INDIANAPOLIS — Many people in rural Indiana face barriers to accessing mental health resources. However, organizations such as Indiana University are working with communities to assist more people in getting help.

Across Indiana, there are more than 200 facilitates that offer outpatient mental health services. However, for many counties, there is only one facility that offers these services.

How the facilities are spread out throughout the state means some residents, even in central Indiana, would have to take more than a 20-minute drive to get help.

While the majority of Indiana residents are within 20 minutes of a mental health outpatient facility, there are pockets of the state that are not covered, even in central Indiana. This includes the rural Hendricks County town of North Salem and the outskirts of Sheridan in Hamilton County.

A 2016 report by the mental health advocacy organization Mental Health America ranked Indiana among the lowest ranking states for several categories related to mental health.

  • Access to mental health care (all ages): 37th
  • Prevalence of mental illness (all ages): 43rd
  • Adults (prevalence of mental illness and access to care): 47th
  • Adolescents (prevalence of mental illness and access to care): 34th

“Mental health is a concern universally across our nation, but what we find in rural communities is their access to care is much more limited than those in urban areas where you have a single provider that could be serving one to many thousands of people in the population area,” said Kerry Thomson.

Kerry Thompson is the executive director for Indiana University’s Center for Rural Engagement. Among the services the center provides, they examine the state of rural healthcare to create a health needs assessment. They look at the statistics and ask residents what they think their health needs are.

“We really look at comprehensively at how to improve community health, and the community gets to decide based on their local health data, what factors they really want to drive, and how to, how to write an actionable plan to improve the health of their community,” said Thomson.

An analysis of the most recent community needs assessments across rural Indiana identified mental health needs are among the top community needs in rural Indiana. In rural Indiana counties, 76 percent reported mental health among top community needs. The only category that more counties reported as a top need was substance use.

Thompson said the lack of readily available mental health services means it is difficult for people to get on the calendar to get regular care without having to drive an hour to see a provider. She says they are working to develop a pipeline to make it easier to make mental health providers available for communities.

If people are in crisis situations, the majority of services are frequently located in hospitals. The center gets involved when people need ongoing mental health care.

“Mental health is really critical to all of us and we all have different needs and different ways of maintaining our mental health,” said Thomson. “When our mental health becomes an issue, it’s important to access care early and really to build it.”

In Central Indiana, IU is working with Decatur County and Owen County to address their needs.

Decatur County

Decatur County is home to 26,600 people, with a median age of 39.2, slightly older than the state’s median age. Its residents are split equally between rural and urban areas.

People living on the southern edge and northeastern tip of the county are more than 20 minutes away from an outpatient mental health facility. The IU assessment identifies mental health as the top need for the county. There are more than 2,300 behavioral health patients per provider in the county.

To address mental health and substance use, members of a committee developed a goal to expand access to prevention, intervention and treatment resources and services. They planned to do this by:

  • Determine the target populations to receive mental health and substance use training
  • Conduct a baseline survey
  • Create a resource card to provide to people seeking support for mental health services and substance use services in Decatur County
  • Create a directory of trauma-informed care trainings
  • Promote prevention education to Decatur County residents
  • Conduct mental health and substance use trainings
  • Provide education to the public about mental health and substance use
  • Monitor and evaluate activities of county-wide mental health and substance use prevention training
  • Develop emotional support resources for organizations and community at large
  • Increase presence of mental health professionals within school setting
  • Increase mental health resources available for students in Greensburg
  • Community Schools and Decatur County Schools
  • Assess the need for a larger regional resource guide for mental health services and substance use prevention and treatment options in Franklin, Ripley, Jennings, Bartholomew, Shelby, and Rush counties

They also developed a goal to develop a recovery system of care network in Decatur County to provide support to individuals living with an active addiction and their family members by Dec. 31, 2021. They planned to accomplish this by:

  • Establish a baseline in the county for the current number of referrals for services
  • Identify a centralized resource for all agencies to utilize that will help increase knowledge of potential referrals and services
  • Create an inter-organizational communication protocol/process to ensure a “warm handoff” or referral
  • Inform community leaders about Choices (the local Crisis Emergency Response Team) and discuss opportunities for inter-organizational collaboration
  • Develop a transportation fund to assist individuals to get to treatment and recovery programs
  • Conduct a feasibility study exploring the expansion of behavioral health services in Decatur County
  • Explore the feasibility of adoption of peer recovery coaches and if deemed appropriate, begin identifying and training peer recovery coaches

Owen County

Owen County is home to just over 20,000 residents. The median age of the residents is 45.2, older than the median age for the state. Residents have a median household income of $49,500, lower than the state’s average of $56,300.

Behavioral care providers have 5,700 patients per provider, nearly five times the average for the state. A Community Health Needs Assessment for Bloomington Hospital, which includes Owen Monroe, and Lawrence County identified mental health among the top needs. There was no reported county-specific assessment.

People living in the southwest and northwest corner of the county live more than 20 minutes away from an outpatient mental health treatment facility. The state identifies Centerstone and the Hamilton Center, both in Spencer Indiana, as the closest mental health outpatient facilities.

The County is currently in the initiation phase of creating a Community Health Improvement Plan to prepare to address the needs that they identified.

Improving access to mental health

The Indiana Family and Social Services Administration (FSSA) encourages people to use the Be Well Crisis Hotline if they are in need of mental health counseling and resources. This line is available through Indiana 211 and lets Indiana residents talk with trained counselors 24/7.

In December 2021, the FSSA reported the helpline surpassed 25,000 calls. Around 59% of the callers got a referral for additional mental health or substance use services or asked for additional crisis counseling.

“FSSA is proud of the important and continuing role our crisis counselors have played to connect with Hoosiers and provide them with the resources they need to support their mental health,” said Dan Rusyniak, M.D., FSSA secretary. “We remain committed to providing free, confidential, and easy access to this resource for Hoosiers in any time of need.”

Indiana residents can speak with a trained mental health counselor by dialing 2-1-1 or the toll-free number, 866-211-9966, entering their ZIP code, and selecting the option for the Be Well Crisis Helpline. In addition, Be Well Indiana’s website contains supplemental resources including blog posts and videos offering tips for maintaining mental health as well as self-screening tools.

Additionally, Thomson said the IU Center for Rural Engagement is working with public libraries in Pike, Sullivan and Lawrence Counties to increase access to mental health resources while reducing the stigma of reaching out for help.

“Everybody goes to the library,” said Thomson. “All of this stigma of parking your car in front of the only mental health provider in the county is removed. Nobody knows what you’re doing. If you’re borrowing books or going in to just have some computer time. You get to have your mental health appointment in private and with no stigma attached.”

Thomson said libraries have been eager to engage with them for Telemental health, finding private spaces within the libraries that can be set up for the program. She says this helps address the issue of people in rural parts of the state that may not have broadband access to connect with other mental health services.

“We need to provide the Telemental health in places that do have broadband access, and so we’re starting with libraries, We may be partnering with faith communities or schools in the future looking at those places where the infrastructure is already in place to serve the people who need it.”

Thomson encourages people to connect with their primary care provider to tailor recommendations for mental health care. They can also visit their website to see other initiatives they are involved in.