This is the first installment in a four-part series from The Reader about Omaha’s mental health and criminal justice systems: how they work, when they fail and what we can do to make them better. Read parts two, three and four.
This story is also part of (DIS)Invested — a longterm Reader investigation into Omaha’s inequities.
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Mary Angus wants to know where it all went wrong.
The grandmother wrings her hands from a recliner in a basement apartment while late November snow dusts Omaha. Family portraits overflow corners of the living room. Warm lamp light illuminates princesses and ponies colored with markers. They’re windows into the life she thought she’d have by 69 — too many birthdays to remember, big family dinners, an ever-growing group of grandkids to spoil.
Instead she has to wonder why she’s still alive. Why police stormed her apartment. Why no one helped her grandson — the kid with too many diagnoses, the teenager who got violent, the illegal drugs that made everything worse, the young man who went from courtroom to jail to probation over and over again.
The signs never got by Angus. She’s spent her career advocating for those with mental and physical disabilities, working among the state’s leaders in the field with organizations like the University of Nebraska Medical Center’s Munroe Meyer Institute and Disability Rights Nebraska. She herself lives with a mental illness and knows healing is not a straight-line journey.
People don’t fail treatment, she often says. Treatment fails people.
So who failed Gage Walter, 27, when, on Aug. 13 of 2022, he allegedly murdered his grandmother and great-grandmother in their South Omaha home with a hammer?
For Angus, the answer is simple. The system failed Gage Walter.
At an October court hearing, prosecutors read off Walter’s criminal history while his attorneys asked for him to be released on bond due to his mental health history. Walter talked about terrorism and nanobots in his brain.
One of the few surprising things about all this to Angus is she’s not dead. Instead it was Linda Walter, Gage Walter’s other grandma, and her 93-year-old mother. Angus was escorted back to her home with police before fleeing to Missouri for safety.
The other surprise is the end Angus hopes for. They tried everything to get Walter help and now the worst has happened. Even though it’s against everything she believes in, Angus sees no other option than to hope her grandson never walks free again.
“We didn’t want to be one of those families that people would say, ‘Look what this guy did. Where was the family during all of this?’” Angus said. “We wanted to make sure we did everything we could.”
‘Adverse Circumstances’
Although the ending may be different, Angus’ story of a family struggling in the gap between mental health care and the criminal justice system is similar to many. Short staffed, underfunded and mired by legal obstacles, Omaha’s mental health system often leaves many with the most serious, persistent mental health issues cycling in and out of local courts and the Douglas County jail, which by default has become the area’s largest mental health facility, costing taxpayers money and leaving many families running in circles.
At any given time, about 20% of people in the Douglas County jail have a serious mental illness — defined as a severe condition that, when untreated, can inhibit someone’s basic life functions. The cost for housing, medical expenses, prescriptions, staff salaries and more is about $2 million annually, according to Douglas County Department of Corrections Director Mike Myers. They also spend almost twice as many days in jail as other inmates and are much more likely to come back, according to county data.
The jail was also never built to treat people with mental illness.
“[We’re] working in a facility that, environmentally and aesthetically, does not promote therapeutic healing,” Myers said. “My staff are doing the best they can under some really adverse circumstances.”
The view inside Nebraska’s state prisons is similar. According to an October memo from the Inspector General of Corrections, Nebraska Department of Corrections has zero psychiatrists and a 39% vacancy rate for behavioral health practitioners. The total behavioral health vacancy rate tripled since 2019. Prison officials didn’t have data on recidivism rates for the mentally ill, or how much their care costs taxpayers, but Corrections’ budgets show they spent about $6.7 million on drugs and almost $15 million contracting outside medical work last year.
Deputy Director Dawn Renee-Smith said often the department’s salaries can’t compete with other employers and a shortage of available candidates has tightened the squeeze. In an anonymous survey distributed by the inspector general’s office, most behavioral health workers inside Nebraska’s prisons said they felt unsupported by leadership. One person described the staffing situation as a “meatgrinder.”
“Very, very low morale,” one respondent said. “[We’re] at the point where we just throw our hands up now.”
