Amid mental health care ‘bottleneck,’ a program helps Nebraskans with intense needs

Carey Hutchison lay on the floor, curled into a ball and sobbed. 

“I’m trapped in hell,” she told her fiance.

The then 26-year-old started hearing voices when she was a teenager. A yearslong carousel of doctors, therapists and psychiatric wards hadn’t silenced them. Instead, she leaned on self medication: Xanax and other drugs, which she stopped taking when she decided to get pregnant.

Now her psychosis was stronger. She cried for herself and for the baby growing inside her. 

In the fall of 2023, skeptical but desperate, she walked into another treatment center, one everyone calls ASPIRE.

Her new therapist asked questions. Her doctor listened and tinkered with medications. Her psychiatrist cried with her. 

“I felt like I was going to be taken care of,” said Hutchison, now 28, who had her baby, Prairie, in March 2024.

ASPIRE, a Nebraska Medicine program, started in 2019 to serve people who often need more care. Its full name drives home its mission: Active Support for Psychosis in Recovery.

For patients like Hutchison, the program is an exciting discovery in a system that, while improving, still struggles to serve people with serious needs due to a lack of programs, providers and coordination. 

That can make life feel like a “revolving door” of trying new treatments or doctors. It might lead to worse health outcomes or the Douglas County Jail, which is treating an increasing number of people with serious mental health issues.

ASPIRE is working to prevent that. On the fifth floor of Nebraska Medicine’s psychiatry clinic at 42nd Street and Dewey Avenue, ASPIRE’s staff of about 15 people works with 300 patients. Therapists, psychiatrists and primary care providers work as a team with a patient-led approach.

“The goal is, ‘Can we just get to know each other? Can you share your perspective with me and over time can I share my perspective with you?’” said Dr. Melissa O’Dell, a psychiatrist and co-founder of ASPIRE. “We develop a trusting relationship, so that if things get worse, if things change … that door is open.”

‘It’s a death’

Dr. O’Dell co-founded the treatment center after watching her father and brother struggle with mental health issues. As an adult, she had to call law enforcement on people in crisis. O’Dell said she once watched a police officer slam a family member to the ground to get them in handcuffs.

“It wasn’t that I had made the wrong decision,” she said, “because there was no alternative. Those are larger systemic issues.”

Paula Adams, Hutchison’s mom, had searched for answers since her daughter was in elementary school. After a 15-minute session, doctors would say she was depressed or just acting out. As she got older, Hutchison got better at convincing them her mom was overreacting.

After she was diagnosed and medicated, Hutchison would be OK for a while. Then things would slip — mania, hallucinations, moving to other states or counties and living in disarray. Her mom felt helpless.

“It’s a death,” she said of those moments watching the future she imagined for her daughter evaporate.

Serious mental illnesses can result in a higher likelihood of incarceration or homelessness. People with schizophrenia also die, on average, 15 to 25 years earlier from natural causes such as cardiovascular disease as well as suicides or overdoses.  

When Hutchison was 17, her mom tried to commit her. She sent a long form to the body that decides whether to force Nebraskans into treatment. Adams never heard back.

“If you’re asking me if the system fails these people,” she said, “yes. Absolutely.”

Some things have changed for the better, O’Dell said. 

Last year, the Omaha Police Department’s Behavioral Health and Wellness Unit, a team of non-law enforcement mental health workers, made 4,279 contacts, a 70% increase over the last four years. And while the department is receiving more mental health-related calls, officers are taking fewer people into protective custody. 

It’s a sign police are improving, said Lt. Neal Bonacci, a department spokesperson. It also shows room for improvement if many people still see 911 as the way to get mental health care, he said.

The city also has a psychiatric emergency room, which opened in 2020, at Nebraska Medicine. Last year, longtime provider Community Alliance opened a new campus near 72nd Street and Mercy Road. Douglas County is planning two new mental health facilities — one for people in jail and another for people in the community.

Many also already use team-centric approaches like ASPIRE. Community Alliance’s ACT team has organized case workers, therapists, psychiatrists and others around clients for years. CHI Health pairs mental health workers in many of its primary care clinics, said Robin Conyers, vice president of behavioral health services.

Still, the area needs more, Conyers said.

It used to take two to three weeks to get a new patient into therapy, she said. Now it takes two to three months. 

Another major obstacle is housing, said Donnie Roman, who helps ASPIRE clients with problems outside the doctor’s office. Rent prices in Omaha have skyrocketed even as benefits like Social Security, which many patients with psychotic disorders rely on, have not.

Roman primarily works with Nebraska Medicine’s Behavioral Health Connection, a hub thousands of people call for help navigating the system. It has become more of an uphill battle in recent years.

“You have more people seeking services with that same amount of providers,” he said. “It’s like a bottleneck.”

