Commission makes nearly 20 legislative recommendations to address Indiana's behavioral health needs

A new report from the Indiana Behavioral Health Commission said the state needs to invest more funding and attention to improve behavioral health infrastructure. The commission recommends expanding on previous investment, building Indiana's workforce and addressing care for vulnerable populations.

Jay Chaudhary, chair of the Indiana Behavioral Health Commission, said the only way to meaningfully improve Indiana’s behavioral health care system is through “intense collaboration.”

“We think ultimately, though, it'll be up to my legislative colleagues to go in there and make the case and fight for it,” Chaudhary said.

The commission made nearly 20 recommendations to the General Assembly for the 2025 legislative session. The recommendations cover a wide range of concerns, including workforce shortages and care for children, older adults, and individuals with intellectual and developmental disabilities.

988 crisis response and Certified Community Behavioral Health Clinics

The commission’s 2022 report advocated to create a new comprehensive crisis response system and expand the Certified Community Behavioral Health Clinics model. This led to a two-year, $100 million investment from the General Assembly during the 2023 legislative session.

In June, Indiana was one of 10 states added to a Medicaid demonstration project to establish Certified Community Behavioral Health Clinics. The model of care is designed to ensure people can quickly access “coordinated comprehensive behavioral health care,” regardless of age, place of residence or ability to pay.

Indiana selected eight pilot sites throughout the state for the program. Chaudhary said the goal is to add eight additional sites during the next two years, and then consider the program's expansion again in 2027.

The 2024 report said in order to continue the progress made for both initiatives, the state would need to invest more funding and attention during this next two-year budget cycle. Indiana estimates the total cost for both would be about $100 million for the first year and about $120 million for the second year.

That estimate includes the cost to maintain Indiana's “crisis footprint” and its share of the Medicaid demonstration program.

The commission recommended the General Assembly continue contributing $50 million to the Community Mental Health Fund, which funds the initiatives. It also said lawmakers could increase that funding to make up for the additional costs to expand the programs or consider some of the funding sources the commission proposed.

Workforce development

As of 2024, every county in Indiana is designated as a behavioral health workforce shortage area. The commission's final report included a number of recommendations on how to build and expand that workforce.

These include leveraging other areas of health care to make care more accessible, sustainably funding psychiatry residency positions, securing funding for first responder mental health and resiliency training, and addressing barriers to workforce development.

Specifically, the commission wants lawmakers to make it easier for doctors to transfer their licenses to Indiana. It also wants to eliminate collaborative practice agreements for advanced practice registered nurses.

Rep. Victoria Garcia Wilburn (D-Fishers) also said there’s an opportunity to encourage young people to explore behavioral health careers through Indiana’s high school diploma redesign.

“Our high school students must know that behavior and mental health careers are scientific, evidence-based professions that they can pursue,” Garcia Wilburn said. “We have to reassure them that they will be compensated with livable wages that acknowledge their expertise and value.”

Garcia Wilburn said these changes would connect Hoosiers to much needed mental and behavioral health care services.

Behavioral health services for children

The commission made recommendations including, among other things, promote the Comprehensive School Mental Health Framework, support for children with high acuity needs and expand care for adolescents with severe mental health needs to reduce risk of incarceration and residential treatment.

Sen. Andrea Hunley (D-Indianapolis) said schools often the first place where mental health needs are recognized — but Indiana has the worst counselor to student ratio in the entire nation. There’s also only one school psychologist per almost 2,700 students.

“How can we expect our counselors and our psychologists and our social workers to reach every child in need when we don't have enough of them?” Hunley said.
 

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Hunley said with that large ratio, school psychologists don’t have the time to provide additional support or treatments beyond assessment and diagnosis.

Behavioral health services for older adults

Among the recommendations, the commission wants to provide better mental and behavioral health support for older Hoosier, including creating a facility for the aging population that provides integrated medical and psychiatric services.

The facility would focus on those with a criminal justice system background.

Rep. Cindy Ledbetter (R-Newburgh) said this would support a population that is often shut out of behavioral health care.

“Currently, nursing homes deny admissions to individuals with psychiatric needs and criminal justice records,” Ledbetter said.

The commission also advocates for standardizing data collection on older adults and encouraging age-friendly health systems.

Behavioral health services for individuals with intellectual and developmental disabilities

The commission also made recommendations to improve the accessibility of behavioral health care for individuals with intellectual and developmental disabilities.

This includes ensuring the Certified Community Behavioral Health Clinics (CCBHC) rollout includes programming to meet the unique needs of dually diagnosed individuals and creating a clinical liaison position. That position would include buy-in from the Family and Social Services Division of Mental Health and Addiction and Division of Disability and Rehabilitative Services.

It would act as a first step in keeping in line with the “ever evolving” national best practices and act as a resource for both divisions and their providers.

Funding continued investment

Garcia Wilburn said improving Indiana's behavioral health infrastructure requires an “all hands on deck” approach from the state.

“We are stretching our municipalities thin with asking our officers and fire personnel to do more with the same amount of money, so we can be thoughtful and creative in our contributions as a state,” Garcia Wilburn said.

Sen. Mike Crider (R-Greenfield) said his goal since creating the commission in 2020 was to institute long-term, sustainable funding for programs or initiatives related to behavioral health care.

“Unless and until we get in a mode where we have long-term, sustainable funding, we're going to continue having this discussion in spite of the federal grants and the other things that we've seen, the other progress that we've seen,” Crider said.

Crider said how the recommendations from the report would be funded is ultimately up to the General Assembly, but the commission did make additional recommendations on potential funding sources.

These include additional appropriations in the state's two-year budget, a surcharge for the 988 system or tax increases on alcohol, cigarettes or operators of sports wagering.

Some of those solutions have failed or struggled at the Statehouse in recent years, including the 988 surcharge and the cigarette tax increase in 2023.

As a member of the Senate Appropriations Committee, Crider said he understands that Indiana is in a difficult financial position right now, but continued investment is a key component of improving the state’s behavioral health infrastructure.

“We will be able to demonstrate very clearly that there are long-term savings by going in the direction and continuing in the direction that we've started,” Crider said.

The commission also made a recommendation to reestablish the Indiana Behavioral Health Commission next year to analyze a variety of topics, including developing a roadmap for full-state coverage for CCBHCs.
 

Abigail is our health reporter. Contact them at aruhman@wboi.org.