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Mental Health and Conduct Disorder

Health Hippo: Mental Health and CD

Health Hippo: Mental Health and CD

US CODE || CFR || REPORTS || CASE LAW || CONGRESSIONAL RECORD || BILLS || FEDERAL REGISTER

From nothing else but the brain come joys, delights, laughter and sports… and from the same organ we become mad and delirious, and fears and terrors assail us.

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires many insurance plans that cover mental health or substance use disorders to offer coverage for those services that is no more restrictive than the coverage for medical/surgical conditions. MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 (MHPA), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits.

U.S. Code

Code of Federal Regulations

Cases

  • Apollo Behavioral Health Hospital (2014) (psychiatric hosptial with condition-level deficiencies relating to patient rights, infection control, and special staffing requirements for psychiatric hospitals did not meet requirements for participation in the Medicare program)
  • C.M. v. Fletcher Allen Health Care (2013) (MHPAE was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions so plan administrators bear the burden of establishing why mental health and medical benefits are treated differently)
  • Jaffee v. Redmond (U.S. June 13,
    1996) (federal courts cannot compel disclosure of confidential statements made by a patient to licensed
    psychiatrist, pyschologist or social worker)

  • City of Edmonds v. Oxford House, Inc.
    (U.S., May 15, 1995) (city zoning code definition of the term family is not a maximum occupancy restriction
    exempt from the FHA, in case involving group home for alcoholics)

  • Rubin v. Coors Brewing Co. (U.S., April
    19, 1995) (Federal Alcohol Administration Act, prohibiting beer labels from displaying alcohol content,
    violated First Ammendment)

  • Tarasoff v. Regents of the University of
    California     (Cal. 1976) (Supreme Court of California held that mental health professionals have a duty to
    protect individuals who are being threatened with bodily harm by a patient)

Reports

  • Office of the President: National Drug Control Policy Office Recent Federal Register documents.
  • DOL: Mental Health Parity Latest developments, guidance, interpretations, FAQs and videos explaining the requirements from the Department of Labor.
  • MedPac: Inpatient Psychiatric Facility Services Medicare beneficiaries with serious mental illnesses or alcohol- and drug- related problems may be treated in specialty inpatient psychiatric facilities (IPFs), either freestanding hospitals or specialized hospital-based units. The services furnished by IPFs are intended to meet the urgent needs of those experiencing an acute mental health crisis.
  • Drug-Impaired Driving:
    Additional Support Needed for Public Awareness Initiatives     (GAO 2015) This report discusses (1) what is known about the extent of drug-impaired driving in the United States; (2) challenges that exist for federal, state, and local agencies in addressing drug-impaired driving; and (3) actions federal and state agencies have taken to address drug-impaired driving and what gaps exist in the federal response.