Meanwhile, Nebraska’s facilities are among the most overcrowded in the nation and the building of a new prison — the cost of which recently climbed to $350 million — seems inevitable after failures to enact criminal justice reform.
Despite the shortage of resources, Smith said the prison is always improving how it treats its inmates dealing with a serious mental illness, which is about 30% of its population, she said. Care starts at admission with individualized care plans and continues with monthly clinical check-ins and, for some, daily care inside the prison’s specialized mental health units. The prison is also starting a program evaluation with the University of Nebraska at Omaha to dive deeper into their clinical programs and get needed data to make improvements.
“The goal is to make people healthier, and so we want to make sure that’s happening, that we’re doing everything we can,” she said. “So I’ve talked to psychologists about those programs and about this evaluation. And they’re really looking forward to seeing, are we making the difference? Are we doing it well? And if we’re not then figuring out what our next step is.”
In 2020, the Nebraska Advisory Committee to the U.S. Commission on Civil Rights held town halls to hear about the prison’s mental health system. Jonathan Benjamin-Alvarado, the chair of the committee, found the system did more harm than good.
“In this instance, [Nebraskans are] willing to waste money warehousing people … You either don’t give a shit or you’re willing to treat people as animals,” Benjamin-Alvarado said. “That’s the problem. If the material condition of those individuals is diminished over the time that they’re incarcerated, then when they go back out into public, what’s going to happen?”
‘There Just Isn’t Enough’
On the outside, a shortage of mental health workers means longer wait times to see a specialist — depending on the service they’re seeking it could take days, weeks or months. That’s not unique to Douglas County or the state as a whole. In fact, Nebraska’s made a serious dent in its shortage over the past decade, but the need remains.
“I think we’ve had some success, but is it to scale? Is it serving as many people as we would like it to? That’s part of the problem … there just isn’t enough,” said Patti Jurjevich, administrator of Region 6 Behavioral Healthcare, which oversees mental health care in Cass, Dodge, Douglas, Sarpy and Washington counties.
That doesn’t mean there aren’t reasons to be hopeful.
Nationwide initiatives like Stepping Up have been adopted locally. The program, which is in 565 counties, provides local governments a framework of solutions to use as they connect the siloed organizations in criminal justice, health care and local government.
The jail, recognizing the need for better mental health services, hired Myers, a licensed mental health practitioner, to run it.
A new $89 million behavioral health facility, paid for with private and public money, for kids and teens is expected to open by 2025 on the Children’s Hospital campus at 84th and Dodge streets.
About half of Omaha’s police officers are trained in crisis intervention and the department’s mental health co-responder program means officers can defer to mental health professionals in non-violent situations. As of November, the department had received 4,638 mental-health-related calls in 2022 (though that number doesn’t include multiple calls for a similar event in a day). Mental health professionals co-responded to 1,155 of those face-to-face when the threat of violence was deemed low enough for them to safely get involved.
But without more community resources, it’s hard to break the cycle.
“There [might be] no capacity at this service or my insurance doesn’t accept that treatment level of care or what have you,” said Lindsay Kroll, mental health coordinator for the Omaha Police Department, “which then recreates that wheel of, ‘Oh I need help again, [calling the police] is how I access that.”
Some solutions around the country could ease that strain. A Denver program that sends health professionals instead of law enforcement into mental health situations has led to better outcomes and huge cost savings. Tucson, Arizona, has a facility that reroutes people from the criminal justice system to a mental health facility instead.
And probably most pertinent, locally, is the prospect of a new Douglas County facility specifically designed for the cross section of criminal justice and mental health.
The county has allocated $55 million pandemic relief money toward mental health and it’s likely this new facility would consume the bulk of it. The goal is to create a therapeutic space designed to help people experiencing serious mental illness with 76 beds for incarcerated people and 20 more for others in the community — which, in total, is a little more than a third of the average number of people with serious mental illnesses the jail houses every month.
But while it’s a step forward, some say it won’t go far enough.
“There are too many loopholes in the mental health system. There are too many loopholes in the continuity of care for these individuals,” said the father of a man struggling with mental illness at an Oct. 4 town hall about the proposed facility. “You get them into the hospital and emergency treatment and they’re there for a week or two weeks … but two weeks isn’t gonna do it. It takes three to six months. We need long-term care for these folks.”
