LINCOLN, Neb. — Nebraska lawmakers are looking for ways to increase mental health services in areas that lack psychologists, psychiatrists and counselors, but that could prove difficult amid a tight state budget

Nebraska has a nearly statewide shortage of mental and behavioral health professionals, but advocates say the problem is particularly bad in rural parts of the state. One senator said the solution may lie in a state-funded internship program to attract more behavioral and mental health students who are working toward advanced degrees.

Sen. John Stinner of Gering said he plans to convene different groups at hearing on Sept. 8 to see how the state might pay for such an incentive.

“We have a big demand for that type of service, but we’re short on personnel,” said Stinner, chairman of the budget-writing Appropriations Committee.

Lawmakers this year delayed spending on some state expenses and cut funding available for services aimed at people with developmental disabilities.

Providers say that a lack of mental and behavioral health services can mean that schools and police end up dealing with the problems.

Wages remain one of the biggest obstacles to keeping well-trained providers in rural areas, said Barbara Vogel, the administrator for western Nebraska’s Region I behavioral health authority in Scottsbluff.

Vogel said rural areas have a particularly great need for nurse practitioners who specialize in behavioral health and are legally qualified to prescribe medication. Some areas also have a shortage of providers to treat sex offenders, she said.

“Practitioners might come out for an internship, but they don’t stay,” Vogel said. “They can get thousands of dollars more per year in eastern parts of the state” with its larger population.

Many providers who stay in rural areas get swamped by the huge demand for mental and behavioral health services, said Dr. Catherine Jones-Hazledine, a clinical psychologist and owner of Western Nebraska Behavioral Health. Jones-Hazledine, who is based in Rushville, travels to eight different sites in rural western Nebraska to see patients. Once a week, she drives to a clinic in Valentine more than 100 miles from Rushville.

“With most of the clinics I visit, it’s back to back,” Jones-Hazledine said. “It’s very common for me to not take a lunch break.”

Jones-Hazledine said some of the burden falls to primary care doctors who don’t have specialized training for patients with mental health problems or addictions. Some patients travel to Scottsbluff; Rapid City, South Dakota; or Denver, Colorado for specialized treatment.

Setting aside state money for an internship program would help, but the bigger challenge is getting advanced-level interns to stay in rural areas, Jones-Hazledine said.

Jones-Hazledine said state officials should focus their incentives on students who grew up in rural areas because they’re more likely to return. Jones-Hazledine was raised in the Rushville area and returned after receiving her education at the University of Chicago and the University of Nebrsaka-Lincoln. For the last five years, she has helped with a youth camp designed to draw aspiring practitioners to rural Nebraska.

“Getting them out here for a year is great, but that’s not what we need,” she said.

New technology can relieve some of the burden by allowing patients to talk to specialists online, said Annette Dubas, executive director of the Nebraska Association of Behavior Health Organizations. But Dubas, a former state senator, said many providers are concerned about state-funded reimbursement rates for Medicaid patients.

Nebraska is struggling to provide adequate mental health services and faces challenges in its efforts to curb binge drinking and substance abuse, according to a December report by a legislative task force. The report found the shortages were most severe in rural areas and recommended that the state set aside money for post-graduate fellowships in psychiatry for physician assistants and psychiatric nurses.

A separate University of Nebraska Medical Center assessment found that only 7 percent of Nebraska residents who abuse alcohol get treatment. Project Extra Mile has said excessive drinking costs Nebraska residents over $1.1 billion a year, $491 million of which falls on the government.


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