to be surrounded by their own support system.

"I think it's a double edged sword," she said. "I think in theory, it's a very, it's obviously very good and what we need to be doing, but the funding and the and the support mechanisms behind that to make it successful, need to be enhanced as well."

Leading the effort for enhancing mental health care in Nebraska is Sheri Dawson, Director of the state Division of Behavioral Health.

"Bottom line did we accomplished everything? I think we accomplished a great deal of the intended work but we still have work to do," Dawson said.

This division in the Department of Health and Human Services was created as part of the same reform law that closed down the regional centers.

Dawson says that bill 15 years ago shows how forward-thinking Nebraska leaders have been. And she’s trying to encourage a totally new way of looking at mental health care, using an approach called Systems of Care.

"In order for Nebraskans to have access to services in the community we're gonna have to think differently and we're gonna have to do business differently," she said. "So we can't just have the silo of the division of behavioral health and we can't have the silo of Medicaid or probation we really need to look at who's providing what, what does that funding look like, having some difficult perhaps policy you know conversations."

Most experts tend to agree on what needs more attention moving forward: better data, early detection and prevention, and involving people in decisions about their own care.

Another thing everyone seems to agree on? Good ideas need more money to make any kind of impact.

"There's great providers out there that are ready and are doing community based services, treating people in new and innovative ways and, and doing a great job," Hebenstreit said. "It's just a matter of whether they have the backing and funding to continue to do that."

Sen. Jensen looks back on his reform efforts with satisfaction – but he says reform never truly ends.

"Looking at other states I think Nebraska has done well in their behavior health," he said. "But that oversight doesn't stop. It's got to continue."

For Nebraskans like Kelsey Leick-Macari, paying attention to mental health isn’t an option – it’s a critical part of living day-to-day.

"Especially with bipolar disorder, you're walking such a fine line of stability and the minute something goes wrong, it can it can get bad fast," she said. "It just makes it so much harder to control every other aspect of your life."

Looking ahead to the next 15 years, Leick-Macari hopes the world her daughters inherit treats mental illness like any other medical problem – and that they have more options for care than she’s had.