"Increase the assessment services available, so that data-based decisions about the number of additional inpatient beds needed can be accessed."

"Increase funding streams for non-privately insured patients to cover the increased costs of doing business for agencies."

"Develop a Dual Diagnosis Facility and increase the assessment opportunities so that the usual 6-9 month wait for diagnosis, then placement, is eliminated."

"Create a stronger referral base in order for the services of a community-based program to become more effective."

"Create opportunities for education. Through education, we can reach the clientele Before they hit the crisis stage that might require hospitalization (which might not be available). By keeping Nebraskans apprised of the current mental health care issues and trends, changes in health care to combat deterioration will have more support. Help all community agencies communicate their Mission."

"Another opportunity for Education is to initiate discussions with the Douglas County Board regarding the role of the DCMHC in the provision of mental health services, and why they do not provide comprehensive services."

"Decrease waiting time for patients to be transferred to Regional Centers so that acute care beds are reserved for those who need them."

"Continue dialogue among agencies (police, providers, government, community, etc.) to promote trust and cooperation."

"The Regional Centers, the Regions, the Providers must be held to greater accountability for the services provided. We must eliminate services that provide substandard care at a very high cost. For example, the Regions could become an oversight organization, brokering federal, state, and county funds to the private sector in a way that requires high quality outcomes and efficiencies."

"Open more beds for inpatient care and provide more hospital days for acutely ill clients to recover before they leave the hospital."

"Stop referrals being made to homeless shelters by hospitals, regional centers and other acute or emergency services."

"Consolidate programs and review expenses. A sound business plan needs to be implemented that shows the direct cost-benefit analysis of how much money the government can save per each dollar spent on mental health versus the cost of ongoing economic drain from lack of treatment."

"Understand the anguish of parents and children who could not get the help they needed and be aware of the kids who are without parents or advocates."

"Ensure that the chief clinical/administrative officer has sufficient independent authority, personal strength and credibility to be able to develop an objective and effective plan and implement that plan, despite the tremendous political pressure that will be brought to bear."

2. What 3 items would you list as essential short-term goals, and why?

"Adequate inpatient resources, expansion of Assertive Community Treatment programs, add more rehabilitative housing. Recognizing that there will always be those unable to function independently, the provision of safe care and housing will avoid repeated crises and re-hospitalization."

"Establish community teams for crisis management. Provide more community-based services to preclude hospitalization and/or emergency room visits and address mental health issues early. Establish a crisis center so that ER’s are not “dumped on” as the provider of last resort and misusing emergency capabilities."

"Develop a Leadership Committee with funders, business leaders, service providers, and consumers totaling no more than 12 people. Develop a business plan with economic breakdown to reduce waste. Involve the media and to develop a marketing plan."

"Hold programs more accountable to clients and community."

"Stop the cuts in Medicaid funding. Medicaid is all we have to fund children’s behavioral health services today. Aggressively pursue all federal dollars available. Don’t lose federal participation through cuts or ineligibility. We also need leadership and commitment to obtain available federal grants."

"Continue to work with the insurance industry for mental health parity."

"Establish assessment programs that are immediately accessible."

"Consolidate the regional centers."

3. Are there other issues that must be addressed for Immediate Action?

"Housing, job training/placement opportunities, transportation for the mentally ill as part of their treatment plan."

"Inability to place patients immediately in Regional Centers is a constant frustration."

"State Government must begin to look at behavioral health treatment for children as a primary function of state government. The behavioral health needs of children in Nebraska cannot continue to be compartmentalized with some of the responsibility being held by various programs that do not work together and rarely collaborate in sharing funds. We must have a unified system that brings prevention, mental health, substance abuse, Medicaid, Juvenile Justice, education, and child protective services under one roof."

"Have a consensus from local treatment providers outlining patients that need regional center care (sex offenders, for instance). Address the lack of effectiveness of the Regions relating to planning and long-range vision and their conflict of interest."

4. Over and Over, we hear that we have failed to achieve a Common Vision for Behavioral Health Care. What are the first steps you believe must be undertaken to form a common vision?

"Analyze why we have failed to develop a common vision. A Leadership Group could be developed that would solicit feedback from the agencies and the government groups. Leadership should come from the corporate community so that all turf issues are left behind. Are there strategic planning processes already available to use as models for our community vision?"

"We need additional community-based services in this state. Those services need to include transitional, supportive housing, dual diagnosis treatment, insurance support for treatment crises, and training of professionals. There is a need to cut through the political entanglements that have prevented change. We need to put aside our differences and look at the overall big picture."

