Ray Lay, a veteran and peer-support specialist at Roudebush VA Medical Center
Ray Lay, a veteran and peer-support specialist at Roudebush VA Medical Center
• •
INDIANAPOLIS — Ray Lay, a veteran and peer-support specialist at Roudebush VA Medical Center, knows as well as anyone the need for a better mental-health system in Indiana.

When he was 5 years old, he was hurled through the windshield of a car during a traffic accident. For the next three weeks, he was unconscious.

When Lay came to, he began seeing and talking to who he thought was his guardian angel. Over the next 10 years, as the imaginary angel watched, he committed a wave of “anti-social acts.” Lay was later diagnosed with paranoid schizophrenia.

After spending years in mental institutions and jails, Lay finally dealt with his disorder and subsequent substance abuse to become an Indiana community health worker and certified recovery specialist.

Now, to help people like him — and anyone facing a mental-health crisis — Lay is calling on legislators to make significant changes.

And he’s doing it as a member of the Indiana Behavioral Health Commission.

State legislators in 2020 created the 22-member commission to investigate where Indiana’s behavioral health system stands and how it can change to better administer its services.

After two years, the commission released its final report last month, finding the state’s system is hugely underfunded, understaffed and in need of a massive overhaul.

As one state administrator put it, it’s like trying to “fill a giant sinkhole with a single spoon,” the report says.

“For far too long, Indiana has approached behavioral health policy in a piecemeal and oftentimes disjointed manner, leading to the fragmented and siloed system we have today,” said Stephen McCaffrey, president and CEO of Mental Health America of Indiana, in the report.

One of the commission’s central recommendations is to form mobile crisis teams to respond to callers using 988, the state’s newly created crisis-and-suicide-prevention hotline that went live in July.

Teams of mental health providers would physically respond to those requiring immediate help. The plan calls for creating more crisis and stabilization facilities, where those teams could bring people experiencing mental health problems.

Legislators appropriated American Rescue Plan money to get the service started, but the report recommends implementing a $1 surcharge on Hoosiers’ phone bills to generate an estimated $90 million a year for long-term funding.

The response system tied to 988 would cut the cost of health care and reduce the need for psychiatric acute care, hospital emergency room visits and police overuse — all while helping people in distress and preventing suicides, the report explained.

A WHOLE NEW SYSTEM

The commission also recommends transitioning from Indiana’s current mental-health system to the federally supported Certified Community Behavioral Health Clinic model.

Such clinics are required to serve anyone, including care of children, who requests care regardless of their ability to pay, where they live or age, according to the Substance Abuse and Mental Health Services Administration. Certified clinics are also required to get people into care quickly.

Seventeen clinics in Indiana are using expansion grants to transition to the federal model, but the report suggests that legislators increase funding by 60% over the next four years to establish the new system as the primary mechanism for behavioral health care.

Expanding 988 and the federal clinic model would significantly ease the burden of mental illness on the criminal justice system, the commission said, which has become the largest provider of mental-health services in the state. Data shows that 37% of people in state and federal prisons, and 44% of inmates in jails, have been diagnosed with a mental illness.

But more help is needed, the report argues. It recommends increasing the number of mental health courts across the state and establishing a Medicaid waiver to allow cost reimbursements for some behavioral health care while people are incarcerated.

‘WE NEED THE HELP’

The single biggest obstacle to implementing the commission’s recommendations stems from the staggering lack of an adequate workforce. The report found it would take about 6,000 additional practitioners to meet the needs, and that number is expected to only grow in the next few years.

Low wages, high caseloads resulting in burnout and high turnover rates are just some of the reasons for the worker shortage, according to the commission.

The majority of behavioral health workers are unlicensed professionals, the report notes, so one solution is providing training and certification through the state and adopting reimbursement rates for those workers to ensure there are enough providers in Indiana.

The commission also called on lawmakers to appropriate funds for a long-term student loan repayment or tuition reimbursement program for behavioral health professionals committed to working with underserved communities in Indiana.

In the end, the commission acknowledges, its recommendations carry a significant price tag, but the cost of not making major changes in Indiana’s mental health care system would be far greater.

The report estimates the cost of untreated mental illness in Indiana to be a staggering $4.2 billion a year.

That’s why Lay of the Roudebush VA Medical Center said the time is now for legislators to take action on the report to bolster services for those like him who suffer mental illness for years.

“I already live with a mental and behavioral health condition,” he said. “But what about those that lack insight? ... We need the help of the whole legislature speaking and acting on behalf of the people of Indiana.”
© 2024 Community Newspaper Holdings, Inc.