‘We must do more’: Nebraska lawmaker investigating mental, behavioral health needs

LINCOLN — Ahead of the 2024 legislative session, one Nebraska lawmaker is investigating state mental and behavioral health care needs amid a state and national “crisis.”

State Sen. John Fredrickson of Omaha introduced Legislative Resolution 202 to determine the severity of mental and behavioral health provider shortages. Fredrickson said he is evaluating ways to increase health care access, which could involve legislation or non-legislative work.

“As a mental health professional myself, I have seen many of these issues firsthand,” Fredrickson told the Health and Human Services Committee on Wednesday. “The struggle is real, and we must do more.”

Mental Health America this year ranked Nebraska 44th in the nation for a higher prevalence of mental illness coupled with lower access to care. For specific populations, Nebraska ranked 34th for adults and 49th for children. The ranking includes all states and Washington, D.C.

Shortages statewide

Dr. Marley Doyle, director of the Behavioral Health Education Center of Nebraska at the University of Nebraska Medical Center, said 88 of the state’s 93 counties are considered mental health professional shortage areas and Nebraska has 48% of needed behavioral providers, according to the U.S. Health Resources and Services Administration.

However, Doyle said, funding for workforce recruitment has gotten more students in seats for such programs, and providers have been “shocked” at the level of interest. She said it’s hard to say how many more students could be eligible if more funding was available.

Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations and a former state senator, said building a strong foundation is critical to success. For behavioral health, much of that includes provider rates.

“Rates are the bread and butter of every behavioral health provider’s ability to provide care,” Dubas said.

Tami Lewis-Ahrendt, executive vice president and COO of the nonprofit CenterPointe, said many industries shut down during the COVID-19 pandemic, but not community behavioral health providers.

“We kept our doors open, providing support and services to those struggling with new issues and isolation and loss of normalcy,” Lewis-Ahrendt testified.

COVID-19 exacerbated challenges

Doyle, Dubas, Lewis-Ahrendt and other health professionals testified that health care problems existed prior to COVID-19 but have become more acute. 

For example, Lewis-Ahrendt said, telehealth services increased during the pandemic, often with contractors from other states, but it’s sometimes challenging to coordinate licensure across state lines.

State Sen. Tom Brewer of Gordon, with Fredrickson’s support, successfully led Legislative Bill 256 this year so telehealth insurance, particularly in rural Nebraska, would not cost more than in-person visits.

Dubas and Lewis-Ahrendt said there are multiple problems in licensing new providers and backlogs, leaving providers waiting sometimes as long as three or six months with no response.

“Folks who are waiting six months for licensure — those are folks who are ready to go, who are ready to see patients,” Fredrickson said.

Community health and long-term care

The Legislature this spring passed LB 276, proposed by State Sen. Anna Wishart of Lincoln, to create Certified Community Behavioral Health Clinics, or CCBHCs, throughout Nebraska. The clinics are designed to ensure access to coordinated comprehensive behavioral care. 

Lewis-Ahrendt said there is “hope on the horizon” with CCBHCs, but more support is needed.

Kierstin Reed, president and CEO of Leading Age Nebraska, said the rates of mental illness, behavioral health concerns and chronic health conditions are expected to rise for older adults. 

Reed said 198 skilled nursing facilities are currently in Nebraska’s long-term care system, but only 17 of those are designated to support behavioral health needs. Four of those 17 are designated for use only within the state’s correctional system. 

Without proper facilities, Reed continued, there is a risk for nurses who have a duty to protect their patients but who often are not prepared to address behavioral health.

‘Move the needle’

Despite such challenges, Fredrickson noted the success Nebraska had in the first-year rollout of the nationwide 988 Suicide & Crisis Lifeline, a 24/7 suicide prevention line available to anyone experiencing a mental health-related crisis. Boys Town in Omaha manages the 988 lifeline.

Kyle Kinney, manager of the Nebraska Family Helpline and the 988 lifeline at Boys Town, said that when 988 calls need additional support, such as police or emergency medical services, there is a direct connection. However, the same is not true if someone first calls 911. 

Fredrickson told the Nebraska Examiner he’s looking forward to compiling the information from the “big success” of Wednesday’s hearing. He said LR 202 is a personal “passion project.”

He noted to the committee there is a broad spectrum of support in society at large for supporting behavioral and mental health initiatives.

“I think this is something that we as a Legislature can really come together on and hopefully move the needle on a little bit,” Fredrickson told the health committee.

Fredrickson is leading a related resolution, LR 201, in the Judiciary Committee related to mental health and addiction issues in the Nebraska criminal and juvenile justice systems. He told the Examiner he’s been in touch with the committee and is awaiting further details, though it appears a hearing could come in the next few months.