Rules threaten Lincoln’s protective custody unit

Nebraska decriminalized public intoxication in 1979, one of 12 states to do so. That means law enforcement relies on civil protective custody as an alternative to jail.
In 22 states, people are still charged with public intoxication and go to a drunk tank in a jail, said a Lancaster County Commissioner who is concerned that state funding for Lincoln’s main detox facility—The Bridge Behavioral Health—may come to an end.
Not only is $150,000 in jeopardy, but state licensure is in question. Without the license, The Bridge’s civil protective custody unit would have to close. Similar programs statewide could be subject to state licensure scrutiny.
It’s all because of locked doors, said County Commissioner Todd Wiltgen.
The Bridge places very drunk people behind locked doors for the first 24 hours of their stay while they are evaluated. The folks who treat very intoxicated people and people high on drugs say there is a great risk that their clients can become violent and combative.
Local officials say if The Bridge is required to change its locked-door policy for handling very intoxicated people brought in by police, many of those people will end up staying on the streets or will be put in jail at a much higher cost to taxpayers. Wiltgen said the cost to Lancaster County alone could be $1.5 million for increased jail expenses ($200 per day) and the costs of criminal prosecution.
State officials want The Bridge to use what is called a social detoxification model in order to retain funding for the more than 3,600 people Lincoln Police take to The Bridge every year.
Wiltgen said as many as 75 percent of those people could stay on the streets or wind up in jail if The Bridge isn’t available. He said the state is over-regulating involuntary civil protective custody out of existence.  
The Bridge Executive Director Tammy Stevenson said when a Lincoln police officer brings an intoxicated person to the facility, the person is initially put in a treatment room with a locked door. The locked door may now be the deal–breaker for Medicaid funds and behavioral health reimbursement. The facility has to be accredited, but the locked room policy runs afoul of the accreditation standards.
The director of the state’s Behavioral Health Division said she believes The Bridge can get accreditation if the people are kept in the locked room for a short time.
But Stevenson said her staff takes time to determine if the person can safely be placed in an unlocked situation. She said The Bridge would have to remodel the 22-bed unit and hire additional staff and security. That would also mean they couldn’t take as many clients into civil protective custody.
The rest of The Bridge treatment programs are accredited, including a social detoxification program for people who voluntarily come in. But the civil protective custody unit can’t get accreditation from its national accrediting organization, the Commission on Accreditation of Rehabilitation Facilities, when people are admitted involuntarily and all are initially housed in locked rooms, Stevenson said.
State officials said they are committed to working with the facility on the accreditation and funding issues.
Medicaid staff said the program would pay only for social detoxification after a new managed care firm takes over the program which provides $50,000 to $60,000 a year.
The state’s Division of Behavioral Health is threatening to cancel its $100,000 in funding this summer if the unit doesn’t get accreditation.
So, the option is to work out funding issues and licensure or to fork over $1.5 million or more to jail all those people after charging them with a crime – disturbing the peace or trespassing – which would have to be adjudicated at an additional cost. In some cases, those with very high blood-alcohol levels would have to be hospitalized.
Stevenson said she is concerned that the state refused to license a similar Omaha facility because it did not use the social detoxification model. She said she’s had verbal commitment but is waiting to see written assurance the state will issue the license.
In the alternative, Wiltgen said the city, county and University of Nebraska-Lincoln will try to find a way to cover the $150,000 in lost revenue.
But Stevenson said it would be hard to staff the program without a license since most medical staff refuse to work for an unlicensed program.