  • Improvements Needed to the Monitoring of Antidepressant Use for Major Depressive Disorder and the Accuracy of Suicide Data (GAO 2015) Addresses the extent to which (1) veterans with major depressive disorder who are prescribed an antidepressant receive recommended care and (2) VA medical centers are collecting information on veteran suicides as required by VA.
  • Dangerous Use of Seclusion and Restraints in Schools Remains Widespread and Difficult to Remedy: A Review of Ten Cases (Senate 2014) There is no evidence that physically restraining or putting children in unsupervised seclusion in the K-12 school system provides any educational or therapeutic benefit to a child. In fact, use of either seclusion or restraints in non-emergency situations poses significant physical and psychological danger to students. Yet the first round of data collected by the United States Department of Education in 2009-2010 demonstrated that these same practices that are prohibited in other settings were used in U.S. schools at least 66,000 times in a single school year. Because fifteen percent of school districts failed to report data, however, this figure likely underestimates use of seclusion and restraints.
  • Vulnerabilities in CMS’s and Contractors’ Activities To Detect and Deter Fraud in Community Mental Health Centers (OIG 2013) We recommend that CMS (1) implement additional CMHC fraud mitigation activities in all fraud-prone areas, (2) develop a system to track revocation recommendations and improve revocation communication with contractors, (3) coordinate activities to deter CMHC fraud in Florida, and (4) follow up on payments made to CMHCs after the effective dates of their billing privilege revocations. [podcast]
  • Fragmentation, Overlap, & Duplication: Social services: Drug Abuse Prevention and Treatment Programs (GAO 2013) GAO reported in March 2013 that federal drug abuse prevention and treatment programs are fragmented across 15 federal agencies. In fiscal year 2012, about $4.5 billion was allocated to these 15 agencies that administer 76 programs that are, in all or in part, intended to prevent or treat illicit drug use or abuse.
  • Questionable Billing by Community Mental Health Centers (OIG 2012) Approximately two-thirds of CMHCs with questionable billing were located in eight metropolitan areas. 90 percent of CMHCs with questionable billing were located in States that do not require CMHCs to be licensed or certified.
  • Nursing Facility Assessments and Care Plans for Residents Receiving Atypical Antipsychotic Drugs (OIG 2012) To determine the extent to which nursing facilities follow Federal assessment and care plan requirements designed to ensure quality of care for elderly residents receiving atypical antipsychotic drugs.
  • Initial Review of the National Strategy and Drug Abuse Prevention and Treatment Programs (GAO 2012) Reporting various challenges in identifying interventions that are proven effective, including (1) availability of data needed to assess effectiveness, (2) ability to determine the impact of prevention interventions, and (3) applicability of interventions to different population groups other than the population for which the intervention was originally intended.
  • Restraint and Seclusion: Resource Document (ED 2012) Every effort should be made to prevent the need for the use of restraint and seclusion and that any behavioral intervention must be consistent with the child’s rights to be treated with dignity and to be free from abuse. Restraint or seclusion should never be used except in situations where a child’s behavior poses imminent danger of serious physical harm to self or others, and restraint and seclusion should be avoided to the greatest extent possible without endangering the safety of students and staff.
  • Access to Mental Health Services at Indian Health Service and Tribal Facilities (OIG 2011) The high rates of suicide, substance abuse, depression, unemployment, and poverty in AI/AN communities contribute to the need for access to mental health services. Although 82 percent of IHS and tribal facilities reported that they provide mental health services, access to some services is limited by shortages of highly skilled staff.
  • Medicare Part B Services During Non-Part A Nursing Home Stays: Mental Health (OIG 2010) We found that 39 percent of Medicare Part B claims allowed for mental health services during non-Part A nursing home stays in 2006 did not meet the program requirements for coverage. Spe~ifically, services were medically unnecessary, undocumented or inadequately documented, or miscoded.
  • Summary Of Seclusion and Restraint Statutes, Regulations, Policies and Guidance by State And Territory (ED 2010) Information reported to the Regional Comprehensive Centers and gathered from other sources.
  • Seclusions and Restraints: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers (GAO 2009) GAO found no federal laws restricting the use of seclusion and restraints in public and private schools and widely divergent laws at the state level. Although GAO could not determine whether allegations were widespread, GAO did find hundreds of cases of alleged abuse and death related to the use of these methods on school children during the past two decades.