“It’s great that you’re trying to do something positive … But I just don’t even know what to tell you … It’s obvious the laws have to change first,” said another person at the meeting. “People would not be in your jail, sir, or your prisons, if some of these laws were changed, and they helped these people. What’s so hard about it?”
‘It’s Really So Simple’
In 1999, the Supreme Court ruled that people experiencing a mental illness, as well as disabilities, have the right to receive state aid to live in the community rather than institutions. In the 2000s Nebraska began deinstitutionalizing, but many say the vision was never realized as state funds dried up. The behavioral health care system has been operating at a deficit ever since.
Another problem is reimbursements for mental health through Medicaid, federal and state health care dollars, don’t cover providers’ costs.
“When you ask, ‘How much is enough?’ Well, right now, the rates … don’t even cover the cost of a provider giving those services,” said Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations. “So if we want to get to a figure, how about we get to just covering costs?”
Solutions can also be challenging because the system itself is so hard to understand. Encouraging programs exist, but there are not enough. Long-term care is out there, but not everyone has access to it. How many beds, or how much money, do we need to move in the right direction? It’s hard to say.
“It’s very complicated,” said Carole Boye, president and CEO of Community Alliance and an employee of the Omaha mental health program since 1981, “but really it’s so simple. We need to have the care people need, when they need it.”
‘The Crap Flows Downhill’
For Mary Angus, choosing where to start fixing problems is impossible. It all needs to change.
She thinks back to when her grandson was diagnosed with attention deficit disorder, defiance disorder and Asperger’s syndrome in grade school. He went to the doctor so much that year his family’s insurance cut him off.
When Gage Walter was placed in a special education program, teachers and administrators peppered his parents with acronyms like IEP, Individual Educational Plan, a special educational framework for certain kids. That wasn’t followed, Angus said, and his experience in school deteriorated.
Then he went to an alternative school meant to course correct kids who’ve fallen behind. Then Boys Town. By 18 years old Walter was living with Angus.
By that time he already had a history with the police and drugs. Angus had to call the police on him several times. On one occasion Walter destroyed his room in her apartment, she said. When he got out, a probation officer or case worker always seemed to have a plan, but then someone would get a new job, or her grandson’s case was switched around, and the cycle would repeat again.
Efforts to get him mental health treatment never worked, either. On one occasion he waited in a Bellevue emergency room for days before being transferred to Douglas County, which declared him stable and sent him home to Angus. She had to call the police again just days later. The family received Board of Mental Health petitions, court-sanctioned ways to force people to receive help if they’re a danger to themselves or others, but those only worked for a while.
At one point he was homeless, sleeping under the Union Pacific railroad tracks in Council Bluffs, and it became hard to connect him with services without a consistent address.
Ultimately Walter cycled through a system in which some succeed and some struggle. Others, whether they’re dealing with a serious mental health issue, homelessness, substance abuse issues, poverty, a combination or all of the above, end up at the only place that can’t refuse them — as do all the problems of the other systems that failed them along the way.
“The crap flows downhill,” said Tom Riley, who’s served as Douglas County’s public defender since 1996 and been in the office since 1975. “And the criminal justice system is at the bottom of the pile.”
The hard part for Mary Angus is that she knows all of this.
She knows, for instance, that there’s never been enough space, never enough money. That there’s a fine line between a mental health record and a criminal record.
She hoped her story could be different. But instead her family has become another alarm bell. She just hopes the noise is getting too deafening to ignore.
“I have another friend with a daughter that has all kinds of legal problems,” Angus said. “We look at each other and go, ‘We should not have to do this.’ I shouldn’t know how to put money on his [jail account]. I should never know how to get a hold of the county attorney. I should never know how to make an appointment to come visit him in jail. I shouldn’t ever know those things. No grandmother should have to know those things.”
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The second installment of this series digging deeper into systemic issues and solutions will run in The Reader’s February issue.
Omaha Documenters’ contributed reporting to this story.
The Reader’s parent company Pioneer Media produced a hiring campaign advertisement for Douglas County Department of Corrections. No one involved in the writing or editing of this story contributed to that campaign.
contact the writer at chris@thereader.com