03/12/2009 - Ind.‘s mental health care remains lacking (Associated Press)

Ind.'s mental health care remains lacking

By Ken Kusmer, Associated Press Writer

INDIANAPOLIS - Indiana does too little to care for hundreds of thousands of mentally ill Hoosiers, leaving many of them in jail, stigmatized, or desperate enough to commit suicide, a top advocate said Wednesday after her group graded states' efforts.

A national report released by the National Alliance on Mental Illness gave Indiana a grade of D for its public mental health care system, the same grade it received three years ago from the advocacy group for mentally ill people and their families.

Twenty other states also received D's, which was the national average. Six states received B's and 17 states and the District of Columbia received a C. There were no A's.

The report praised Indiana for its strong network of community mental health centers and for developing a long-range strategic housing plan for people with mental illness. It also said Indiana was one of just nine states with health plans for uninsured people that provide mental health and substance abuse benefits, but covered services are limited.

NAMI Indiana President Teresa Hatten of Fort Wayne said the Division of Mental Health and Addiction in the Family and Social Services Administration has made improvements since the last report card three years ago, but in other areas care has stagnated.

"We expected and were led to believe that things would be changing in a fairly comprehensive way," Hatten said. "Overall, you have to wonder if we have set our priorities where they need to be."

An FSSA spokeswoman issued a statement saying the agency recognized it still had much work to do.

Pam McConey, NAMI Indiana's executive director, said it costs Indiana taxpayers less to provide proper mental health care than to bear the financial and social costs if it doesn't.

The report said Indiana has 226,713 people with serious mental illnesses -- about 1 of every 25 state residents -- but many more have milder forms of mental illness. Hatten said one in every four people will have a mental illness sometime in their lifetime, and at any one time it's 5 percent to 9 percent of the population.

"When we don't put our priority on good mental health care, the population all too often ends up in jails and prisons," Hatten said.

More than one in seven Indiana prison inmates take medicine for mental illness, and nearly one in five receive additional treatment.

Despite the prevalence of mental illness, many people suffering from mental illness feel stigmatized, and too often resort to suicide, Hatten said. It's the leading cause of death for teenagers.

NAMI based its grades on 65 criteria, including access to medication, housing, family education and support to National Guard members. It said the grades were based mostly on information provided by state governments.

It said Indiana most urgently needed to reduce barriers to medications, divert mentally ill arrestees from incarceration to treatment, and fix problems with the state's Medicaid managed care plans.

"Denials of (Medicaid) services have put people at risk, and community mental health providers have cash flow problems due to payment delays. Diminished services may be a result of more money being directed towards (managed care) provider profits," the report said.

McConey said the managed care system "is way out of control" with the three insurers managing the plans taking 14 percent of proceeds for profits while denying or delaying many of the claims submitted to them. FSSA implemented the current system in 2007.

Many patients rely on community mental health centers for treatment, but Indiana's network is strained. The services they provide and receive no money for now amounts to 19 percent of their revenues, said Executive Director Matt Brooks of the Indiana Council of Community Mental Health Centers.

Gov. Mitch Daniels' budget would cut mental health care appropriations for both adults and children by 3 percent, Brooks said. The managed care plans, meanwhile, drive up costs because the centers must get services approved in advance.

Medicaid does not pay for services in advance, Brooks said. The average number of days that payments were behind grew by nearly a week since 2006 to 64.2 days last year. Meanwhile, the cash the centers had on hand to pay operating costs shrunk 11 percent, or nearly 16 days, to 126.8 last year,

"The less stable community mental health centers are from a financial perspective, the more at-risk clients become," Brooks said.

FSSA spokeswoman Lauren Auld said the agency was working toward improvements that would result in better marks from NAMI.

"We recognize that system change is not a quick and easy process and know we still have much work to do," Auld said in a prepared statement. ___