  • Residential Treatment Facilities: Selected Cases of Death, Abuse, and Deceptive Marketing (GAO 2008) In the eight closed cases GAO examined, ineffective management and operating practices, in addition to untrained staff, contributed to the death and abuse of youth enrolled in selected programs. The practice of physical restraint also figured prominently in three of the cases. The restraint used for these cases primarily involved one or more staff members physically holding down a youth.
  • Residential Treatment Facilities: State and Federal Oversight Gaps May Increase Risk to Youth Well-Being (GAO 2008) Survey respondents from 49 states reported investigating complaints of youth maltreatment in residential facilities in 2006, including physical abuse, neglect, and sexual abuse, and 28 states reported deaths. There were no discernable patterns in the types of facilities involved, including whether facilities were operated by government or private entities, or located in urban or rural areas.
  • School Mental Health: Role of the Substance Abuse and Mental Health Services Administration and Factors Affecting Service Provision (GAO 2007) The U.S. Surgeon General reported in 1999 that about one in five children in the United States suffers from a mental health problem that could impair their ability to function at school or in the community. Yet many children receive no mental health services. While many of the existing mental health services for children are provided in schools, the extent and manner of school mental health service delivery vary across the country and within school districts.
  • Medicare Payments for 2003 Part B Mental Health Services: Medical Necessity, Documentation, and Coding (OIG 2007) Mental health services covered by Medicare include psychotherapy, psychiatric pharmacologic management, and evaluation and management. Mental disorders that occur most frequently for Medicare beneficiaries include affective psychoses, senile psychotic conditions, schizophrenic disorders, and neurotic disorders.
  • Carrier Determination of Copayments for Medicare Mental Health Services (OIG 2006) Beneficiary copayments can be more than double for the same mental health service in different service areas. Because their payment policies are inconsistent, carriers do not uniformly apply the outpatient mental health treatment limitation.Carriers overstated copayments for beneficiaries with Alzheimer’s disease and related disorders by approximately $27 million during a 4-year period.
  • Medicare Carriers’ Policies for Mental Health Services (OIG 2002) The quality and comprehensiveness of guidance furnished to mental health service providers should not vary depending on which carrier is processing payment for services. The lack of comprehensive guidance in local medical review policies may result in inconsistent Medicare coverage determinations and inappropriate payments for mental health services.
  • Inaccuracies in the Unique Physician Identification Number Registry: Incorrect Addresses for Mental Health Service (OIG 2001) We identified inaccurate addresses in the UPIN Registry for 28 percent of the providers in our sample during the course of an inspection assessing the appropriateness of Medicare Part B payments for outpatient mental health services. Even the Medicare carriers did not have correct addresses for all of these providers. We estimate that Medicare paid about $35 million (± $17 million) in 1998 for outpatient mental health services billed by providers with inaccurate mailing addresses.
  • Medicare Reimbursement for Electroconvulsive Therapy (OIG 2001) Electroconvulsive therapy is a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure. Electrodes connected to an ECT machine are attached to the scalp of a patient who has received general anesthesia and a muscle relaxant.
  • Inaccuracies in the Unique Physician Identification Number Registry: Incorrect Addresses for Mental Health Service (OIG 2001) We identified inaccurate addresses in the UPIN Registry for 28 percent of the providers in our sample during the course of an inspection assessing the appropriateness of Medicare Part B payments for outpatient mental health services. Even the Medicare carriers did not have correct addresses for all of these providers. We estimate that Medicare paid about $35 million (± $17 million) in 1998 for outpatient mental health services billed by providers with inaccurate mailing addresses.
  • Medicare Part B Payments for Mental Health Services (OIG 2001) One-third of outpatient mental health services provided to Medicare beneficiaries were medically unnecessary, billed incorrectly, rendered by unqualified providers, and undocumented or poorly documented.
  • Younger Nursing Facility Residents with Mental Illness: An Unidentified Population (OIG 2001) This report attempts to ascertain the extent to which younger individuals with mental illness reside in nursing facilities. In addition, we wanted to identify the amount of Medicaid funds spent to care for this population.
