Mental Health Care, Conditions And Related Matters In NDCS Facilities SUMMARY OF INVESTIGATIVE REPORT NO. 2025-01

By OFFICE OF INSPECTOR GENERAL OF THE NEBRASKA CORRECTIONAL SYSTEM; Doug Koebernick, Inspector General Zach Pluhacek, Assistant Inspector General

This report by the Office of Inspector General of the Nebraska Correctional System (OIG) explores five areas of interest and/or concern related to mental health services within Nebraska Department of Correctional Services (NDCS) facilities. The findings and recommendations in this report resulted from more than a year of examination of the NDCS mental health system. This work began in early 2024, after NDCS moved to consolidate almost all of its inpatient mental health beds for men from across the system into the Reception and Treatment Center (RTC) in Lincoln. The change – which was directed by NDCS administration, not mental health officials – prompted complaints from patients and their advocates about the living conditions and how this disruption had impacted their mental health. Through interactions with more patients and providers, additional matters came to the OIG’s attention. Although not an exhaustive list, the five topics addressed in this report were selected based on 1) how frequently they were mentioned by people in the system, including patients and staff; 2) the significance of their impact on the system; and 3) their relevance to the Legislature, based on existing statutes and past legislative engagements in this area. These five topics are as follows: 1. Staffing. NDCS mental health services are in a longstanding staffing crisis, which appear more significant than the staffing challenges facing the overall behavioral health industry, including other state-run institutions. However, NDCS appears to be making some progress in this area. 2. Living conditions. The OIG fielded a variety of complaints about the living conditions in NDCS mental health units, including the use of custody restraints, limited out-of-cell time, and quality of facilities. Some of these conditions may be improving with new facilities, management changes and better custody/security staffing, but concerns remain. 3. Restrictive housing for seriously mentally ill individuals. State statute prohibits placing seriously mentally ill people in longer-term restrictive housing. However, NDCS’ interpretation and implementation of statute results in many people with serious mental illnesses being placed in these settings, anyway. 4. Discharge review. State statute also requires NDCS to have “evidence-based criteria” for screening people nearing release who are mentally ill and dangerous and may require civil commitment. However, it is unclear whether an evidence-based tool even exists for such a purpose. 5. Programming for high-risk individuals. There is a general lack of structured, clinical treatment programming available for individuals in high-security settings. NDCS terminated its version of the Violence Reduction Program (VRP), intended for those at high risk for violence, in early 2024 and has yet to identify a replacement. More specific findings are included in each section of this report. The report concludes with a summary of these findings, as well as recommendations for NDCS and the Legislature to consider. The OIG appreciates the efforts of NDCS mental health providers, administrators, and others involved in this area of the correctional system. Although this report provides a broad (and, hopefully, instructive) look at NDCS mental health services, it is not intended to serve as a comprehensive review. It is hoped that these findings and recommendations will help further the Department’s own efforts at improving this system as well as the Legislature’s role in assisting and guiding that process through policy.