Power struggle: Mental health patients caught in middle of fight between elected leaders

Sheriff’s deputies escorted the handcuffed man toward the eighth-floor conference room of the Omaha-Douglas County Civic Center. Inside, the members of the Douglas County Board of Mental Health, which oversees hundreds of peoples’ mental health treatment every year, prepared to discuss his progress.

Also in attendance: Crystal Rhoades, clerk of the district court in Douglas County. 

District court judges in Douglas County had, earlier that day, threatened to hold her in contempt of court, the latest reprimand during a year-long fight between Rhoades and other elected leaders over the important, but under-resourced, mental health board.

The handcuffed patient going before the board on May 14 had invited a Flatwater Free Press reporter to attend. But given Rhoades’ presence, his lawyer said, it would be better if the reporter wasn’t in the room.

“I wouldn’t feel right about (my client) being potentially roped into a political (fiasco),” said Henry Nunn, the patient’s public defender who, after speaking to his client and bosses, successfully objected to Flatwater Free Press attending the hearing.

Since June 2023, Rhoades has raised concerns about the Douglas County Board of Mental Health. She’s alleged she’s being asked to do unauthorized legal work, a misdemeanor punishable by a $500 fine and/or three months in jail. She’s also alleged patients’ rights are being violated, according to emails obtained by Flatwater Free Press through a public records request.

The board’s chair and other leaders, including Sheriff Aaron Hanson, disagree. They say there’s a half-century of precedent backing many of the board’s practices.

The political dust-up has prompted calls to evaluate the mental health board, something Mary Ann Borgeson, a county commissioner since 1994, said she’s never seen. 

“If this system that everybody seems to have thought worked so well for so long has gaps and issues then to me this is a very good time for us to take a look at it,” she said. “So I’m looking at it as a good thing.” 

The Board of Mental Health process starts when someone — a family member, police officer, a doctor  — believes a person is mentally ill, dangerous and unwilling to seek treatment. The Board of Mental Health then works with doctors to build a plan or commit the person to a state-run regional center or other treatment.

The board also oversees the commitment and treatment of people under the Sex Offender Commitment Act. Each of Nebraska’s six judicial districts is required to have a Board of Mental Health. In 2023 the Omaha-based board processed at least 844 petitions, according to data provided by the Douglas County Sheriff’s Office. 

The board, which has no budget or staff, relies on multiple county offices to function. 

The sheriff’s office serves warrants and brings people to the board. The public defender represents them. The county attorney lobbies for specific treatment options. And the clerk of the district court serves as the connective tissue, certifying orders, attending Board of Mental Health meetings and preparing filings. 

Rhoades, elected in 2022, believes the prep of those filings is a practice of law that should be handled by the county attorney. She’s also attempted to make other changes that ruffled feathers in multiple other county offices.

Last summer, a supervisor in Rhoades’ office announced that Board of Mental Health meetings would be held at the clerk’s office. Some meetings were already held there. Typically, though, the board meets with people suffering from serious mental illness in hospitals and treatment facilities. It’s done so for nearly 50 years, its chair said in an email. Rhoades said the changes were designed to save money and “limit the office’s overall liability.”

Leaders with the public defender, county attorney and sheriff’s offices raised logistical, ethical and financial concerns. Through July, emails volleyed between board chair Michael McClellan, who accused Rhoades of obstructing the board, and Rhoades, who alleged that patients’ rights were being “violated left and right.”

McClellan involved two lawyers with the Nebraska Attorney General’s Office, though a spokesperson recently said that office “had nothing on the matter.”

The back and forth continued over email, through meetings and in formal letters. Eventually district court judges stepped in, issuing several orders to keep board operations at the status quo.

Then earlier this month Rhoades sent a new letter to the district court judges, announcing changes that included reassigning several duties previously held by the clerk. The judges again responded, ordering Rhoades to keep things as they are and cited statutes suggesting she refrain from speaking publicly about Board of Mental Health cases. 

“This order shall be enforceable by all remedies available, including, but not limited to, contempt proceedings,” the order reads.

Some of Rhoades’ objections may not be baseless, said Douglas County Public Defender Tom Riley. While it was understood for decades that people appearing before the board would be represented by the public defender, Rhoades pointed out that his office wasn’t officially appointed to represent those clients. A judicial order later clarified that Riley’s office would represent all people appearing before the board. 

“There was some corner cutting that was done for pragmatic purposes as opposed to strictly by the book, shall we say, and she pointed some of those things out,” he said, “and she wasn’t wrong about some of those things.”

The court administrator declined comment and said judges wouldn’t, either. Rhoades declined to speak for this story, citing the judges’ order. McClellan declined to be interviewed, saying he didn’t want to answer questions from reporters he believed Rhoades had influenced. County Attorney Don Kleine didn’t respond to interview requests.

Rhoades has a right to question her role in the board’s process, Borgeson said. But the continued animosity, coming from all directions, bothers the longtime county board member. 

“We (have to) stop all this nonsense and get down to, if we’re going to change the process, let’s change it,” she said. “But we’ve got to keep the person we’re serving at the top.”

Tim Heller, chair of the state’s advisory committee on mental health services, said the board is failing to adequately serve people in mental health crises. Heller has filed multiple petitions with the Douglas County Board of Mental Health for his son who suffers from serious mental illness. Heller said he often speaks with families who find the mental health board experience confusing, scary and ineffective.

For Heller, the squabble over board responsibilities misses the point.

“It needs to be broken down and completely rebuilt,” he said.

One problem, Heller said: The board has no teeth, and no way to ensure patients stick to their treatment plans. Heller said similar groups in other states have programs to identify and help people who veer from treatment plans. He said the area also needs more mental health resources, something everyone interviewed for this story agreed on.

A Sarpy County Board of Mental Health pilot program  is currently assigning a caseworker to patients. Heller believes a caseworker could help people better navigate Nebraska’s mental health system, which recently became the subject of a U.S. Department of Justice civil rights investigation.

Local officials need to focus on lobbying the Legislature for changes, Hanson said, and not get lost in internal fighting.

“I absolutely believe that we need to take a fresh-eyes look at the board of mental health system,” Hanson said.

While the board’s functions have seen little interruption due to the internal squabbling, at least one person feels it has affected him: Adrian Martinez, who invited the Flatwater Free Press reporter to his May 14 Board of Mental Health hearing.

Nunn, Martinez’s public defender, had suggested in the hearing room that Rhoades shouldn’t be there, resulting in a tense back-and-forth. Nunn withdrew his objection after Riley said he told him he was wrong.  

In an interview, Riley also said he told Nunn to advise his client that it’s generally not beneficial to have a journalist at a mental health board hearing where unflattering information might be shared. His advice, Riley said, had nothing to do with Rhoades’ presence. 

In a letter Martinez wrote the next day titled “Violation of Rights,” he said he was told the reporter’s presence would be bad for his case and that “under duress I had no choice but to object.” His rights to a public meeting, to letting press see the inner workings of a board that’s become integral to his life, were denied for one reason, he wrote.

“Politics is what all the fuss was about.”