Nebraska needs more mental health care providers, says retiring state medical officer | Politics

A top medical officer for the State of Nebraska sees opportunity and challenges ahead for the state’s ability to deliver mental health resources, and they both boil down to the same factor: people.

For the last few years, Janine Fromm has served as executive medical officer in Nebraska’s Department of Health and Human Services, capping off decades of work, most of it spent here and in her home state of California.

When she retires next month, she’ll walk away from the job with a uniquely intimate perspective on some of the state’s obstacles, as well as an appreciation for the caseworkers who directly interact with people under the state’s care.

Fromm, a Stanford University-educated psychiatrist, came to Nebraska 21 years ago along with her four children and her husband, who had been offered a job at the University of Nebraska-Lincoln.

She worked at UNL’s student health center for over a decade, then in Medicaid before her current role — the highest-paid role in state government in 2021, according to the Flatwater Free Press public salary database, at just under $400,000.

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She oversees the clinical functions of all DHHS departments aside from public health, working to ensure people in the state’s care get the most cost-effective and appropriate care available. She’s on-call for caseworkers and facilities at all hours.

“My job, on a day-to-day basis, is kind of like the emergency room,” Fromm said. “You just never know what’s going to come up, be a crisis, need to be dealt with.”

She said she’s most proud of redesigning how the state’s system of Youth Rehabilitation and Treatment Centers for juvenile offenders operates. When she came here, she said, they had hit a crisis point. Now, they’re a much more therapeutic environment.

One story, from when the YRTC in Geneva was in crisis, particularly illustrates the nature of her work.

That center, which served female juvenile offenders, is now closed. HHS officials moved all of the youths in August 2019 — after staff shortages, inadequate programming and deteriorating buildings made the facility unlivable — to a separate building at the YRTC in Kearney, which was male-only.

Fromm said that, while that turned out to be the right choice, people weren’t happy about it.

Late one night, she learned that a couple of girls had escaped from the Kearney facility. She and DHHS CEO Dannette Smith jumped into her car and headed there, she said, to start looking for the girls themselves.

They drove to Walmart, golf courses and neighborhoods. About 4 a.m., Fromm said, they realized that maybe the girls had jumped into a truck, so they visited area truck stops. After becoming too exhausted to run after the girls if they did find them, Fromm said, they headed home. The girls were found safe, she said — but the story illustrates the terror of the job, its round-the-clock nature, and the concern for the safety and well-being of people in the state’s care.

“You really grow to feel responsible for both the adults and the kids, but especially the kids,” Fromm said. “So many of the kids, when you sit down and talk with them, you get to know them. They are survivors.”

Fromm also has had a unique look at mental health in the state. Nebraska is short on providers, she said, like other places in the U.S. It’s also short on facilities, levels of care, and options for housing and vocational rehabilitation.

Similar observations were documented in a 2021 report from the Behavioral Health Education Center of Nebraska. Though that report noted some positive developments, such as a 32% increase in behavioral health providers in the state from 2010 to 2020, it found that Nebraska continues to experience a shortage of care providers, and the existing provider workforce is aging.

Fromm repeatedly stressed that the state needs to recruit more people.

“We just need to figure out ways to incentivize people to come to Nebraska, to stay in Nebraska to grow our services to meet the needs of the population here,” she said.

Over the last few years, she’s seen the COVID-19 pandemic increase the number of people experiencing mental health and substance abuse problems as people were hit with isolation and massive lifestyle changes.

But she has also seen progress: The 988 suicide prevention and crisis hotline that’s set to launch in Nebraska and nationwide next month; reinvestment funds from the American Rescue Plan Act that will help build more behavioral health infrastructure; more providers offering services such as applied behavioral analytics for autism.

And she spoke highly of the state’s caseworkers and CEO Smith, saying she’s “astute on the behavioral health and substance use side” and has been focused on building more infrastructure and better programs.

“I mean, before her, there was no executive medical officer, you know, these caseworkers and these kids were kind of just flying by the seat of their pants,” Fromm said. “So, I see all those things as being very positive and moving forward and expanding services in time.”

Smith offered kind words about Fromm, too, in a statement: “She has been a true asset to the Department of Health and Human Services in meeting the needs of children and families in the state of Nebraska. We are well positioned for continuing the great work that has been implemented under her leadership.”

A “perfect storm” led to Fromm’s retirement: Her last kid is graduating from college, she’s turning 65, it’s been 40 years since she graduated from medical school and she’s ready to shed Nebraska’s harsh winters in favor of Florida sun.

But Fromm said she’s leaving it in good hands. Her role will be split into an adult psychiatrist and a child and adolescent psychiatrist, making it a bit more focused.

“What I’ve really learned and come to appreciate is how many incredibly talented, dedicated hard-working people are at DHHS that have to be so creative day in and day out to make the system work somewhat,” she said. “The structure is not in their favor, and yet they persevere and stay on it. They are stronger people than I am — I mean, truly — and I’ll miss them.”