By Marissa Meador
Indiana Capital Chronicle

INDIANA — Several weeks ago, Porter-Starke Services — one of Indiana’s 24 community mental health clinics — received a call. A person was experiencing a mental health crisis and was suicidal, but the office was closing.

The only option left was Starke County’s hospital, which Sandy Carlson, Porter-Starke’s vice president of clinical services, said is small and not equipped to manage psychiatric patients. A crisis that began around 5 p.m. took until the early morning hours to stabilize the patient through hospitalization.

But under the mental health care transformation shepherded by Senate Enrolled Act 1, the individual could have gotten the help they needed in a more efficient and effective way.

“If we would have had a mobile crisis response at that moment, that was able to engage, we could have accelerated that whole process,” Carlson said. “The person, they wouldn’t have burned through resources at the ER, we wouldn’t have had to … spend that length of time, frustration, unknowing … it would have just been a direct contact with mobile crisis, they could have gotten them to where they need to be and then they’d be on their way to some treatment.”

The model proposed by the new law is part of a federal initiative to coordinate care and improve access to mental health care and can be broken down into three parts: someone to contact, someone to respond and a safe place to go for help. These pieces are the 988 crisis line, mobile assessment teams and crisis stabilization units.

The goal is to reroute people experiencing crises from hospitals and jails, freeing up overburdened medical providers and police officers and saving people from harming themselves or others. Indiana is currently one of more than 30 states receiving grant-funding for the transformation, but SEA1 carves out a path for the state to receive demonstration, a coveted position that ensures long-term funding.

A History Of Mental Healthcare In Indiana

Indiana’s current framework of mental health care was established by President John F. Kennedy’s Community Mental Health Act in 1963, which allowed states to build their own structure.

Zoe Frantz, president of the Indiana Council of Community Mental Health Centers, which supports the state’s 24 CMHCs in matters of state and federal policy, said Indiana did a good job at the time. Frantz also serves on the Indiana Behavioral Health Commission.

In 2014, the Protecting Access to Medicare Act developed a federal standard for mental health care delivery in the form of certified community behavioral health clinics. These differ from CMHCs by coordinating mental health care with different stakeholders, like police and hospitals, and improving access to care overall, including 24/7 crisis services. Notably, the program stipulates that no one be denied service for their inability to pay — any costs for these individuals must be reduced or waived.

The ultimate goal of the legislation is to encourage states to transition their CMHCs to CCBHCs.

The changes come at a critical time for the Hoosier state. Mental healthcare is only becoming more necessary as workforce vacancies — currently at 20% according to Frantz — persist.

Frantz describes the new process like this: a person experiencing a crisis calls 988, a 24/7 mental health line, and is assessed over the phone. If the responder determines a mobile assessment team is needed, a group of providers will meet the person and determine if they need to go to a crisis stabilization unit. If not, the assessment team will connect the individual with an outpatient provider.

The steps are almost entirely implemented for the 19 pilot organizations across the state, Frantz said, with only crisis stabilization units still in development.

SEA 1 takes steps to treating mental illness more like a physical illness and preventing the extreme result of a suicide or overdose.

How Will The New System Be Funded?

The new system is projected to cost $130 million per year when it’s fully mature and needs a long-term funding solution. At the same time, an IBHC report estimated the cost of untreated mental illness in Indiana at $4.2 billion a year.

The most recent state budget allocates just $100 million for the program over two years.

Mobile assessments are mostly covered by Substance Abuse and Mental Health Services Administration grants for the time being, Frantz said. That makes the system currently free for Medicaid recipients, although the future of that benefit remains uncertain as advocates search for a sustainable method.

Frantz, along with others like the bill’s author, Sen. Michael Crider, want to fund the system with a $1 surcharge for using 988. The surcharge method is used for 911 and brings in about $90 million a year.

However, legislators decided against the surcharge this session, saying the current budget was enough to support the system for now.

Indiana is also eligible for a federal payment structure if they demonstrate they’ve satisfied the program’s standards by March 2024. If approved, the full model with the federal payment structure will be implemented by 2027.

However, only 10 states will be selected in 2024, making the process competitive. If Indiana is not selected, Frantz said SEA 1 authorizes Indiana to make their own state plan amendment until they are selected, which they will have the opportunity for every two years. Almost every state is currently participating in the move to CCBHCs, although some are already demonstration states.

Demonstration states fund their systems through a prospective payment system, which reimburses providers a predetermined amount for providing services to Medicaid recipients. ​​The goal of this system is to expand services and increase clients by addressing underlying costs.

So far, early results of the program are promising. After five years as a demonstration state, Missourisaw a 35% increase in access to care and $15 million in savings on hospital costs.