Nebraska's high rate of binge drinking and low rate of treatment among those who abuse alcohol caught the eye of a legislative task force working over the interim.
The Behavioral and Mental Health Task Force, chaired by Lincoln Sen. Kate Bolz, included the problem on its list of 18 recommendations, released Thursday.
Senators also took on the challenges of a lack of adequate mental health workers, a waiting list and shortage of staff at the Lincoln Regional Center and the limited ability of the state's jails and prisons to meet the high mental health needs of those arrested and sentenced to those facilities.
Binge drinking, defined as five drinks within two hours for a man and four for a woman, is associated with a host of problems and Project Extra Mile says excessive drinking costs the citizens of Nebraska more than $1.1 billion a year, $491 million of which falls on government.
Among Nebraskans who abuse alcohol, only 7 percent received treatment, according to a 2016 University of Nebraska Medical Center assessment.
The task force looked at the statewide capacity to address substance use, Bolz said.
"When we have waiting lists that are three weeks long for the right level of care, those are issues of resources and capacity," Bolz said.
The seven-member task force looked at how to better invest in prevention, while looking at rates paid to providers of those services.
"We know that we are underfunding those services," Bolz said.
The Legislature and the state's Division of Behavioral Health should work together to fund provider rates that have fallen significantly behind the cost of providing the services, specifically in the substance abuse area, the report said.
The report said the state, in general, and rural areas in particular, don't have a sufficient number of mental health workers. Senators recommended publicly funded post-graduate fellowships in psychiatry for physician assistants and psychiatric nurses. There are 791 physician assistants in the state, but only 14 are psychiatric providers.
Providing internships for master's level students in rural and underserved areas, and expanding student loan forgiveness, especially for those willing to serve populations including non-English speakers and substance abusers, were also recommended.
The senators found a waiting list for services at the Lincoln Regional Center and a need for additional inpatient beds and staff, especially nurses.
They recommended adoption of a mental health care provider shortage emergency act, to ensure that if the Regional Center falls below a certain staff level, a portion of vacancy savings would go for staff retention bonuses.
A study could determine the right size and staffing for the center to ensure those who get civil or court-ordered commitments receive treatment they need, the task force said.
Bolz said a recommendation to create an emergency protective custody "no-refusal center" for short stays for violent or dangerous people who cannot be served at the Regional Center or a hospital, could ease pressure.
Senators also recommended mental health technical assistance opportunities for law enforcement and county jails for assessment, treatment, referral and health and safety stability. And developing appropriate mental health treatment and programs in state prisons would help people succeed after they have left.
Greater access is also needed to medications, and managing those medications for people in outpatient settings, the task force learned. Recommendations included adjusting rules for inmates leaving prison to have sufficient medications until a medical appointment can be made in their communities, and expanding access to services to support recovery.
Task force members are already drafting legislation based on the recommendations, Bolz said.
She will have a bill to expand drop-in and respite housing opportunities statewide, such as Lincoln's Keya House, a crisis diversion home, and the Honu Home, a respite residence for people with mental health needs who were recently released from jail or prison.
Sen. Sue Crawford of Bellevue will work on workforce development. And Omaha Sen. Sara Howard is working with state Medicaid to authorize reimbursement for peer support services.