A top medical officer for the state of Nebraska sees opportunity and challenges ahead for the state鈥檚 ability to deliver mental health resources, and they both boil down to the same factor: people.
For the last few years, Janine Fromm has served as executive medical officer in Nebraska鈥檚 Department of Health and Human Services, capping off decades of work, most of it spent here and in her home state of California.
When she retires next month, she鈥檒l walk away from the job with a uniquely intimate perspective on some of the state鈥檚 obstacles, as well as an appreciation for the caseworkers who directly interact with people under the state鈥檚 care.
Fromm, a Stanford University-educated psychiatrist, came to Nebraska 21 years ago along with her four children and her husband, who had been offered a job at the University of Nebraska-Lincoln.
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She worked at UNL鈥檚 student health center for over a decade, then in Medicaid before her current role 鈥 the highest-paid role in state government in 2021, according to the , at just under $400,000.
She oversees the clinical functions of all DHHS departments aside from public health, working to ensure people in the state鈥檚 care get the most cost-effective and appropriate care available. She鈥檚 on-call for caseworkers and facilities at all hours.
鈥淢y job, on a day-to-day basis, is kind of like the emergency room,鈥 Fromm said. 鈥淵ou just never know what鈥檚 going to come up, be a crisis, need to be dealt with.鈥
She said she鈥檚 most proud of redesigning how the state鈥檚 system of Youth Rehabilitation and Treatment Centers for juvenile offenders operates. When she came here, she said, they had hit a crisis point. Now, they鈥檙e a much more therapeutic environment.
One story, from when the , particularly illustrates the nature of her work.
That center, which served female juvenile offenders, is now closed. HHS officials moved all of the youths in August 2019 鈥 after staff shortages, inadequate programming and deteriorating buildings made the facility unlivable 鈥 to a separate building at the YRTC in Kearney, which was male-only.
Fromm said that, while that turned out to be the right choice, people weren鈥檛 happy about it.
Late one night, she learned that a couple of girls had escaped from the Kearney facility. She and DHHS CEO Dannette Smith jumped into her car and headed there, she said, to start looking for the girls themselves.
They drove to Walmart, golf courses and neighborhoods. About 4 a.m., Fromm said, they realized that maybe the girls had jumped into a truck, so they visited area truck stops. After becoming too exhausted to run after the girls if they did find them, Fromm said, they headed home. The girls were found safe, she said 鈥 but the story illustrates the terror of the job, its round-the-clock nature, and the concern for the safety and well-being of people in the state鈥檚 care.
鈥淵ou really grow to feel responsible for both the adults and the kids, but especially the kids,鈥 Fromm said. 鈥淪o many of the kids, when you sit down and talk with them, you get to know them. They are survivors.鈥
Fromm also has had a unique look at mental health in the state. Nebraska is short on providers, she said, like other places in the U.S. It鈥檚 also short on facilities, levels of care, and options for housing and vocational rehabilitation.
Similar observations were documented in . Though that report noted some positive developments, such as a 32% increase in behavioral health providers in the state from 2010 to 2020, it found that Nebraska continues to experience a shortage of care providers, and the existing provider workforce is aging.
Fromm repeatedly stressed that the state needs to recruit more people.
鈥淲e just need to figure out ways to incentivize people to come to Nebraska, to stay in Nebraska to grow our services to meet the needs of the population here,鈥 she said.
Over the last few years, she鈥檚 seen the COVID-19 pandemic increase the number of people experiencing mental health and substance abuse problems as people were hit with isolation and massive lifestyle changes.
But she has also seen progress: The 988 suicide prevention and crisis hotline that鈥檚 set to launch in Nebraska and nationwide 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 behavioral analytics for autism.
And she spoke highly of the state鈥檚 caseworkers and CEO Smith, saying she鈥檚 鈥渁stute on the behavioral health and substance use side鈥 and has been focused on building more infrastructure and better programs.
鈥淚 mean, before her, there was no executive medical officer, you know, these caseworkers and these kids were kind of just flying by the seat of their pants,鈥 Fromm said. 鈥淪o, I see all those things as being very positive and moving forward and expanding services in time.鈥
Smith offered kind words about Fromm, too, in a statement: 鈥淪he has been a true 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 positioned for continuing the great work that has been implemented under her leadership.鈥
A 鈥減erfect storm鈥 led to Fromm鈥檚 retirement: Her last kid is graduating from college, she鈥檚 turning 65, it鈥檚 been 40 years since she graduated from medical school and she鈥檚 ready to shed Nebraska鈥檚 harsh winters in favor of Florida sun.
But Fromm said she鈥檚 leaving it in good hands. Her role will be split into an adult psychiatrist and a child and adolescent psychiatrist, making it a bit more focused.
鈥淲hat I鈥檝e really learned and come to appreciate is how many incredibly talented, dedicated hard-working people are at DHHS that have to be so creative day in and day out to make the system work somewhat,鈥 she said. 鈥淭he structure is not in their favor, and yet they persevere and stay on it. They are stronger people than I am 鈥 I mean, truly 鈥 and I鈥檒l miss them.鈥