"Use the known problem solving steps: identify the problem, gather the data, analyze and synthesize it, develop solutions, implement and evaluate. Students would be willing to assist with in-depth research."

"Be aware that the needs of the SPMI differ from the needs of the persons with acute mental health crisis, and are different from the needs of children with behavioral illness. This leaves us talking of apples and oranges. The needs of both types of consumers must be addressed by the system, but the system will appear different to these different consumers."

"Maybe instead of having mental health professionals deciding for clients and the community, we need to be asking clients and the community what they need and identify as concerns."

"We need to focus our actions so that we can change the system into one that gives people access to the services they need delivered in a way that ensures continuity of treatment and effective patient-focused communication among providers. Unfortunately, the publicly funded mental health system is highly politicized. The people running agencies are set up to compete, not collaborate. The system is fraught with distrust, territorialism, dysfunction, and arbitrary administrative systems. It is a system that must rely on public funds for survival. “Mental Health funding is, unfortunately, basically a dog fight.” We lack leadership."

5. If you could define the vision yourself, what would it include?

"Accessible, compassionate, comprehensive community based services based on latest research and best practices. Providing the appropriate level of mental health care at anytime to whoever needs it, maximizing use of federal and state financial resources supporting mental health initiatives. Cooperation throughout the community in financing and providing services. Cooperation from HHSS particularly in grant applications."

"Focus on the whole person and the whole family, not just the diagnosis."

"Government should be the brokers and funders of services. Their primary role should be the purchase of highest quality service. Service providers should be held accountable for agreed outcomes."

"Cutting the role of Government (including the HHSS and Regions) in direct service provision would free up money for direct services by the private sector. The funds should flow to patient care through adapted best practice research."

"Funds saved by smaller government could be used to provide prevention programs and community-based programs."

"In order to achieve meaningful change in the overall behavioral health of the youth of Nebraska, we will have to develop a strong link between child care, K-12 education, and all the funding and service streams that we now include in the behavioral health systems."

"Acute care facilities must permit patients to stay until they are actually functioning. Seven days for acute schizophrenic relapse is ridiculous. Then the client should be transitioned to the next level of care. We can’t just drop the patient off at home or at homeless shelters. Continuity of care is essential. My vision would permit NO wait lists, fragmentation, (such as treatment of co-occurring illness or discriminatory treatment.)"

"Reconstruct the guidelines in order to reduce waste."

6. How would you contribute to the development of a dual diagnosis center?

"All Behavioral Health Services should be equipped to serve dual diagnosis clients. Outpatient services should be structured to assess and provide both substance abuse and mental health needs"

"We must assure a continuous funding stream is available to support on-going care. We are unable to negotiate the state/regional funding streams to assure provision of services."

"We cannot stop at the development of a parallel system and we must strive for treatment that treats both diagnoses as equal issues providing simultaneous treatment. Persons with SPMI do not do well in most treatment programs designed for persons without SPMI, as the level of confrontation is too great, and they find it difficult to establish peers. A Dry House for short-term crisis intervention substance abuse treatment for persons with SPMI would alleviate additional issues."

7. How should we approach the issue of Medicare/Medicaid funding?

"Medicaid funding for outpatient care is significantly lower than Medicare and Region 6 reimbursement. If a strong community-based system of care is to develop, Medicaid rates would need to be increased. The State will also need to look at expanding the rehab options that could expand Medicaid coverage. Nebraska Government needs to work with federal officials to fund treatment equitably for adults and children, focus more on outpatient services, and reduce management entanglements that currently exist."

"Nebraska does not currently take advantage of every federal dollar available."

"Medicaid should be applied for, as a matter of course, as part of the discharge planning, for those admitted to Regional Centers for Treatment. This planning and application for Medicaid needs to begin upon admittance."

"We could reduce the administrative burden to prove a certain level of care is required."

"Medicaid leaders in the state do not seem to understand the system or be aware of the need for rehabilitation services."

"Educate the Nebraska state leaders of Medicaid about the mental health system and the needs of the mentally ill."

"Services approved for Medicaid funding go for years prior to state implementation and therefore Nebraska looses millions of federal matching funds. When we restrict Medicaid eligibility for various services, the State ends up paying the whole bill if not in the Behavioral Health System, than through medical bills, corrections, homelessness, etc."