  • Younger Nursing Facility Residents with Mental Illness: Preadmission Screening and Resident Review Implementation and Oversight (OIG 2001) The Omnibus Budget Reconciliation Act of 1987 (OBRA-87) mandated Preadmission Screening and Resident Reviews (PASRR). The intent of the PASRR process is to ensure that only individuals with serious mental illness who are in need of nursing facility care be admitted and continue to reside in nursing facilities, and to determine whether persons with serious mental illness need specialized mental health services.
  • Medicare Payments for Psychiatric Services in Nursing Homes: A Follow-Up (OIG 2001) More than half of unnecessary services are provided to individuals whose cognitive limitations make them unable to benefit from the psychiatric intervention, and about half have an inappropriate frequency and/or duration. Additionally, many medically unnecessary services do not appear to stabilize or improve patients’ conditions.
  • Drug Abuse Treatment: Efforts Under Way to Determine Effectiveness of State Programs (GAO 2000) GAO reviewed the efforts by the Substance Abuse and Mental Health Services Administration (SAMHSA) and states to provide effective drug abuse treatment programs, focusing on: (1) activities supported by SAMHSA’s Substance Abuse Prevention and Treatment (SAPT) block grant and Knowledge Development and Application (KDA) grant funds for drug abuse treatment; (2) SAMHSA and state mechanisms for monitoring fund use; and (3) SAMHSA and state efforts to determine the effectiveness of drug abuse treatment supported with SAPT block grant funds.
  • Community-Based Care Increases for People With Serious Mental Illness (GAO 2000) The ability to care for more people in the community has been facilitated by the continued development of new medications that have fewer side effects and are more effective in helping people manage their illness. Furthermore, treatment approaches, such as assertive community treatment, supported employment, and supportive housing, provide the ongoing assistance that adults with serious mental illness (SMI) often need to function in the community.
  • Restraint and Seclusion: State Policies for Psychiatric Hospitals (OIG 2000) We recommend that HCFA work aggressively with States and accreditation organizations to quickly raise psychiatric hospital compliance with the new Patients’ Rights Condition of Participation where necessary. Particular attention should be given to policies for private psychiatric hospitals.
  • Mandatory Managed Care: Changes in Medicaid Mental Health Services (OIG 2000) While States reported that managed care programs have expanded out-patient services, and reduced costs, the overall effect on the health of persons with serious mental illnesses was not quantified. However, resolution of several important concerns could significantly improve Medicaid mental health programs as more States convert to mandatory managed care.
  • Mandatory Managed Care: Early Lessons Learned by Medicaid Mental Health Services (OIG 2000) States have become more efficient in their managed care mental health programs. Each State learns from the successes and mistakes of its predecessors. The continued sharing of lessons learned could greatly benefit other States that are considering converting to mandatory managed care, and those preparing for contract renewal.
  • Mandatory Managed Care: Children’s Access to Medicaid Mental Health Services (OIG 2000) Although conversion to managed care does offer State Medicaid programs opportunities to improve mental health services for children, respondents told us that conversion can also intensify existing problems. When implementing mandatory managed care systems, States should be aware of obstacles that can interfere with access to mental health services for children.
  • The External Review of Psychiatric Hospitals (OIG 2000) Medicare requires such hospitals to meet two special conditions of participation (staff requirements and medical records) that apply only to psychiatric hospitals.
  • Mental Health: Improper Restraint or Seclusion Use Places People at Risk (GAO 1999) People with serious mental illness or mental retardation are among the country’s most vulnerable citizens. An estimated 120,000 individuals with mental retardation lived in intermediate care facilities, while about 240,000 others lived in smaller residential settings in 1998. The Hartford Courant reported that patient deaths were related to the use of restraint or seclusion1 in 142 cases over the past 10 years in several types of residential treatment settings across the country.
  • Mental Health: Extent of Risk From Improper Restraint or Seclusion Is Unknown (GAO 1999) We found that federal and state regulations that govern the reporting of injuries and deaths and that govern the use of restraint and seclusion are not consistent for different types of facilities. The experience of several states demonstrates that having regulatory protections and reporting requirements can reduce the use of restraint and seclusion and improve safety for individuals receiving treatment as well as for facility staff.
  • Medicaid:
    Disproportionate Share Payments to State Psychiatric Hospitals     (GAO 1998) Reviews Medicaid disproportionate share hospital (DSH) program payments to state psychiatric institutions.

