Judges and prosecutors are steering low-level drug offenders away from jail cells and back home for treatment, under new sentencing laws. But finding enough people to counsel those drug abusers isn’t easy.
Indiana falls far below the national average of mental health professionals trained to treat addiction, according to a report earlier this year by the Pew Center on the States. The shortage worries district attorneys, public defenders and treatment providers who blame the problem on a lack of funding.
Several initiatives should help narrow the gap, they predict, though not soon enough for some.
“We’re sending people to prison for a long time because they’re addicts, and there’s no other place to send them,” said Larry Landis, head of the Indiana Public Defender Council.
The shortage confronts a 21-member task force created Tuesday by Gov. Mike Pence. Made up of public health and law enforcement officials, the committee is charged with finding gaps in drug treatment, enforcement and prevention.
Pence announced the task force at a press conference at Eskenazi Health hospital near downtown Indianapolis. The hospital’s Midtown Community Mental Health program is scrambling to hire counselors and doctors trained in addiction treatment.
So, too, is Centerstone, which offers health services in mostly rural communities.
“We’re having a tremendous amount of difficulty filling those positions,” said Linda Grove-Paul, Centerstone’s vice president for recovery and innovation.
The problem is felt throughout the state.
A Pew Center on the States report in April shows that Indiana has fewer than 20 trained treatment providers for every 1,000 adults under age 64 with addictions. The national average is 32.
That puts Indiana fourth-lowest among all the states, behind Nevada, Georgia and Texas.
“There’s no question there’s a critical workforce shortage. We just don’t have enough people trained,” said Steve McCaffrey, a longtime advocate for addiction treatment who heads Mental Health America of Indiana.
Many addicts wind up in prisons and jails. Law enforcement experts estimate up to 80 percent of those incarcerated have substance abuse or mental health problems. Often they have both.
While vowing to crack down harder on drug dealers, Pence has also promised that his task force will look at treatment issues.
“We can’t arrest our way out of this problem,” he said.
Dave Powell, head of the Indiana Prosecuting Attorneys Council, which has called for tougher drug penalties, said a lack of treatment choices in rural Indiana is a “terrible situation.”
The problem is compounded by new sentencing guidelines, in place since July 2014, that steer low-level offenders out of jail and prison and into community-based programs. Many of those offenders face drug-related charges and bring addictions with them. Powell said rural judges often have few choices for treatment programs and lock up offenders anyway, so they’ll at least have access to addiction treatment programs in prison.
The shortage of counselors outside prison walls is tied to money.
Until recently counselors, doctors and other health care professionals had little financial incentive to train in addiction treatment, according to McCaffrey and Grove-Paul.
Few private insurers have covered addiction treatment, and the state has invested little money in treating addicts, instead opting to focus on crime enforcement.
That situation has made it difficult to recruit treatment counselors, Grove-Paul said.
“There hasn’t been a reimbursement system in place that guarantees people can earn a living doing this,” she said.
But that’s changing.
Earlier this year, lawmakers set aside $30 million for local substance abuse and mental health treatment programs. They attached the funds to a sentencing reform measure aimed at diverting low-level offenders — many of whom are addicted, just out of state prisons and back in their home communities.
The money is going into a voucher program to be managed by the state Division of Mental Health and Addiction. Addicts who qualify can use vouchers to pay for treatment from state-certified providers.
In addition, more Medicaid dollars may be funneled into treatment programs.
In January, Indiana significantly expanded the health insurance plan for the poor by opting into the federal Affordable Care Act. In doing so, state officials agreed for the first time to use Medicaid dollars to cover the treatment of drug and alcohol addiction.
The decision could prove costly. The U.S. Substance Abuse and Mental Health Services Administration estimates 21 percent of the Medicaid-eligible population in Indiana has a substance use disorder, compared with a 10 percent national average.
Treatment providers express confidence that the state will fill the void of treatment counselors, though it could take time.
The state has set licensing guidelines for providers, and it has approved training programs for existing health care workers to become certified in addiction treatment.
It is also creating incentives to draw people into addiction-treatment jobs — for example, by offering to repay their student loans.
“We’ve got more pieces in place on the macro level than ever before,” McCaffrey said. “But they’ve yet to be implemented in a way to see immediate results.”