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Emergency mental health crisis center among recommendations

Omaha World-Herald - 12/2/2016

LINCOLN - Nebraska needs an emergency "no-refusal center" where authorities can hold people with mental illnesses who are particularly agitated and potentially violent.

But it also needs more drop-in and respite centers where people with mental illnesses can seek support and safety from peers.

And it needs to update rates paid for services and treatment of people with mental illnesses and substance abuse problems.

Those are among the recommendations from a legislative task force on the state's behavioral and mental health system. The group released a report Thursday.

State Sen. Kate Bolz of Lincoln, who chaired the task force, said the task force heard from several people about the need for a no-refusal emergency protective custody center.

Such a center could handle a person in the throes of a mental health crisis who has been denied placement in a hospital. The denial could be because the person is too violent or because the hospital is full.

Bolz said authorities currently have few options for such people.

If they have committed a crime, they can be jailed or placed in the state prison system's Diagnostic and Evaluation Center under a program that provides safekeeping for county inmates.

Neither is ideal, she said. Jails are not equipped to handle mental health problems, and the Diagnostic and Evaluation Center already is overcrowded.

The only other option is to release the person in the same condition they were in when authorities were called, she said.

Along with a center that could take such people before hospitalization, the task force recommended creating a high-security residential facility for people leaving the Lincoln Regional Center, the state psychiatric hospital.

The proposed facility would help people make the transition from the highly structured hospital setting to the community.

Elizabeth Lay, the Platte County deputy county attorney, told the task force that Nebraska has one such transitional program but it often is full or will not take some people.

Bolz said the task force also heard concerns about the need to review payment rates to behavioral health providers.

Current rates have not kept pace with the cost of providing services, which leaves providers without the resources needed to develop new services, she said.

The task force called for addressing the problem in multiple ways.

One involves boosting the rates for services that are the most severely underfunded, a strategy that state officials used recently to bump up payment rates for halfway houses and medication management.

Another calls for the state to pursue a federal waiver so that Medicaid dollars can be used for behavioral health wraparound services.

Waivers allow states to cover a broader array of services for specific groups of people than is possible under the traditional, medically oriented Medicaid program.

The federal matching dollars available through Medicaid would make state funds stretch further, Bolz said.

Bolz said she expects legislative proposals addressing at least three task force recommendations.

She plans to have a bill expanding the use of peer-supported housing, similar to two programs in Lincoln.

The Keya House provides a place where people can stop by and get support when coping with flare-ups of their mental health problems. The Honu Home provides respite for people with mental illnesses who have been recently released from jail or prison.

Sen. Sue Crawford of Bellevue plans legislation aimed at expanding the behavioral health workforce, while Sen. Sara Howard of Omaha is working on a bill to make Medicaid dollars available to pay for peer support services.

The services are provided by specially trained people who have dealt with mental illnesses or substance abuse problems themselves.

The task force was charged with monitoring progress in addressing issues and gaps identified in a legislative performance audit last year.

martha.stoddard@owh.com, 402-473-9583