'Phenomenal starting point': Indiana takes first steps to expand mental health treatment

Jun. 8—It's been a long wait for mental health providers and advocates who have pushed the state of Indiana and its leaders to seriously invest in mental health and treatment.

The wait is finally over.

The Indiana General Assembly earlier this year passed a slew of mental health-related bills, including Senate Enrolled Act 1 that offers $100 million over the next two years to expand access to mental health resources to Indiana residents.

The bills were hailed by Gov. Eric Holcomb as a "sea of change" for the state and garnered near-universal support from the General Assembly.

Dr. Carrie Cadwell, the president and CEO of the community mental health center 4C Health, described the moment as "a phenomenal starting point" for the state.

"In the course of my 20-plus years working in behavioral health, it's been really rare — it's actually been a very rare occurrence — to see any type of substantial funding going toward mental health and substance abuse efforts," Cadwell said.

While the passage does mark a considerable and historic change of direction in how the state and organizations across the state will tackle mental health issues, the total funding amount is lower than the $200 million over two years State Sen. Michael Crider, R-Greenfield and author of SEA 1, was seeking. It's also lower than the approximately $260 million over two years it would cost to fund a truly statewide crisis system, according to an estimate by the Indiana Family and Social Services Administration (FSSA).

The FSSA said with the $100 million, about half the state will be covered. The agency is aiming for statewide coverage by 2027.

"Although this is not where we need to completely end up to have a high quality of system across all areas of the state, the reality is this is more than I've ever seen invested in my entire career," Cadwell said.

THE NEED

Indiana, like many other states, has chronically underfunded its behavioral health system, and the results have not been pretty.

U.S. News and World Report's 2021 "Best States" ranking listed Indiana 35th in mental health. The nonprofit Mental Health America last year ranked Indiana 42nd in treatment.

The suicide rate in Indiana is above the national average and drug overdoses grew more than 100% over the last decade, which, in turn, has caused the state's life expectancy to decline, according to researchers at Indiana University.

In fact, the state's life expectancy of 77.1 as of 2018 is 1.9 years lower than the U.S. average and places the Hoosier state 40th nationally, only in front of largely southern states, such as Tennessee, West Virginia, Mississippi and Alabama.

The Indiana Behavioral Health Commission, created in the 2020 legislative session and tasked with the job of examining the state's behavioral health system and recommending ways of improvement, found that approximately one in five Hoosiers experience mental illness each year.

In addition, an estimated 40% of people who are incarcerated have a mental illness, and nearly half (45%) of the state's homeless population have a mental illness. Of those who do have a mental illness, 80% of them are unemployed.

The 24-person commission pegged the economic cost of that at a staggering $4.2 billion a year in direct and indirect costs. That includes $708 million in direct health care costs and $116 million in direct, non-health care costs, including $106 million in costs to Indiana's criminal justice system.

In indirect costs, mental illness leads to $1.5 billion in premature mortality, $885 million due to productivity losses and $407 million in unemployment to those unable to work.

For context, the sale of corn in the state had $3.8 billion in sales in 2018.

In its report published in late 2022, the Commission recommended the state use the 988 suicide and crisis line as the foundation of a comprehensive crisis response system; the state make a concerted effort to transition to the federally supported Certified Community Behavioral Health Clinic (CCBHC) model; increase the number of mental health courts; implement a $1 surcharge on phone bills to provide longterm funding for mental health care; look at Medicaid reimbursement rates and consider a student loan/ tuition reimbursement program to attract more, quality individuals to work as behavioral health professionals.

THE RESPONSE

Flush with statistics on Indiana's poor health rankings and with recommendations from both the Indiana Behavioral Health Commission and Governor's Public Health Commission, state legislators filed a number of health-related bills.

All the major ones passed.

Senate Enrolled Act 1

In essence, Crider's bill is an expansion of the state's relatively new 988 crisis hotline. Under the bill, the hotline would be expanded into three parts: 1.) The 988 hotline itself is to be established and maintained. 2.) Create mobile crisis teams across the state that would respond to calls and 3.) Create crisis stabilization units across the state where people in need can go for up to 23 hours to receive care.

SEA 1 passed with a 46-0 vote in the Senate and a 96-3 vote in the House. It was signed into law by Holcomb.

The idea is for the 988 system to work much like calling 911 does but for someone experiencing suicidal thoughts, having a mental health crisis or experiencing a substance abuse issue. While law enforcement would still respond to the scene, a mobile crisis team could also respond and work to either deescalate and stabilize the situation at the person's residence, help that person get connected to the care they need or admit them into a nearby stabilization unit or hospital if needed.

Thanks to a federal grant, 4C Health has already started operating such a mobile crisis response team, which initially covered Cass, Miami, Fulton and Pulaski counties. Just recently, the organization expanded into Howard, Tipton and White counties.

Progress is slow in the newly expanded counties, but 4C Health has been operating in its original counties for two and half years now. In that time, the mobile crisis response teams have conducted more than 3,000 calls, and 4C Health says it has been able to "stabilize over 65% of crisis calls," avoiding costly options such as emergency rooms or inpatient care.

That mobile crisis response team, paired with community stabilization centers and hopefully more Certified Community Behavioral Health Clinics opening in the state in the next couple of years or so, 4C Health believe this model can have a transformative effect on the state's treatment of mental health.

House Enrolled Act 1006

The General Assembly passed House Enrolled Act 1006, a major piece of legislation that ensures people experiencing a mental health crisis who don't need to be in jail get treatment in local hospitals and not prisons or jails.

"Jails are not the place for the mentally ill and they're not able to be treated as they properly should," Rep. Greg Steuerwald, R-Avon, said on the House floor Jan. 31.

Previously, family and law enforcement officers could take people to mental health facilities, but hospitals said they didn't receive payment for the care they administered and were expected to assume liability for the person.

HEA 1006 clarifies Medicaid and health insurance can be used to pay hospitals and clarifies liability. A change made late in the legislation process also states that while a physician assistant or nurse can examine the person, only a doctor can sign off on actually admitting the person for care.

Tyler Juranovich can be reached at 765-454-8577, by email at tyler.juranovich@kokomotribune.com or on Twitter at @tylerjuranovich.

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