There are many reasons to admire the State of Indiana. Our provision of mental health services, however, isn’t one of them.
Mental Health America (MHA) is the nation’s leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and promoting the overall mental health of all Americans. It recently published the 2018 State of Mental Health in America report that documents several national concerns:
• One in five adults has a mental health condition. That's more than 40 million Americans; more than the populations of New York and Florida combined.
• Youth mental health is worsening. Rates of youth with severe depression increased from 5.9 percent in 2012 to 8.2 percent in 2015. Even with severe depression, 76 percent of youth are left with no or insufficient treatment
• More Americans have access to services. Access to insurance and treatment increased, as healthcare reform has reduced the rates of uninsured adults. However, most Americans still lack access to care. About 56 percent of American adults with a mental illness do not receive treatment.
• There is a serious mental health workforce shortage. In states with the lowest workforce, there is up to six individuals to only one mental health professional. This includes psychiatrists, psychologists, social workers, counselors and psychiatric nurses combined.
For several years, MHA has been using 15 measures to rank the 50 states on prevalence of mental illness and access to mental health care. The 2018 report (based on 2015 data) indicated that Indiana ranked poorly compared to its peer states:
• Indiana was ranked 48th of the 50 states, indicating high incidence of mental illness and low access to care. Indiana’s ranking on the other four categories were:
• Adult 47th of 50 states.
• Youth 38th of 50 states.
• Prevalence of mental illness 47th of 50 states.
• Access to care 33rd of 50 states.
These data are concerning enough, but in the four years since MHA began ranking the states, Indiana has fallen 29 places from 19th to 48th of the 50 states In Behavioral Health Barometer 2015, the U.S. Substance Abuse and Mental Health Administration (SAMHSA) noted that more than 60 percent of adolescent s in Indiana who had a major depressive episode did not receive treatment for depression and more than 56 percent of adults who had any type of mental illness did not receive any for of mental health treatment or counseling. In the2016 report on Depression in Indiana Adults, Ball State University noted several areas of concern:
• In every year studied, episodes of depression in Indiana were higher than the U.S. average rates across all age groups.
• Suicide rates in Indiana are consistently in the top 25 states.
• Drug-related deaths in Indiana are consistently in the top 15 states.
• There are shortages of mental health providers across counties and across types of providers.
Clearly there are good things happening in certain aspects of mental health care in Indiana. The new Neuro-Diagnostic Institute under construction in Indianapolis is intended to be the hub of the State's recently created mental health hospital network. It will allow people with chronic mental health issues who might otherwise be incarcerated, homeless or inadequately cared for will be able to go to a central location to be accurately diagnosed by experts. From there, they could be referred to other services, treatment or be sent to one of the state's five other regional facilities. The state has maintained per-capita funding for mental health services, but the community mental health system is really strapped and their effectiveness is undermined by the shortage of mental health professionals, particularly psychiatrists.
The shortage of capacity makes it difficult, if not impossible, for patients to obtain the care needed. This is one of the key factors in the growing problem with addiction to opioids and other substance abuse, particularly among young people. One observer put it this way: "It’s easier to get high than to get treatment.” A perhaps unintended consequence of the lack of access to community mental health services has been a shift of treatment responsibility to our correctional system, in effect criminalizing the treatment process.
What to do? I believe it is time for a high level, “blue ribbon” commission to evaluate Indiana’s mental health capabilities and recommend improvements that will move Indiana from one of the most problematic states in the nation to obtain mental health care. It’s been three decades since Governor Robert Orr spearheaded such a review. The new Neuro-Diagnostic Institute is a very positive step, but unless we have effective and accessible mental health services at the community level, Hoosiers will suffer needlessly, and we’ll continue to send people to prison that should be in treatment.
Leigh Morris is former President and CEO of La Porte Hospital and former Mayor of La Porte.