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Dear Advocates,
In what is possibly the most far-reaching study on mental health in Indiana, legislation authored by Senator Mike Crider created the Indiana Behavioral Health Commission.
The charge of the Commission was to study the cost of untreated mental illness and make recommendations to enhance the behavioral health needs of our state. The Commission was Chaired by DMHA Director Jay Chaudhary, and the recommendations would recreate the mental health and addiction infrastructure in Indiana. The initial recommendations have been incorporated into SB 1, authored by Senator Crider. While SB 1 is just the beginning and the Commission needs to continue its work, it is certainly an amazing first step in the process of improving Indiana’s behavioral health service delivery system.
According to the Report, the substantial burden of mental illness on Hoosier families and communities is demonstrated by the following:
· Approximately one in five Hoosiers experience mental illness each year.
· For every four Hoosiers treated for mental illness, one additional Hoosier is untreated.
· Mental illness is associated with the prevalence and progression of many burdensome and costly chronic diseases, such as diabetes and cardiovascular disease.
· An estimated 40% of individuals who are incarcerated have a mental illness. One in four who are incarcerated have a serious mental illness. This does not include substance use disorder which pushes the number to 80%.
· Nearly half (45%) of homeless individuals have a mental illness, particularly among those who are chronically homeless.
· Eighty percent of Hoosiers with a serious mental illness are unemployed.
The cost of untreated mental illness in Indiana is estimated to be $4.2 billion every year. The largest cost attributable to untreated mental illness was premature mortality, which is valued at over $1.4 billion. Productivity losses were estimated to cost $885 million each year, and direct healthcare costs $708 million. The Report distinguished between Direct and Indirect Costs. Direct healthcare costs include costs of $708 million annually, which include $142 million to Medicaid and $567 million to private insurers. Direct non-healthcare costs include costs of $106 million to Indiana’s criminal justice system and costs of $9.9 million to Indiana through homeless supports. Indirect Costs include $1.5 billion in premature mortality, which includes both the risk of unintentional death attributed to mental illness and the cost due to intentional death.
Also included, were the costs of $885 million due to productivity losses, $750 million of which was lower productivity among workers. The Report included the costs of $566 million for caregiving, $546 million of which was lower productivity among caregivers and the cost of $407 million in unemployment for those unable to work.
The Report recognized that the behavioral health service delivery system in Indiana was lacking and that an enhanced infrastructure would provide services for Hoosiers to create a higher quality of life.
In addition, cost savings may be realized through reducing the number of Hoosiers with untreated and undertreated mental illness. The Report stated that such may be achieved by strengthening the mental health provider workforce, improving access to mental health services, ensuring that policies enable providers to use the full range of treatment options, reducing barriers to treatment initiation such as transportation challenges, increasing awareness and reducing stigma around mental illness, and encouraging employers to support mental health initiatives.
Specifically, the Indiana Behavioral Health Commission Report recommends the following:
A. Crisis Response System: implement the three-part model (someone to contact; someone to respond, and a safe place for help) to build the sustainable infrastructure for a new statewide Crisis Response System in conjunction with implementation of Indiana’s 988 system.
(a1). The General Assembly should implement a one dollar ($1) 988 surcharge to fund the comprehensive crisis response system.
B. Develop a Sustainable Infrastructure to Expand CCBHCs in Indiana
(b1). Pass legislation requiring FSSA to apply for CCBHC demonstration status as allowed by the federal Bipartisan Safer Communities Act. Should Indiana not be awarded demonstration status, FSSA must initiate another process such as a State Plan Amendment or Waiver to implement the CCBHC model.
(b2). Using the Missouri experience as a model, the General Assembly should appropriate adequate, incrementally increasing funding to support permanent CCBHC expansion in Indiana.
C. Implement System-Wide Collaboration between the Justice and Behavioral Health Systems
(c1). The General Assembly should appropriate funds to the Office of Court Services to increase the number of mental health courts available on a local level.
(c2). Legislatively create an alternate statutory path for individuals with non- violent crimes who have a mental illness and are declared incompetent to stand trial. Include Judge discretion to dismiss changes when individuals cannot achieve competency.
(c3). FSSA should apply for an 1115 Medicaid Waiver for Care while incarcerated.
(c4). Allow access to behavioral health medications, including MAT with medication adherence planning. Ensure improvement and alignment of the formulary of psychotropic drugs while incarcerated.
(c5). Provide pathways for reductions in the length of probation and parole time due to the provision of behavioral supports.
D. Develop Policy to Improve Mental Health Literacy
(d1). Develop policy that funds and incentivizes schools and early childcare providers to implement mental health literacy to increase school safety and improve skills and mindsets needed for the next generation to contribute to the Indiana workforce.
E. Expand the Scope and Use of the Be Happy Program Model
(e1). Develop legislation to expand the scope and use of the Be Happy Program model by including the requirement for insurance carriers operating within Indiana to proportionally share in the program cost based upon covered lives/month and, expand the current psychiatry access program scope to include adult and perinatal mental health consultations.
F. Ensure the Indiana Department of Insurance and the Division of Mental Health and Addiction have Authority to Enforce Parity.
(f1). Review current policy and legislation to ensure that the Indiana Department of Insurance and the Division of Mental Health and Addiction either currently have (or) be given the authority to enforce parity.
G. Develop Legislation to Expand Provider Workforce in Indiana.
(g1). Increase Medicaid rates to support competitive hiring and retention.
(g2). Develop legislation to expand universal licensure recognition language to behavioral health licenses issued under the Indiana State Psychology Board and the Behavioral Health and Human Services Board; facilitate the implementation of physician and psychology compacts as well as other future compacts advocated for by other IPLA recognized behavioral health professionals; and mandate the modernization and increasing digitization of the IPLA licensing process.
(g3). Legislate the funding for a long-term student loan repayment or tuition reimbursement program for behavioral health professionals committed to working in Indiana and serving underserved communities.
H. Infrastructure Recommendations
(h1). Legislatively require Indiana Managed Care Entities to participate in a centralized credentialing process.
I. Funding Recommendations
(i1). Pass a $1 surcharge to fund a comprehensive crisis response system
(i2). Request for the General Assembly to increase the appropriation for care of individuals with Serious Mental Illness by no less than 60% over the next two biennium budgets
This Commission Report provides Indiana with the opportunity to develop the infrastructure in behavioral health that has been historically lacking. SB 1 is the first step in implementing the recommendations from this report and would begin to develop Indiana’s Behavioral Health infrastructure with the development of a Crisis Response System and CCBHCs. Please contact your legislator and ask him/her to vote for SB 1 as well as the $1 surcharge for 988 with the recommended funding in the budget.
To read Senate Bill 1, click here.
To read a one page fact-sheet on the economic burden of untreated mental illness in Indiana click here.
To read about other key legislation we are tracking, please read below.
As always, stay safe and be well.
Stephen C. McCaffrey, JD
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