Editor’s note: This is the second in a series covering mental health in the metro.
Besides raising funds for the new $110 million Behavioral Health & Wellness Center on 89th and Dodge streets, the Mental Health Innovation Foundation (MHIF) had another major challenge to contend with: staffing the 107,250 square foot center.
Nebraska, not unlike other states, has been lacking adequate behavioral health care providers for decades. The Human Resources and Services Administration found that of Nebraska’s 93 counties, 80 are classified as mental health shortage service areas.
“I think even more staggering is that a third of counties don’t have any behavioral health provider at all,” said Dr. Marley Doyle, executive director of the Behavioral Health Education Center of Nebraska (BHECN).
Limited providers to oversee clinical students, unpaid internships, and a lengthy training process are all major barriers for potential behavioral health care professionals.
Ken Stinson, who leads MHIF as chairman, said when planning began in early 2021 the workforce shortage was one of the first items flagged.
“We said we can’t go out and plan a facility, raise money for it and build it and then hope there’s people who can work there,” he said. “We had to do something more proactive.”
Conversations with inpatient mental health facilities and hospitals identified mental health technicians and mental health nurse practitioners as two in-demand careers that could drastically improve the landscape.
Together, with the help of CHI Health, MHIF brought together the University of Nebraska at Omaha, Metropolitan Community College, Bellevue University, Creighton University, and Iowa Western Community College to find solutions.
On the education side, staffing to support students through their clinical experience on their path to becoming mental health nurse practitioners was a significant bottleneck.
Dr. Tina Chasek, chair of UNO’s Clinical Counseling Department and associate rural development director for BHECN, explained that due to accreditation rules, student positions are limited. UNO is unique in that it has a clinic on campus where students get 40 hours of experience before transferring into an internship.
“We can only have one faculty member to six students in their practicum experience,” she said. “We had 100 applicants for this round of admissions and based on our ratios we could only take 37.”
She said that of the 200 students in graduate-level counseling programs, roughly 150 are in clinical counseling.
Students looking to move into an internship also face similar challenges as well as the prospect of working 260 hours for free.
“Most internships aren’t paid because practices can’t bill for an intern’s work,” Chasek said. “Plus, they’re taking time out of their billable hours to supervise the interns. That’s why the ARPA (American Rescue Plan Act) grants were game changers.”
Opening the Floodgates
In 2022 the Nebraska Legislature dedicated $25 million in ARPA funding to address the impacts of the COVID-19 pandemic and the shortage of behavioral health professionals. As Nebraska’s workforce development center, BHECN was tasked with distributing the funds.
“When we got the funding our initial thought was we were going to have quarterly applications over three years,” Doyle said.
“What ended up happening is in the first round we got nearly 200 applications. Nearly $50 million in funding requests. We awarded about $20 million.”
The second round of funding, which closed in April 2023, also finished with $25 million in requests and winners have yet to be announced.
The first round of funding provided funding for 83 unique projects focused on four categories: behavioral health training and education opportunities, telebehavioral health in rural areas, behavioral health workforce COVID-19 projects, and funding for the supervision of professionally licensed providers.
For UNO this meant a clinical supervisor could be hired bringing the number of students supervised in their clinic to 12 at a time.
For CHI Health it provided a pathway for current nurse practitioners to become certified psychiatric mental health nurse practitioners (NP’s) through Creighton University. Robin Conyers, CHI Health division vice president of behavioral services, said this will allow NPs to treat their regular patients whom they already have a relationship with.
Psychiatric mental health nurse practitioners are able to diagnose a mental health illness and treat the illness, whether that’s through prescribing medication, psychotherapy, or a combination.
“That then creates access because our partners are comfortable caring for folks in a primary care setting,” she said. “That then allows for those really specialty appointments to be available for individuals that need specialty care.”
The grant will cover tuition for 15 students over the course of three years. The program spans about a year and is 100% online, and CHI is able to complete the hands-on training in-house, eliminating common barriers for full-time professionals.
Dr. Catherine Todero, Creighton College of Nursing dean, said there also may be travel stipends.
“We’re trying to mitigate anything that might be perceived as a barrier to students taking this opportunity,” she said.
While upskilling the current workforce is an essential piece of the puzzle, the coalition of higher education institutions also recognized time and money as a barrier.
Common careers in the field – psychiatrist, physician assistant, psychiatric nurse practitioner, licensed psychologist, professional mental health counselor, marriage and family therapist, and clinical social worker – require a bachelor’s, master’s, or doctoral degree.
That’s one of the reasons MHIF and its institutional partners zeroed in on mental health technicians. Not only was it one of the most requested positions, but it also doesn’t require a degree or certificate to start.
What Bellevue University, Metropolitan Community College, and Iowa Western Community College wanted to pursue were better-equipping technicians.
Gary Stessman, who is an associate professor at Bellevue University, said burnout happens quickly when technicians don’t understand how a mental health issue manifests. Stessman knows firsthand; he’s a licensed independent mental health practitioner and provisionally licensed alcohol and drug counselor with over 14 years of experience.
He said if a technician doesn’t understand a person’s trauma response or underlying mental health issue, it’s easy to take a negative reaction personally.
“If they understand trauma and its impact on brain function, or if they understand developmental disabilities and psychiatric disorders, they can separate the behavior from the patient and not personalize it,” he said. “When you don’t personalize it, then you can stay focused on making sure the patient receives the treatment they need.”
The mental health technician certificate program that Bellevue University, as well as IWCC and MCC, have launched teaches students those foundational skills and more.
The hope is that by better-preparing technicians they will stay in the field longer, providing stability, and possibly deciding to receive more training.
“It’s an entry-level job, but if they’re working at a hospital they might have benefits like tuition assistance, which allows them to take a look at other avenues they could explore,” said Dr. Michelle Eppler, dean of Bellevue University’s College of Arts and Sciences. “They could go the counseling, social service, or psychiatric nursing routes.”
In the end, it all comes back to creating a better future for Omaha, and the greater Nebraska area.
“The key here is, the larger the pool, the better off everyone in our community will be,” Stinson said.
In-demand Careers in Behavioral Health
Information courtesy of BHECN
Psychiatric Nurse Practitioner (APRN-NP) – Prescriber
Psychiatric Nurse Practitioners are advanced practice registered nurses who can diagnose and treat mental illnesses and promote the mental health of individuals and families. Psychiatric nurse practitioners offer psychiatric/mental health assessments, order laboratory tests, conduct psychotherapy, and manage medications.
Education Requirements: Typically Bachelor of Science in Nursing and Master of Science in Nursing or Doctor of Nursing Practice degrees. Expect six to nine years of coursework post-high school.
Work Environment: Offices of physicians or other health practitioners, private practice, hospitals, outpatient clinics, community agencies, colleges, and universities.
Projected Growth: 31% (much higher than average).
Average Salary: $91,000.
Professional Mental Health Counselor- Non-Prescriber
A professional mental health counselor creates relationships to empower individuals, couples, families, children, adolescents, and groups to accomplish mental health, wellness, education, and career goals. They apply mental health, psychological, human development, or family systems principles and interventions to help clients adjust their thoughts, feelings, or actions. They also diagnose and treat mental and emotional disorders, such as anxiety and depression.
Education Requirements: Typically a bachelor’s degree followed by a master’s degree that includes a supervised practicum and internship. Expect six to seven years of coursework post-high school.
Work Environment: Individual and family services; outpatient and inpatient intellectual and developmental disability, mental health, and substance abuse centers; hospitals; state and local government.
Projected Growth: 20% (much higher than average).