In 2004, following a national de-institutionalization trend, Nebraska fundamentally changed the way it delivered state-sponsored behavioral health care through the law LB1083.
Today, mental health care experts and state administrators are evaluating the effectiveness of LB1083 and the subsequent changes. The law emptied beds at the state regional centers, increased community-based services and, critics say, has allowed some individuals to fall through the cracks.
In 2003, then-Gov. Mike Johanns and Nebraska Sen. Jim Jensen championed legislation to transfer money from the three state psychiatric hospitals to six mental health regional communities that divide the state.
The move permanently changed the way Nebraska delivers mental health care to afflicted individuals and the purpose of the state regional centers.
The old system was too expensive and didn't meet the needs of patients, said Vicki Maca, the behavioral health administrator of community services for the Nebraska Department of Health and Human Services, or DHHS.
"Experts across the country said serving people in institutions isn't the best for them," Maca said. "Mental health care can be administered just as well in the community because (individuals) have their family support system."
Nebraska's push followed a national trend of de-institutionalizing, said Bob Glover, executive director of the National Association of State Mental Health Program Directors. He said 6.1 million individuals a year receive care through community-based services, while at any time, only 47,000 people are in the 235 state psychiatric hospitals.
"In 1983, two-thirds of all (state mental health) expenditures went to state hospitals," he said. "Now, that's in reverse: 70 percent of all funds go to community mental health services" as a result of mandated legislative changes.
THE CHANGE TO COMMUNITY CARE
Nebraska has three state psychiatric hospitals, called regional centers, located in Norfolk, Hastings and Lincoln. In the hospital hey-days of the 1950s, the Lincoln Regional Center had 2,000 patients, according to Bill Gibson, the behavior health administrator of the regional centers for the Nebraska DHHS.
The national trend of releasing patients and decreasing the number of beds at state hospitals started in the 1970s when effective psychiatric drugs began to replace in-patient treatment. As a result, only 500 patients remained at the Lincoln Regional Center in 2000.
In 2003, state administrators at the regional centers began identifying patients who would be able to live successfully in the community with an adequate support system in anticipation of behavioral health reform.
In 2004, LB1083 passed.
The bill shifted money within the DHHS from the regional center budgets to community services, forcing the centers to reduce inpatient capacity and allowing communities to expand or initiate outpatient and therapeutic services.
"There was lots of resistance at Norfolk – a lot of people stuck in the old way of doing things," Gibson said. "They believed (a patient) would never be able to survive if he was placed in the community. But with community support, they've stayed there."
The increased effectiveness of community support resulted in the reduction in voluntary commitments, and now the regional centers are reserved for involuntarily admitted individuals.
"Today, there are 300 people at the regional centers, and almost everyone here has a legal issue," Gibson said. "We take people who are at a low point in their lives and have gotten in trouble with the law or are a danger to you and me."
He said there are two paths an individual can take to end up at a regional center, both involving the legal system.
First, if police think someone is having a mental episode or crisis that makes that person a danger to him or herself or to other people, they will place him or her in emergency protective custody before sending him or her to the mental health board.
Involuntary commitments from the board can result in admission to certain hospitals, but the more severe or persistent patients end up at the Lincoln Regional Center, Gibson said.
Of 200 patients at the center, 80 were committed by the mental health board.
The other path does not involve a public safety issue. If, before a court hearing, jailers notice a person in custody is not behaving normally, or if the individual becomes incapable of participation in his or her own hearing, then the individual is involuntarily committed until the episode passes and he or she is able to stand trial.
There are 40 patients admitted to the Lincoln Regional Center for that reason, Gibson said.
"This is an absolutely devastating experience to come here," he said. "They're on a downhill spiral, and we're the last thing to catch them."
The criteria for people who are experiencing a mental health crisis to receive admission to a regional center are now very limited, and every aspect of community care is explored before a commitment is granted, Maca said.
"The community service increase means less waiting for the regional centers. So when someone needs to get in, they can get in faster," she said. "People are still going if they truly need to go, but they're also getting served in the community."
She pointed to a graph with a downward-sloping line, detailing time from Jan. 7 to Dec. 23, 2008. The graph illustrates the number of people on a waiting list for admission to the Lincoln Regional Center, and the numbers range from a high of 25 – at the beginning – to a low of 0, which is where the graph ends.
is a member of the 
1 comments