The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.

Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.

But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.

"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.

Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.

Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.

Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.

"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.

Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.

'Tis the season for celebration and good cheer. However, for many Michiganders, the absence of a loved one - whether through death, divorce or another painful separation - can make this time of year feel almost unbearable. According to the National Alliance on Mental Illness, 64% of people with depression report the holidays just make them feel worse.

Dr. Ibrahim Sablaban, a psychiatrist and addiction medicine physician at Corewell Health, offers a surprising insight: he says sadness is one of the most universal human emotions, and should be embraced.

"The worst thing somebody can do is really try to suppress feeling human - really suppress feeling lonely, feeling sad, feeling a sense of loss," he explained. "It's very easy to say, 'Oh, I need to get my mind off of so-and-so who passed away,' but that's not the healthy way forward."

If you or someone you know is struggling with a mental health crisis, help is available 24/7 - call or text 988, the Suicide and Crisis Lifeline, to connect with someone for free and confidential support.

While many enjoy Michigan's snowy holiday scenes, the state's long winters and reduced daylight can also worsen depression, especially for those with Seasonal Affective Disorder, the aptly-named "SAD." Dr. Sablaban advises sharing emotions with trusted family and friends, and reflecting on happy memories of loved ones.

"To be able to embrace the traditions and the things that you shared with that individual, even if they're not in your presence. To be able to keep those things alive," he continued.

Mental health professionals also emphasize that while family traditions can provide comfort and remembrance, it's okay to let go if they become too painful. Explore new ways to celebrate, and over time, new traditions will naturally evolve.


get more stories like this via email

On this Election Day, Indiana residents may be feeling the effects of what some are calling election stress disorder, but there are several ways to cope.

If you're suffering with anxiety related to the biggest day of the year for politics, Dr. Jennifer Embree - chief wellness officer and clinical professor at the Indiana University School of Nursing in Indianapolis - encourages taking a moment to pause before reacting to election-related news, especially on social media, and focusing on what you can control.

"When we pause, it's easier to take the emotion out of that situation and then really thinking about what exactly are you afraid of," said Embree. "What's the worst thing that can happen? And then, what issue impacts you the most?"

Deep breathing exercises can lower heart rates and reduce anxiety. One popular technique is known as box breathing: inhale for four seconds, hold for four, exhale for four, and hold again for four.

Medical experts caution against using alcohol or drugs to cope, noting the substances often disrupt sleep and ultimately do little to alleviate stress.

Instead, clinicians prescribe seeking professional help if stress becomes unmanageable.

Embree suggested connecting with supportive people who help keep them calm. For those greatly stressed, she recommended meditation, exercise, or even dancing to manage emotions.

"Think about the people that keep you calm and really are your support peope," said Embree. "Those are the people you need to be connecting with - not people that are going to make you more anxious, more upset, that's one thing - is to keep the calm around you."

While election outcomes are beyond individual control, Embree said maintaining personal well-being is key to victory in navigating this high-stress period and future events.

By Deanna Pistono for MinnPost.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the Rural News Network-Public News Service Collaboration

If Minneapolis therapist Emily Abeln could wave a magic wand, the political rhetoric flooding the airwaves this election season would likely look a lot different. 

“I would just have every single human mind on the planet actually humanize each other. If we see everyone as human, then we don’t tend to do all this hate, violence, discrimination and restriction,” said Abeln, MA, LP, who co-founded Transcend Psychotherapy with spouse Max Abeln, MA, LMFT.

For many in America, this year’s election rhetoric has felt dehumanizing as parts of their identity are being discussed, often negatively, as political talking points. 

“Anytime that we have people who have to justify their own existence, (we’re) creating an environment for mental health problems and mental illness to form and be sustained,” said Shonda Craft PhD, LMFT, who runs Craft Psychotherapy and Consultation in the Twin Cities. 

Abeln and Craft are among the many providers with clients in Minnesota and across the U.S. who have had their identities – race, gender, or immigration status – invoked in various ways during the election. How they are impacted, however, can vary greatly. 