  • Follow-up to Detoxification Services for Medicaid Beneficiaries (OIG 1998) Assesses whether Medicaid and other State programs provide linkages for patient services between substance abuse detoxification and follow-up treatment programs.
  • SAMHSA’s Treatment Improvement Protocols (OIG 1998) Treatment Improvement Protocols (TIPS) are consensus-based “best practice” guidelines developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) for use in the treatment of individuals with alcohol and other drug problems. Since 1993, 23 TIPS have been developed and issued at an estimated average cost of approximately $300,000 each.
  • Substance
    Abuse and Mental Health: Reauthorization Issues Facing the Substance Abuse and Mental Health Services Administration
    (GAO 1997). GAO discussed the Substance Abuse and Mental Health Services Administration’s (SAMHSA) role in: (1) coordinating its efforts with federal agencies involved in related research or services; (2) measuring the results of its programs or activities, particularly in light of the fact that most of its funds are used to support services provided by states and local grantees; and (3) monitoring the impact of the transition to managed health care on individuals with mental disorders and substance abuse problems.

  • Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities (GAO 1996). Pursuant to a congressional request, GAO provided information on the financial support provided for substance abuse and treatment activities by federal, state, and local governments and the private sector.
  • Oversight of Institutions for the Mentally Retarded Should Be Strengthened (GAO 1996) Pursuant to a congressional request, GAO reviewed the role of the Health Care Financing Administration (HCFA), state agencies, and the Department of Justice (DOJ) in overseeing quality of care in intermediate care facilities for the mentally retarded (ICF/MR).
  • Psychiatric Hospital Oversight (GAO 1996) Failure to evaluate a patient’s strengths when developing a treatment plan, specify each patient’s treatment goals, and indicate the methods of treatment were the most common deficiencies cited in surveys of psychiatric hospitals that failed to satisfy HCFA certification requirements.
  • Cocaine Treatment: Early Results From Various Approaches (GAO 1996) Pursuant to a congressional request, GAO reviewed the extent to which federally funded cocaine treatment therapies have proven successful and additional research initiatives that are needed to increase knowledge of cocaine treatment effectiveness.
  • Medicare Payments for Mental Health Services in Nursing Facilities (OIG 1996) In 32 percent of the records received, Medicare paid for medically unnecessary services; this projects to $17 million, or 24 percent of all 1993 Medicare payments for mental health services for nursing home residents.
  • Medicare Payments for Mental Health Services in Nursing Facilities: ORT State Data (OIG 1996) Events in the past few years have raised concerns about the subject of mental health care for nursing facility residents: the number of nursing facility residents with mental disorders has increased, and the expansion of Medicare Part B coverage of these services has tripled payments.
  • Community Mental Health Centers and Homeless Persons (OIG 1996) Community Mental Health Centers (CMHCs) are a major component of health care servces for people who are economically disenfranchised and homeJess. The centers primary objective is providing mental health servces to persons with mental ilness or emotional disturbances.
  • Treatment of Hardcore Cocaine Users (GAO 1995) Information on the effectiveness of drug treatment for hardcore cocaine users, focusing on the: (1) types of clients categorized as hardcore users; and (2) results of recent national cocaine treatment outcome studies (CTOS).
  • Services to Persons with Co-occurring Mental Health and Substance Abuse Disorders: Provider Perspectives (OIG 1995) Describes the experiences of staff that work directly with people who have co-occurring mental health and substance abuse disorders.
  • Services to Persons with Co-Occurring Mental Health and Substance Abuse Disorders: Program Descriptions (OIG 1995) Describes 30 programs that serve people with co-occurring mental health and substance abuse disorders in a community setting,
  • Medicaid Payments to Institutions for People with Mental Retardation (OIG 1993) The preferred treatment setting for people with mental retardation has shifted from large ICF/MRs to community-based care. Yet, in 1991 estimated Medicaid spending (including State and Federal shares) for large ICF/MRs reached $6.7 billion for approximately 110,000 residents. The average annual Medicaid reimbursement to large ICF/MRs was $61,000 per resident. Eight percent of Medicaid dollars are spent on 0.4 percent of Medicaid recipients who still reside in large ICF/MRS.
  • Measuring Drug Abuse Treatment Costs (OIG 1992) To show how effectively the Alcohol, Drug Abuse and Mental Health Administration measures costs for drug abuse treatment.
  • Indian Alcohol and Substance Abuse: Legislative Intent and Reality (OIG 1992) Alcohol and substance abuse are the foremost health concerns for American Indians and Alaska Natives (hereafter referred to as “Indians ). Four of the top 10 causes of death among Indians are alcohol- and drug-related injuries, chronic liver disease and cirrhosis, suicide, and murder.
