Bill in Unicameral aims to train, retain psychiatrists in state

Psychiatric outpatients at the medical center in North Platte schedule appointments a month in advance - but not by choice.

The center's behavioral health unit serves an area of several thousand square miles in southwestern Nebraska. A constituency spanning more than 15 counties and 101,000 residents, it's an expanse speckled by farms and small towns. 

And it's a region understaffed by mental health professionals.

The Great Plains Regional Center boasts an often near-capacity, 17-bed inpatient psychiatric unit complemented by several outpatient programs, but there's only one full-time psychiatrist.

"We're in need," said Karen Weston matter-of-factly while discussing the staff shortage. Weston is the behavioral health director for the GPRC.

The center's struggle to recruit and retain licensed mental health care providers – specifically psychiatrists – isn't rare in Nebraska. Representatives from three rural Nebraska hospitals agreed it can sometimes take years to fill vacant positions in behavioral health units.

As practicing psychiatrists age and potential physicians gravitate toward cities, needy populations suffer as they wait weeks for appointments and are juggled between temporary providers.

Or worse, they wind up in emergency rooms and prisons, according to the Nebraska Legislature's Health and Human Services Committee.

Senators are hoping to thwart these exact problems.

LB603, which the committee introduced in January, aims to buff up the state's behavioral health program in both strength and size.

The legislation would provide money for the addition of eight psychiatric medical residents who would be trained in rural care in Nebraska by 2013.

The news comes at a good time for facilities in Kearney and Norfolk, which have been reeling from holes in their mental health staff.

Norfolk's Faith Regional Health Services has contracted with nearly 60 temporary psychiatrists during the past 11 years. Such short-term contracts bear a hefty price tag, reaching about $316,000 last year alone, said Robb Paulk, Faith Regional's director of behavioral health.

That, Paulk said, could've paid for a full-time psychiatrist and a mid-level practitioner – if the clinic had  been able to find one.

The unit would like two new psychiatrists to complement the pair already on staff, but Paulk said it's tough to lure permanent physicians to the 25,000-person town in northeast Nebraska.

"When I was a kid, doctors came to town and lived and died there," he said. "Now, doctors are more mobile than ever. They used to stay, but they just don't do that anymore."

Kearney's Richard H. Young Hospital is hit by mental health professionals' dash for the cities, too.

Pairs of psychologists, psychiatrists and advanced practice nurses oversee the 80-bed inpatient unit and wide-ranging outpatient program.

After losing two psychiatrists last year to "better opportunities," the hospital isn't having much luck in the search for replacements.

Trish Sandstedt, the hopsital's community liaison, said it could likely be a years-long hunt.

The difficulty of bringing in big-city, out-of-state professionals is something the Legislature's HHS committee is hoping to avoid with LB603's provisions to promote in-state training.

"Once you start (training), there's a good chance you're going to practice (medicine) in the same state," said committee chairman Sen. Tim Gay of Papillion.

The bill would establish six behavioral health training sites throughout the state; four would have to be in counties with fewer than 50,000 people. This mean all counties except Lancaster, Sarpy, Hall and Douglas counties would be eligible.

In addition, LB603 encourages providers to use telehealth techniques, which use a massive fiber optic network for remotely communicating, videoconferencing and transmitting medical images and records.

Gay said Nebraska already has such a network, but it's underused.

Telehealth techniques would enable metropolitan doctors to reach underserved rural areas. For example, consumers in Valentine could be spared a two-hour drive from near the South Dakota border to North Platte, GPRC's Weston said.

However, to apply the technology effectively, the center would need to add another full-time psychiatrist to its payroll, she said. GPRC has one full-time, one part-time and one contracted psychiatrist on staff. An advanced practice nurse is also employed at the center.

Overall, LB603 has big dreams of resuscitating ailing mental health programs, but its good intentions may not shine brighter than its robust price tag.

The legislation, with a cost of $4.8 million over three years, would be funded by revenue from the state's settlement with tobacco companies.

After 2012, the bill's programs would receive a 3 percent funding increase each year.

In the end, it may not be realistic for legislators to adopt LB603  at a time when the state's economy is in a tailspin.

Gay acknowledged the legislation's biggest contention point is the funding, but he's not giving up hope.

And neither will workers in Norfolk, Kearney and North Platte.

teresalostroh@dailynebraskan.com