“Some people are desensitized to what’s happening. The constant exposure has caused them to emotionally disconnect and experience emotional fatigue, which can be a good coping mechanism (and) buffer for psychological distress,” said Fathi Kofiro, MSW, LICSW, who owns and practices at Daryeel Therapy in the Twin Cities. “For others, they’re terrified. They’re afraid for their lives. They’re afraid for their family’s lives. They’re afraid for the people that they care about.” 

Mental health providers use therapeutic techniques and practices while validating clients’ emotions and giving them a space to share their feelings. Providers working with clients from these communities also emphasize the importance of connection with a community that affirms their client’s identity and supports them.

“The gap between (a person’s ideal life and the life they live right now) is oftentimes where mental illness lives. That gap between what I expect life to be and what I experience life (to) actually (be) can be filled in with depression. It can be filled in with anxiety, it can be filled in with hopelessness (and) loneliness,” Craft said, adding that she works with clients to close the gap. “How can we build connections with people who are affirming of who you are? How can we help you to understand your own value and identify what makes you unique, and how that uniqueness is actually very needed in this world?” 

In addition to individual therapy, some providers host support groups for members of targeted communities. But providers also acknowledge their own limitations: While they can help clients deal with their identities being part of political discussion, they cannot stop these identities from being part of the conversation.

“We can support people in gaining insight and we can support people in restructuring the way that they’re thinking. But we cannot get rid of the fact that (stress and trauma) continue to happen over and over and over,” said Candace Hanson, LPCC, and executive director of Canopy Mental Health & Counseling in Minnesota.

Ghazel Tellawi, who has therapy clients in Minnesota, Kentucky and Wisconsin, hopes those whose identities are not subject to political attacks will understand that “the things that are said have a real-life impact on people’s lives and people’s wellbeing. It’s not just locker room talk.” 

Here are three examples of political rhetoric affecting marginalized communities this election:

Mental health providers working with the Black community and other communities of color have noticed how right-wing backlash against diversity, equity and inclusion initiatives has been used to question Vice President Harris’s competency.

“When you add in this political environment, where we’re labeling certain types of people as inherently not qualified for a job that they hold, that starts being something that plays out in workplaces. It reinforces that pressure to perform that a lot of BIPOC folks have in the workplace (and) dials up the pressure and the stress,” Hanson, of Canopy Mental Health & Counseling, said. 

This stress can go on to negatively impact a person’s mental health, leading to a loss of self-confidence, along with signs of anxiety and depression. All the microaggressions in the workplace, along with “DEI hire” rhetoric, said Hanson, builds up to a “cumulative effect that can amount to racial trauma.”

Adriana Ines Quiñones Peña, a mental health practitioner and advocate based in Minnesota, also referenced a statement by Trump that immigrants were stealing “Black jobs” as something that was evocative of a history of colonization and racist perceptions of Black people. 

“There’s Black people in tech, there’s Black people in STEM, there’s Black doctors (and) there’s black people that are artists, so when it comes to (the) idea (of) ‘Black people jobs,’ it feels as (if) we are supposed to go back to those days when we (were) doing hard labor (and were) severely underpaid or not getting paid,” she said. 

Having one’s identity othered can also lead to distrust and isolation. 

“There is this withdrawal that happens (in communities of color) because they don’t know who they can trust and they don’t know who’s safe,” said Hanson, who noted that even while former President Barack Obama was running, clients would indicate that they were unsure of what their white neighbors were saying about them when they weren’t around, or what they thought of racist rhetoric. 

“It is sort of like this daily reminder that this hostility against who you are as a person exists and there’s nothing you can do about it.”

What has also been concerning and harmful to communities of color, specifically mixed-race people, has been the periodic questioning of Harris’ racial identity. Harris is multiracial, a group that comprises the fastest growing part of the U.S. population, according to the most recent U.S. census in 2020. But just because the numbers of mixed-race people are growing does not mean that there is a greater understanding of mixed identities. 

The struggle for determining one’s identity as a mixed-race person remains “a really complicated dynamic,” said Hanson, who noted that people from different groups may not “claim” individuals who are mixed race as part of their group. 

