Photo by Bulletin graphics
Tamara Martin-Linnard, Chief Clinical Officer, Great Plains Health
In rural Nebraska, a set of grandparents are struggling mightily with a tragedy.The tragedy did not strike them directly, but it hit their child and grandchild.
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy and activity levels, and the ability to carry out day-to-day tasks, the National Institute of Mental Health says.
It can lead to other behavioral issues, and such troubles can linger like a curse if treatment cannot be found, as is often the case in rural Nebraska.
The grandparents, who asked to remain anonymous, now have a grandson in foster care, after they failed to find an adequate treatment center and their problems escalated. When their grandson became increasingly unruly, they finally had to call law enforcement, which led to loss of custody.
The struggle has been agonizing, they said.
Heaping discouragement upon discouragement, they struggled to find a place where their grandson could be treated, but could not.
Over many months, they contacted the Nebraska Department of Health and Human Services. They were referred to a boys home in Fremont. There, they met a consulting psychologist from Norfolk, who referred them to a psychiatrist in Lincoln – a four-hour drive. When they arrived for their appointment, the psychiatrist could not help because he had not received the written report from Fremont.
Crestfallen, they went home and arranged a subsequent meeting in Grand Island. But that fell apart when the counselors took the wrong road and arrived late.
Finally, their grandchild became violent, and one thing led to another, and he was placed in foster care.
In the interests of forging the bonds of the new family, foster care separations are definititive. The grandparents didn’t see the grandson for more than a year, and when they did, visits were strictly limited.
The couple went through similar ordeals, although not violent, with their daughter, who is now disabled in middle age. They took an active role in her situation, learning about behavioral health and looking for treatment. They were encouraged that there was light at the end of the tunnel.
“If they can get the right help and get right medications, they can live a normal life,” the grandparents said. “The first challenge is for the victim to admit they have a problem and that they need help. Then, the next step is to find a place for them to be diagnosed and treated.”
But finding such a place is another huge challenge. There are few treatment centers in Nebraska, because a decade ago, the state chose to close centralized treatment centers in the name of community based treatment – small places where victims are not separated from the support of family and community.
But community-based treatment is lacking. Trained staff is hard to come by. In fact, there is only one child psychiatrist in all of western Nebraska, who is in Scottsbluff.
There is a shortage of child psychiatrists all across the nation, said Tamara Martin-Linnard, the Chief Clinical Officer at Great Plains Health in North Platte.
Psychosis is the most prevalent health issue in patients who arrive at GPH, and the No. 1 reason for admittance, said Fiona Libsack, the vice president in charge of communication.
“It is increasing year to year,” Libsack said. “It affects all ages. We are seeing an increase (of psychosis) in college age students, all across the nation.”
GPH is looking into use of tele-psychiatry, whereby a medical professional could confer with patients and families via computer or telephone to span the extensive distances with prompt responses to the needs. But the reliability of electronic connections presents a challenge.
At hospitals such as Great Plains Health, victims can and do receive emergency care, but not long-term treatment. Long-term treatment is hard to come by.
Compounding the problem, many victims self-medicate with alcohol or drugs. They often wind up in the hospital after a psychiatric breakdown or injury. They get help, but not the long term assistance needed to break the addiction or treat an underlying psychosis.
“We can de-tox, but that doesn’t beat the addiction,” Libsack said. “Treatment requires a long term out-patient program, which is not available in our community."
Martin-Linnard said the number of treatment facilities across the state are few and far between.
If a victim does not recover, they are apt to spend the rest of their lives in poverty, surviving on Medicaid, which limits their opportunities to earn more money. .
“If they’re on Medicaid, they don’t dare work. If they work too much, they lose Medicaid. If they lose Medicaid, they will lose their medications,” the grandparents said.
If there had only been a place to evaluate their grandson, to find the proper medications and physical treatments, "we could have all be spared this,” they said.
Great Plains officials said providers are not being reimbursed for care they provide. Just breaking even financially is good, they said. That’s true even when a victim is insured.
“Some policies limit people to six visits in their lifetime for behavioral health care. That is a drop in the bucket,.” Martin-Linnard said.
In something of a response to the need, a new statewide crisis response program was launched in early May, thanks to a four-year, federal grant of $12 million.
The program is touted to make improvements in Nebraska’s fragmented and sometimes cumbersome behavioral health response system.
“We have heard directly from families that Nebraska’s response when they are in crisis has been fragmented. This is a tangible step to change that,” said Courtney Phillips, the Chief Executive Officer of the state department of health and human services.
Crisis response, previously provided in pockets across the state, is now available statewide, Phillips said. People in need can call an emergency number, and response teams are expected to provide immediate mental health crisis counseling.
The phone number for Lincoln County is Region 2 Human Services, 308-390-4645.
The grandparents are not overly impressed with the expenditure of federal money for something that is pretty much in place now, with a few exceptions. When they were in need, they called, they received advice and a list of places to go, and help from law enforcement.
What they didn’t receive was enough help – a place of diagnosis and study, where a long-term treatment plan could be set.
“There are lots of people in trouble,” the grandmother said. “There is nowhere to go. Forgive me if I sound sarcastic, but nothing ever changes. I don’t think the kids are really that important to HHS. They have a job and they have assignments. I think their biggest worry is to keep their job.”
Libsack said more could be done, but it takes money.
The recently adopted state budget contains a 3% cut to Medicaid for behavioral health, she said.
“We have a lot of good ideas,” Libsack said, “but we don’t have the funds to the implement them. We need enough funding to stabilize the mental health population for ongoing sustainability and independence. We can’t do that as long as people are keeping their thumb on the money.”
(This report was first published in the Bulletin's May 31 print edition. It is reprinted here by request. - Editor.)