In 2015, Indiana ranked rather low in the nation in regards to health concerns. The Hoosier state ranked 32nd in diabetes and 36th in infant mortality.
Our collective mental health is struggling, too.
Almost five percent of adults in Indiana experienced effects of a serious mental illness in 2014-2015, according to a report by the Substance Abuse and Mental Health Services Administration. In the same years, almost 21 percent of people in the state reported a mental illness of some type. These numbers are slightly higher than the national average for that time, where about four percent of Americans reported a serious mental illness and just over 18 percent of people reported any mental illness to the study.
Mental health issues encompass a wide range of illnesses, from depression to anxiety to psychosis and ADHD, among many others. The mental health system in the state is doing what it can, and improvements have been made, but there are many ways in which the system is still in need of help.
Josh Sprunger, the executive director of the National Alliance on Mental Illness, says Indiana is in the middle in regards to spending and funding of mental health care.
"Indiana is doing a good job," he says. "What I would say is that Indiana has come a long way in the past five years or so, but they have a long way to go." Sprunger adds that Indiana, in relation to other states, has maintained relatively steady per capita funding for mental health services, while other states have decreased their services and funding.
"We're glad about that," Sprunger says. Still, he maintains, there is much work to be done.
"The community mental health system is really, really strapped," Sprunger says. "There aren't a lot of resources there, either financially or in terms of workforce."
Psychiatrists are especially needed in Indiana, he says, but what is also needed is time to build relationships that don't get made in normal scheduled appointment blocks.
"There's no time in the system right now," Sprunger says. "Time means money."
But time also could mean relationships that are crucial to the treatment and recovery process for mental health conditions. This is why NAMI has volunteers who themselves have mental illnesses and who lead others in treating their own mental illnesses.
"We've got program leaders who experience symptoms of psychosis on a daily basis, but they're able to manage those symptoms in a way that allows them to live the life that they want to live and to help others," Sprunger says. "When you ask those folks to tell their stories and what made a difference for them, certainly medication and treatment are a part of the story, but usually it comes down to a relationship [with a person] who has gone above and beyond in terms of taking time."
Without time and money, those who cannot afford the care on their own or who do not know how to go about seeking treatment are left without many options. But with funding and help, as at Eskenazi Midtown Community Mental Health Center in Indianapolis, comprehensive mental health treatment can be made accessible to more people.
Dean Babcock, the associate vice president at Eskenazi Midtown Community Mental Health Center, says that the center treats about 16,500 people each year. A lot of the funds that the Community Mental Health Center receives are public funds, he says. With this money, the centers pay particular attention to the lower-income population.
"We treat a wide range of people," Babcock says, "but I think many times we treat people that otherwise may not be able to access care of this sort."
Midtown Community Mental Health Center's location in Indianapolis, Babcock adds, helps the center provide so well for patients.
"We feel very fortunate that we're part of an organization that can work in the community, and so close with the community, and so close with other policy makers and professional schools and the criminal justice system and the other members of local city government and state government... that we can create very creative partnerships in which to help the citizens in the neighborhoods that we treat," he says.
Mental illness used to be institutionalized, Sprunger of NAMI reminds us. When those institutions started being dismantled, mental health issues became largely criminalized.
Under the Kennedy administration, Babcock says, the idea of the Community Mental Health Centers was established to help people return to their communities and receive the support they need without being locked in a hospital. Eskenzai's Midtown Community Mental Health Center, the first in the state, opened its doors in 1969.
Early intervention, Sprunger says, is key to helping a person with a mental illness receive treatment and recover. But, again, without the resources and know-how to navigate the system, people in need often do not get the treatment they need.
"A lot of those folks that are getting treatment are getting it in a corrections setting, which is a big problem," Sprunger says.
Sprunger commends former Governors Daniels and Pence as well as Governor Holcomb, for their openness to change in the Division of Mental Health and Addiction and in corrections. Sprunger points to a reduction in solitary confinement as well as new programs geared toward helping increase access to mental health services for children.
In 2016, an agreement between the Indiana ACLU and the Indiana Protection and Advocacy Services Commission prohibited, with some exceptions, solitary confinement for seriously mentally ill patients. This, Dawn Adams, the executive director of IPAS, says in the press release, opened up treatment opportunities that didn't include harmful solitary confinement for the 5,600 mental ill inmates in Indiana prisons at the time.
"[The mental health system is] improving, but it could be improving a lot more quickly," Sprunger says.
Now, NAMI is advocating for the state to go a few steps further in helping mentally ill inmates. Senate Bill 155 would have prohibited a sentence of the death penalty for a person with a serious mental illness who committed a crime. This bill did not make it through the Senate Judiciary Committee.
Senate Bill 231 also deals with interactions between people with mental illnesses and law enforcement. The bill, which was passed unanimously by the Senate on Feb. 22, establishes a technical assistance center for crisis intervention teams as well as training for the teams. The bill will now move on to the House Public Health Committee for discussion.