‘We don’t have the capacity’

Providers at ASPIRE ease some of that tension by working as a team, said Dr. Sarah Fischer, a psychologist with the clinic. It’s easier to talk and problem solve when everyone’s in one place, she said. 

Providers also make a point to involve families, Fischer said. That might make it easier to catch warning signs, consider med changes or get someone into therapy sooner.

O’Dell wants to see the clinic expand — offering more services and taking more clients — but some issues such as homelessness are currently beyond its scope.

“We don’t have the capacity to offer everything to everybody,” she said.

Nebraska’s not alone. Nationally, demand for services has far outpaced the supply of workers able to provide them in many places, according to the Association of American Medical Colleges. 

Inpatient psychiatric beds are also in demand. The Treatment Advocacy Center, a national group that lobbies to change state laws around mental health, estimates a healthy system should have 60 beds per 100,000 people. 

Nebraska, with about 19 beds per 100,000 people, is slightly above the national average. 

That’s “still terrible,” said Dr. Marvin Swartz, a professor of psychiatry at Duke University who studies the effectiveness of services and treatments for people with severe mental illness. Nebraska also scored near the bottom of the Treatment Advocacy Center 2020 grading of each state’s psychiatric treatment laws.

Understanding the breadth of community-based care — from long-term care to seeing a therapist — can be challenging, said Patti Jurjevich, administrator of Region 6 Behavioral Healthcare, which oversees state funding for behavioral health in Cass, Dodge, Douglas, Sarpy and Washington counties. 

That “fragmentation” can create confusion for patients seeking services — and for administrators. 

“I don’t know who can get their arms around everything going on out there in the behavioral health world,” Jurjevich said. “I wish we knew. I wish we had a total picture of what those needs were. But unfortunately, we don’t.”

Nebraska suffers from a lack of leadership, accountability and coordination, said Jason Haglund, co-founder of Rural Policy Partners, a mental health policy consultant in Iowa. His firm researched Nebraska’s system for an October 2024 report to a special legislative committee focused on mental health resources.

The state’s patchwork of laws, accumulated over decades, has created a confusing system, Haglund said. Other states plagued by similar problems, like Iowa and Colorado, have overhauled their systems in recent years. Nebraska has not.

“Sometimes you’ve just built bad legislation on bad legislation on bad legislation,” he said. “And sometimes it takes a whole new redesign to come in and wipe everything else away and design it the way it needs to be.”

Nebraska already is seeing the consequences of sticking to the status quo, said Sen. John Cavanaugh, a Democrat from Omaha and the head of the committee that received Haglund’s report. He doesn’t see it improving anytime soon.

Addressing worsening mental health issues in Nebraska’s prisons will require criminal justice reform, the report states.

“I don’t think there’s a political will in Nebraska at this point to do something big,” Cavanaugh said.

Locally, people are getting better at working together, said Roman with ASPIRE. Years ago, patients sometimes disappeared if they ended up at a different hospital or facility. Now, it’s easier to coordinate with other providers and figure out how to get the patient the best care.

“We’re all in the same boat. We’re trying to do what’s best for the patient,” Roman said. “I think we just learned that it’s better for everybody to play nicely.”

Mentoring future doctors, counselors and nurses is a big focus at ASPIRE, O’Dell said. Residents, interns and others who work with ASPIRE may not stay at Nebraska Medicine or in behavioral health care, but O’Dell said it’s important for people to see what good treatment for psychosis looks like. 

“Hopefully, they take that wherever they end up, and we sow seeds that way,” O’Dell said.

‘Almost like a friend’

For Hutchison, there’s one thing that stands out about ASPIRE.

She feels listened to.

Hutchison broke down in front of O’Dell after a friend died by suicide. O’Dell got emotional. It was a very different attitude from other psychiatrists who kept her at arm’s length. 

“She’s almost like a friend,” Hutchison said of O’Dell.

ASPIRE has brought Adams relief. Her daughter has a new family and their relationship is improving.

“Me and her were always cat and mouse — she would do something and I was trying to catch it and fix it or change it,” she said. “Now it’s completely different.”

With ASPIRE, Hutchison is hopeful about the future. As her baby becomes a toddler, Hutchison is completing a bachelor’s degree in philosophy. In psychosis, existential questions about reality and life plagued her. Now she’s able to explore them through research and writing — something she hopes to continue in a career, maybe in academia.

She’s also willing to retry some more challenging therapy. In the past, she had been hopeful they could uncover and heal past trauma. Instead, it made her psychosis and depression worse. But now, nearly two years after she started working with her team at ASPIRE, she’s ready to try again.

“That was the moment where I decided, ‘We’re doing this,’” she said. “We’re stuck together now.”