Sen. Mike Crider, R-Greenfield, discusses the need to establish long-term, sustainable funding for Indiana’s behavioral health system at a Oct. 1 press conference. Photo by Whitney Downard, Indiana Capital Chronicle.

By Whitney Downard
Indiana Capital Chronicle

INDIANA — Sen. Mike Crider likened the dual problems of funding and workforce shortages within Indiana’s behavioral health system to an age-old philosophical question: What came first — the chicken or the egg?

“If you don’t have funding, you don’t necessarily attract workforce. If you don’t have workforce, you don’t have, really, the ability to deliver the service that would consume the funding,” Crider, R-Greenfield, said in a Tuesday press conference.

Crider was one of several members of the Behavioral Health Commission — spearheaded by chair and longtime advocate Jay Chaudhary — who unveiled a two-year analysis summarizing issues within the state’s system to deliver care to Hoosiers in a mental health or addiction crisis. As the primary author of a 2023 law reforming Indiana’s system, Crider secured $50 million annually to tackle a problem that a previous commission report found cost the state more than $4 billion annually.

The bill had near-record levels of support, but a rosy revenue forecast derailed efforts to dedicate long-term funding sources to supporting 988 — a mental health crisis hotline — as well as staffing needs and community-level crisis centers. Now, Crider and others are back with a new ask: an additional $50 million in the next fiscal year — for a total of $100 million — followed by $120 million for the 2026 fiscal year.

The report documenting the need comes with several funding proposals that previously failed to win legislative approval: a $1 surcharge on phone bills similar to the one Indiana levies to fund 911 that could raise $90 million annually; a $1 increase on a 20-pack of cigarettes that could bring in $132.6 million annually; an alcohol tax; or a sports wagering tax.

Crider didn’t rule out the possibility that money could be secured in a standalone budget line item or that other legislators could bring forward new ideas. However, budget writers are already cautioning their peers that funds will be tighter in the 2025 session.

Report Details

The 77-page report includes both high points — such as Indiana’s high in-state response rate for 988 calls — and lows like Indiana’s near-bottom ranking for school counselor to student ratios.

Much of the additional funding will be earmarked for Certified Community Behavioral Health Clinics to provide treatment at the local level and work with teams responding to active 988 calls. The state is transitioning from Community Mental Health Centers — a more siloed approach that pays per service — to the clinics by launching eight pilots geographically dispersed around the state. An additional eight clinics would be needed to eliminate coverage gaps.

But commission member Rep. Victoria Garcia Wilburn, D-Fishers, notes that every Indiana county has a mental health workforce shortage and current federal funding streams are about to expire. Future professionals could be recruited as early as high school, where behavioral health careers can be highlighted in the state’s high school diploma redesign, she said.

To better incentivize providers, commission members recommended indexing the reimbursement rate for mental health and addiction services to match Medicare’s rates while tapping into other health providers to expand care options.

To widen the pipeline of future behavioral health providers, the report urges the state to secure funding for more psychiatry residency positions and address other barriers. As a psychiatric nurse practitioner, Rep. Cindy Ledbetter must find a psychiatrist to partner with her and oversee portions of her work.

And while Ledbetter said she took on the additional duties of preceptorship — a training program for young professionals — with no additional pay, she said others didn’t. Adding a tax credit for preceptors could help add to the number of people willing to work with the next generation of behavioral health workers.

Any efforts should be made in coordination with agencies serving smaller populations of Hoosiers, such as those with intellectual or developmental disabilities, children or older adults. By 2030, one in five Hoosiers will be retirement age or older.

Now, however, one in five children and adolescents have a mental health disorder that requires treatment but accessing care is uneven, said Sen. Andrea Hunley, D-Indianapolis.

“We need to strengthen the entire continuum of care, but this also includes a dedicated, very specific focus on our schools,” said Hunley, an educator and former principal. “… schools are often the very first place where these mental health needs and challenges are recognized — and by addressing them early, we can prevent them from growing into bigger problems.”

In particular, schools needed the resources to improve school psychologist and counselor staffing.

Ledbetter detailed recommendations for the other end of the age spectrum, such as incentivizing age-friendly health systems and standardizing data collection for this cohort by establishing a state position under the Division of Mental Health.

Additionally, the state needed to make more efforts to fund a group home that served elderly Hoosiers with serious mental illness or a criminal justice record, who many times aren’t accepted into nursing homes.

“Establishing a facility in Indiana that addresses both needs for this high-acuity, aging population could reduce state costs by preventing extended hospital stays,” Ledbetter said.

Additional savings occur when mobile crisis teams divert mental health and addiction calls away from public safety officers and hospitals — both of which shoulder much of the burden currently. A crisis team intervention could save as much as $2,050 by avoiding a one-day hospital stay or $2,237 by keeping someone out of jail for the night. If each of the thousands of crisis team calls yielded such results, the savings could be in the millions.