  • Youth and Alcohol: Drinking and Crime (OIG 1992) In response to public health concerns and the adverse consequences of alcohol abuse the Surgeon General requested that the Offce of Inspector General (OIG) provide information on the number or percentage of youth who were under the influence of alcohol when they committed a crime.
  • Youth and Alcohol: Dangerous and Deadly Consequences (OIG 1992) As part of her campaign against underage drinkig, the Surgeon General requested that the Offce of Inspector General (OIG) provide information on some of the negative consequences of youth alcohol use.
  • Alcohol, Drug, and Mental Health Services for Homeless Individuals (OIG 1992) Recent research suggests that approximately one-third of an estimated 600 000 homeless population are severely mentally il, at least 40 percent have problems with alcohol, and an additional 10 percent abuse other drugs. In addition, it is estimated that at least one-half of the homeless mentally il population also have alcohol or other drug problems.
  • Youth and Alcohol: Summary of Research–Alcohol Advertising’s Effect on Youth (OIG 1992) OIG found that more than 10 million 7th though 12th grade students drank alcohol in the past year and 6.9 mion are able to walk into a store and buy alcohol. Thus, students not only have access to alcohol but also represent a group of consumers who are potentially open to suggestions from alcohol advertisements.
  • The Crack Cocaine Epidemic–Health Consequences and Treatment (GAO 1991) Pursuant to a congressional request, GAO reviewed the: (1) health consequences of the crack cocaine epidemic; and (2) types of treatments available for crack addicts.
  • Youth and Alcohol: A Sample of Enforcement and Prevention Programs (OIG 1991) This inspection identified a sample of national, State, and local programs that educate youth about (1) the health and social effects of using alcohol, (2) State alcohol laws and penalties for minors, and (3) ways to resist alcohol and increase self-esteem.
  • Youth and Alcohol: Controlling Alcohol Advertising that Appeals to Youth (OIG 1991) This inspection examined (1) the Federal, State, alcohol industry, and national television networks’ advertising and marketing regulations and standards, (2) the monitoring of these regulations and standards, and (3) the application of the regulations and standards to five current alcohol advertisements.
  • Youth and Alcohol: Laws and Enforcement–Compendium of State Laws (OIG 1991) This compendium presents State alcoholic beverage control laws relating to youth for all 50 States and the District of Columbia.
  • Youth and Alcohol: Laws and Enforcement–Is the 21-Year-Old Drinking Age a Myth? (OIG 1991) At the Federal level, the National Minimum Drinking Age Act of 1984 required all States to raise their minimum purchase and public possession age to 21. States that did not comply faced a reduction in highway funds under the Federal Highway Aid Act. The Department of Transportation has determined that all States are in compliance with this Act.
  • Drug Abuse Treatment Waiting List Reduction Grant Program (OIG 1991) This inspection assesses the extent to which the Drug Abuse Treatment Waiting List Reduction Grant Program reduced waiting lists for drug treatment by expanding the capacity of existing programs.
  • Rural Drug Abuse: Prevalence, Relation to Crime, and Programs (GAO 1990) GAO found that: (1) total substance abuse rates are about the same in rural and nonrural states; (2) alcohol was the most widely abused substance in rural and nonrural areas; (3) prevalence rates for certain drugs were lower in rural areas than in urban areas; (4) rural and nonrural areas had similar arrest rates for substance abuse violations; (5) the few thorough evaluations that have found substance abuse programs to be effective did not focus on programs in rural areas; and (6) while some treatment programs appeared to reduce drug abuse, over 80 percent of treatment admissions in rural areas were for alcohol abuse.
  • Youth and Alcohol: A National Survey–Drinking Habits, Access, Attitudes, and Knowledge (OIG 1991) This report is one in a series prepared by the OIG related to youth and alcohol. It describes survey findings relating to youth perceptions, knowledge, opinions, and drinking habits and is based on structured interviews conducted with a random national sample of junior and senior high school students.
  • Sheltered Workshop Services Provided Residents of Intermediate Care Facilities for the Mentally Retarded (OIG 1986) HCFA concurred with our recommendation and published a policy issuance in the State Medicaid Manual clarifying the definition of vocational training. The instruction excludes payment for most sheltered workshop care and should ensure the problem identified during the inspection does not reoccur.
  • Deinstitutionalization of the Mentally Ill in Oregon (GAO 1976) Deinstitutionalization occurs when a person changes from a dependent status in a State institution to an independent and meaningful life in the community.
  • Deinstitutionalization of the Mentally Ill in Maryland (GAO 1976) Until the early 196Os, the mentally ill were cared for predominantly in large public institutions. Frequently, the conditions in these institutions were deplorable and unacceptable but alternatives to lnstltutlonallzatlon did not exist.
  • Nebraska’s Efforts To Provide Alternatives to Institutional Care for the Mentally Disabled (GAO 1976) The population in Nebraska’s mental instltutions for the mentally ill reduced from 4,785 in 1955 to 748 by 1975. The population in the instltutions for the mentally retarded had declined by about one-half to 1,072 since 1968.

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