“Having that become this public and ugly kind of discussion and criticism can be very difficult to cope with for some folks,” Hanson added. 

Craft said the rhetoric “does cause some anxiety because it’s almost like telling them, ‘You’re not allowed to know who you think you are.”

When speaking about the mental toll on the trans community during the election cycle, Christine Kerno, LICSW, a trans mental health provider who also serves trans clients, referenced the quote above, noting that it was clearly a reference to trans and nonbinary people using they/them pronouns. 

“There’s a lot of fear of what will happen if Trump wins the presidency,” Kerno said, adding there’s also concern about what a Republican-controlled Congress would do. State legislation in Minnesota protecting trans rights, “will help, but it won’t protect us completely,” Kerno said.

“The rights of trans folks are very much being used as this political tool (and) talking point to sway certain people,” Tellawi said. “(They) use fear-based tactics to make people afraid of trans people.”

While coping with anxiety, fear and depression ahead of the election, some members of the trans community are trying to prepare for how the election results could affect them, Max Abeln of Transcend Psychotherapy said. 

“I definitely hear about the specifics of people getting legal documents in order and making sure they have their passports for fear of what might happen, or hurrying up their gender-affirming care, making sure they’re getting on hormones or stockpiling hormones,” they said.

For undocumented immigrants, being the subject of election discourse is nothing new. According to mental health provider Mayra Barragan-O’Brien, the mental health senior manager at Immigrants Rising, however, things are different from “the first time around,” during the 2016 election.

“The way that the past president was talking about the communities that we are a part of, the way he described our communities, described who we are was very violent,” Barragan-O’Brien said. “There is still a lot of fear, a lot of anxiety, a lot of sadness, frustration, rage that comes along (with) this election. But there’s also a lot of feeling numb – feeling like it’s the same thing, just a different year.” 

While some have become numb, others are afraid. 

For undocumented immigrants, talk of deportation “has definitely increased a fear and maybe some distrust in the system,” Quiñones Peña said. “They’re coming here thinking that they’re searching for that American dream – that they’re going to have a better quality of life for themselves and their family. And then when they come here, they have this reality check that not everyone’s going to be welcoming of them. That not everyone’s going to be accepting of them. And (even) if they’re accepted here, that doesn’t mean that they belong here.” 

An undocumented immigrant in Minnesota, who asked to be referenced using only their last name, Flores, said that they were, for their own mental health, trying to avoid hearing about the election cycle as much as possible while still keeping up to date. 

“(Growing up, the perception was that undocumented immigrants were) only older folks or folks who were smuggled in (and) they (were) here to take your jobs or get handouts or all these other things. That’s not the reality. Sometimes it just feels like we’re like still in the shadows because even if we did speak about coming out with our stories and sharing our experiences, I just feel so scared about people calling ICE, or feeling justified to let local authorities know my whereabouts,” said Flores, who described their life as one of “uncertainty.” 

Though Trump has often been criticized for his rhetoric regarding undocumented immigrants, Flores added that Harris’ response has also been lacking.

“Although (Harris) is receptive to listening to people’s stories and does hear them out, she just comes back to stricter borders. It’s disheartening to hear, but it’s nothing new,” Flores said. 

While they have coping mechanisms, such as nature walks, journaling and finding community with other undocumented immigrants online through Immigrant Risings’ wellness support groups, “sometimes I feel I’m drowning in the stress,” Flores said.

Barragan-O’Brien said she hopes more non-immigrants would empathize with those fleeing to the United States. 

“There’s this poem that says, ‘Nobody puts their children on the boat unless the water is safer than the land,’” she said. “I wish people could hear that and take it in and understand that if they were in a similar situation (as undocumented immigrants) they would try to survive (and do) whatever would be possible for themselves and for their children and their loved ones.”


This story was originally produced by Deanna Pistono of MinnPost as part of the Rural News Network, an initiative of the Institute for Nonprofit News (INN), supporting more than 475 independent, nonprofit news organizations.


get more stories like this via email