"During this year’s HHSS Appropriations Committee hearing, it was stated that the regional centers are loosing significant federal dollars because they are not billing properly. Perhaps corporate leadership would help to correct the billing system."

8. What other issues would you like to comment on concerning Setting Goals?

"There needs to be a sense of urgency on setting realistic goals and getting planning started.

"We need parity in the insurance provision for behavioral health and physical health needs."

We must all share the same strategic vision for mental health care and understand that every service must be somehow related to that vision. We need leadership in the field of Mental Health.

"Mental Health professionals should commit to taking full responsibility for their clients’ needs instead of constantly passing and referring them on. If one professional is ultimately responsible for the client, the patient is less likely to slip through the cracks."

"There needs to be a common mission statement for Nebraska’s mental health system. Agencies have their own mission statement, but we need one common statement amongst all."

9. We all know that it will take collaboration and cooperation to develop a Blueprint for Action. How would you divide the areas of responsibility for crafting this Blueprint

"Crisis planning related to current critical issues."

"System redesign for community based services with elimination of regional centers."

"Building public awareness and support."

"We need governmental leadership. The government holds the financial cards."

"Think in terms of AT LEAST 5-year blocks of commitment to issues, not annual funding."

"Patients and families have a responsibility to be involved in changes."

"The private sector must take leadership in developing new systems. Collaboration with the private sector and organizations would develop a grassroots change agent. The responsibility would then fall upon this collaboration to promote the type of legislative, regulatory, and private sector changes needed."

"Areas to include: funding, finances, inter-agency communication, intra-agency quality and efficiency, federal and state regulations, public awareness, clinical expertise, consumer perspective."

"We need a systems approach: financing will probably be most successful if led by the business sector and legislature, rather than HHSS, regions, or private providers."

"Committees need to focus on various health and non-health factors that are contributing to the growing problem of mental illness in the State of Nebraska."

"One person should head this mission, taken it on as a business, and then be held accountable.

10. What strengths, assets, abilities, or experiences are YOU willing to contribute to this Blueprint for Action?

"I would contribute based on my experience."

"As an administrator for outpatient community-based providers."

"As a parent of a child with behavioral disorders."

"In budgeting and program development."

"As a provider of inpatient care."

"With discharge planning."

"In public education."

"And contacts nationally in the provision of mental health care."

"And understanding of political and fiscal systems."

"And enthusiasm and unbiased perspectives."

"And commitment to research, planning and design."

11. What role would you assign the Kim Foundation in creating this Blueprint for Action?

"Facilitating the process by convening key players and providing support to make a planning process successful."

"Help develop a rational plan for mental health treatment."

"Organize committees."

"Help to develop a strategic vision."

"Provide a central gathering point and dissemination of information."

"Bring together the private and public sectors."

"Hold HHSS accountable for their attitudes."

"Bring in business and community leaders and help with public relations."

"Hold discussions about the next steps when LB 724 is passed."

"Be willing to confront some of the harder systems issues that providers can’t address, like funding streams."

"Serve as the liaison among community agencies, the state of Nebraska, and the community."

"Remain a mental health advocate to the media."

12. Please give us a rough sketch of what your Blueprint for Action would look like.

"Immediately assess the need for inpatient service and begin planning as if the Regional Centers did not exist. Start asking what services need to be developed or expanded to develop a community-based integrated system. Add more transitional care beds with supportive services. Determine a workable solution to the problem of paying for the newest medications to control mental illness."

"Integrate the funding from Medicaid, the regions, and the regional centers. Be sure people have the long term treatment they need to stay stable."

"Require the State to return to including transportation as a case management service in Community Support."

"Reducing the current barriers in obtaining CADAC licensure for master’s level counselors will provide more trained personnel to fill CADAC positions."

"Increased numbers of dually certified counselors would address the problem of limited professional resources and eliminate the need for some agencies to hire high school graduates just out of treatment to be ‘counselors’."

"Establish higher compensation rates for dual diagnosis treatment."

"Consider how Nebraska wastes treatment time and money. Medicaid officials need to change the Nebraska Medicaid regulations to allow licensed mental health practitioners to diagnosis and treat, without psychiatric supervision, all but the seven major mental health diagnoses, as it is done in other states. Medicaid is the only third-party payer in Nebraska that requires this level of evaluation and supervision of licensed mental health practitioners. It is an unnecessary cost, and involves a minimum 8-10 weeks wait for a client to get an MSE, before treatment planning can even begin."