Two sides of LB1083: community care vs. psychiatric hospitals

There is no talking to patients at the Lincoln Regional Center; no one is here by choice.

At the Goodwill Industries complex for education, training and treatment in Grand Island, fewer than two hours away, clients go from class to seminar to support group, too busy to speak.

Although the Lincoln Regional Center, or LRC, and Goodwill Industries are worlds apart in day structure and program objectives, the two represent the dual aspects of the state-run behavioral health program: psychiatric hospitals and community-based care.

The institutions manifest the behavioral health changes the 2004 law LB1083 mandated – such as moving civilian patients from state regional centers to community-based services – and assist individuals with mental illnesses to lead productive, normal lives.

LB1083 organized the transfer of money away from the regional centers to the six behavioral health regions, reducing the amount of people who could be served in regional centers but enabling community-based behavioral health care to assist an additional 9,000 people last year.

"The intent of 1083 … was to serve better," said Vicki Maca, the behavioral health administrator of community services for the Nebraska Department of Health and Human Services. "Choices weren't available before."

Lincoln Regional Center

At the LRC, the challenge is patient stabilization prior to their initial court appearance. It was built in 1874 and is a sprawling institutional complex surrounded by an arboretum on 2705 S. Folsom St., far from the heart of Lincoln and the University of Nebraska-Lincoln.

"It's not a mystery as to why it was put out on West Prospector," said Bill Gibson, the behavior health administrator of the regional centers for the Nebraska Department of Health and Human Services. "It was all marsh back then. If someone ran away, it would be difficult to get into town."

Now, there is a neighborhood subdivision adjacent to the LRC, and somewhere in the middle of the homes is a historic graveyard, filled with patients who lived out their lives there.

Their life and death records are kept in old, leather-bound books in a little hospital museum in the administration building, along with sports trophies, straightjackets and electroshock therapy boxes that look like record players.

"This just shows you how independent hospitals were," Gibson said. He picked up a pole with a wooden block on the bottom, covered with leather.

"They didn't have drugs to help people with their issues. If someone had energy – these old buildings all had hardwood floors and they'd give them this," he said. "The patients would put candle wax on the bottom and push them for hours. They spent hours waxing the floor."

While some therapy was harmless, others could be painful. Electroshock therapy was performed without anesthesia or painkillers applied to the area prior to the shock. Boxes showing the progression of technology are on another table: a vintage 1930 model, two from the 1950s and 1960s. Two straightjackets hang from pegs the wall.

"Those restraints were pretty traumatic, especially to females. It made them vulnerable," he said.

Patient therapy has advanced since the days of wood waxing blocks and straightjackets, and building No. 10, across the street from the little museum in the LRC Admission building, is one example.

At the LRC, the men and women are kept in separate buildings with identical available services and similar interiors.

"That way, they can focus on therapy with less distraction," said Barry Burumen, the assistant director of nursing for the male unit, housed in building No. 10.

The first floor houses a piano, the recreational room and the resource room. Patients don't live on this floor but are allowed to visit as they gain more privileges, he said. Patient-produced finger paintings in bright neon colors are hung on the walls outside the rec room. Inside, there are tables, mismatched chairs, a long shuffleboard table and a pool table.

"Patients can do painting and artwork or work on their leisure skills," Burumen said. "Leisure skills are important, and patients work with our recreational therapist."

Around the corner from the rec room and down the hall is another popular room: the resource center, headed by Tom Schmitz. It's a small room with books lining every available shelf of the walls, tables for reading, a large magazine selection and a computer, tucked neatly into the corner.

Schmitz said most of the collection is professional non-fiction, and many patients choose to research their illness or diagnosis.

Most of the books are out-of-date, so he works with Lincoln City Libraries through the inter-library loan program. Patients can use the computer to send e-mail or apply for jobs.

"We don't refuse a patient any information, but I call their wards so they can go over the information with them," he said. "We've got hometown newspapers, a big self-help section and sports and health magazines in English, Spanish and Vietnamese" to cater to all the native languages of LRC patients.

"There's something for everyone here."

The second floor elevators open to a common room with        ng hallways leading to the cafeteria and dormitories. Thirty-six beds and 35 patients reside in Building No. 10. The nurses' station is in the middle of the common room, adjacent to a wall full of board games that reaches the ceiling.

"Everyone here has a schedule: 40 hours of active treatment and then self-directed time," Burumen said.