A senior Nebraska state medical official sees opportunities and challenges ahead for the state’s ability to deliver mental health resources, and they both boil down to the same factor: people.
For the past few years, Janine Fromm has served as an executive physician with the Nebraska Department of Health and Human Services, capping decades of work, most of it spent here and in her home state of California.
When she retires next month, she will leave her job with a uniquely intimate perspective on some of the state’s obstacles, as well as an appreciation for the social workers who interact directly with those in state custody. .
Fromm, a Stanford University-trained psychiatrist, came to Nebraska 21 years ago with her four children and her husband, who had been offered a job at the University of Nebraska-Lincoln.
She worked at UNL’s student health center for more than a decade, then Medicaid before her current role — the highest-paying state government role in 2021, according to the Public Salary Database. Flatwater Free Press, at just under $400,000.
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She oversees the clinical functions of all DHHS departments outside of public health, working to ensure those in state care receive the most cost-effective and appropriate care available. She is on call for social workers and facilities around the clock.
“My day-to-day job is kind of like the emergency room,” Fromm said. “You never know what’s going to happen, be a crisis, need to be treated.”
She said she took great pride in rethinking how the state’s system of youth rehabilitation and treatment centers for juvenile offenders works. When she came here, she said, they had reached a critical point. Now it’s a much more therapeutic environment.
One story, dating from the YRTC crisis in Geneva, particularly illustrates the nature of his work.
This centre, which served female juvenile offenders, is now closed. HHS officials moved all of the youths in August 2019 — after staffing shortages, inadequate scheduling and deteriorating buildings made the facility unlivable — to a separate YRTC building in Kearney, which was for men only.
Fromm said that while it turned out to be the right choice, people weren’t happy with it.
Late at night, she learned that two girls had escaped from Kearney Institution. She and DHHS CEO Dannette Smith jumped in her car and headed there, she said, to start looking for the girls themselves.
They went to Walmart, golf courses and neighborhoods. Around 4 a.m., Fromm said, they realized the girls might have jumped into a truck, so they visited area truck stops. After becoming too exhausted to chase after the girls if they found them, Fromm said, they headed home. The girls were found safe, she said – but the story illustrates the terror of the work, its 24-hour nature and concern for the safety and well-being of those in the care of the State.
“You really grow up to feel responsible for both adults and children, but especially children,” Fromm said. “So many kids, when you sit down and talk with them, you get to know them. They are survivors.
Fromm also had a unique look at mental health in the state. Nebraska lacks suppliers, she said, like other places in the United States. It also lacks facilities, levels of care, and options for housing and vocational rehabilitation.
Similar observations were documented in a 2021 report from Nebraska’s Behavioral Health Education Center. While this report noted some positive developments, such as a 32% increase in the number of behavioral healthcare providers in the state from 2010 to 2020, it revealed that Nebraska continues to experience a shortage of behavioral healthcare providers. care and that the existing provider workforce is aging.
Fromm repeatedly stressed that the state needed to recruit more people.
“We just need to find ways to entice people to come to Nebraska, to stay in Nebraska to expand our services to meet the needs of people here,” she said.
In recent years, she has seen the COVID-19 pandemic increase the number of people suffering from mental health and addiction issues as people were hit with isolation and massive lifestyle changes.
But she also saw progress: the 988 suicide and crisis prevention hotline set to launch in Nebraska and across the country next month; reinvestment funds from the American Rescue Plan Act that will help build more behavioral health infrastructure; more providers offering services such as applied behavior analysis for autism.
And she praised state social workers and CEO Smith, saying she’s “savvy about behavioral health and substance use” and focused on building more infrastructure and better programs.
“I mean, before her, there was no executive physician, you know, these social workers and these kids were just flying by the seat of their pants,” Fromm said. “So I see all of these things as being very positive and moving forward and expanding the services over time.”
Smith also offered Fromm kind words in a statement, “She has been a real asset to the Department of Health and Human Services in meeting the needs of children and families in the State of Nebraska. We are well placed to continue the excellent work that has been implemented under his leadership.
A ‘perfect storm’ has led to Fromm’s retirement: her last child is graduating from college, she’s 65, it’s been 40 years since she graduated from medical school and she’s ready to shake off the winters rigorous Nebraska in favor of the Florida sun.
But Fromm said she left him in good hands. His role will be split into an adult psychiatrist and a child and adolescent psychiatrist, which will make him a bit more focused.
“What I’ve really learned and come to appreciate is the number of incredibly talented and dedicated people who work hard at DHHS and have to be so creative day in and day out to make the system work a bit” , she said. “The structure is not in their favor, yet they persevere and stick to it. They’re stronger people than me – I mean, really – and I’m going to miss them.
Photos: Leaders of Nebraska State Offices and Agencies