Mental Health in Rural Indiana

INDIANAPOLIS — Many people in rural Indiana face barriers to accessing mental health services. However, organizations like Indiana University are working with communities to help more people get help.

Throughout Indiana, there are more than 200 institutions that provide outpatient mental health care. However, for many provinces there is only one facility that offers these services.

How amenities are spread out across the state means that some residents, even in central Indiana, have to drive more than 20 minutes to get help.

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

A 2016 report from the mental health organization Mental Health America ranked Indiana as one of the lowest-ranking states for several categories related to mental health.

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

“Mental health is a concern all over our country, but what we see in rural communities is that their access to care is much more limited than that in urban areas where you have a single health care provider serving one to many thousands of people in the population area,” he said. Kerry Thomson.

Kerry Thompson is the Executive Director of Indiana University’s Center for Rural Engagement. Among the services that the center provides, they survey the state of the nation’s health care system to make an assessment of health needs. They look at the statistics and ask residents what they think their health needs are.

“We’re really looking in depth at how to improve community health, and the community can decide based on their local health data, what factors they really want to drive and how to write an actionable plan to improve the health of their community,” said Thomson.

An analysis of the most recent assessments of rural Indiana community needs found mental health needs to be one of the most important needs of the rural Indiana community. In rural Indiana counties, 76 percent reported mental health as one of the most important 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 care means it is difficult for people to get on the calendar to get regular care without having to drive an hour to see a health care provider. She says they are developing a pipeline to make it easier to make mental health providers available to communities.

When people are in crisis situations, most services are often located in hospitals. The center is called in when people need ongoing mental health care.

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

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

Decatur County

Decatur County is home to 26,600 people, with an average age of 39.2 years, slightly older than the state median age. The inhabitants are equally divided between rural and urban areas.

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

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

  • Determine the target audiences for receiving mental health and substance use training
  • Carry out a zero measurement
  • Create a resource map to provide to people seeking mental health and substance use support in Decatur County
  • List trauma-informed care training
  • Promote Prevention Education to Decatur County Residents
  • Provide training on mental health and substance use
  • Educate the public about mental health and substance use
  • Monitor and evaluate the activities of nationwide training in mental health and substance use prevention
  • Develop emotional support tools for organizations and the community at large
  • Increasing the presence of mental health professionals in the school environment
  • Increase the mental health resources available to students in Greensburg
  • Community Schools and Decatur County Schools
  • Assess the need for a larger regional resource guide to 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 health care network recovery system in Decatur County by December 31, 2021 to provide support to individuals with active addiction and their family members. They intended to achieve this by:

  • Establish a province baseline for current service referrals
  • Identify a centralized resource that all agencies can use to increase knowledge of potential referrals and services
  • Create a communication protocol/process between organizations to ensure a “warm handover” or referral
  • Educate community leaders about Choices (the local Crisis Emergency Response Team) and discuss opportunities for collaboration across organizations
  • Develop a transportation fund to help individuals get treatment and recovery programs
  • Conduct a feasibility study to explore the expansion of behavioral health services in Decatur County
  • Investigate the feasibility of adopting peer recovery coaches and begin identifying and training peer recovery coaches if deemed necessary

Owen County

Owen County is home to just over 20,000 residents. The median age of 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 average of $56,300.

Behavioral health providers have 5,700 patients per provider, nearly five times the state average. A community needs assessment for Bloomington Hospital, which includes Owen Monroe and Lawrence County, identified mental health as one of the most important needs. There was no reported county-specific assessment.

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

The county is currently in the early stages of developing a community health improvement plan to prepare for the needs 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 need mental health help and resources. Available through Indiana 211, this line allows Indiana residents to talk to trained counselors 24/7.

In December 2021, the FSSA reported that the helpline had more than 25,000 calls. About 59% of callers were referred for additional mental health or substance use services or requested additional crisis counseling.

“FSSA is proud of the important and ongoing role our crisis advisors have played in connecting with Hoosiers and providing them with the resources they need to support their mental health,” said Dan Rusyniak, MD, FSSA Secretary. “We remain committed to providing Hoosiers with free, confidential and convenient access to this resource at any time.”

Indiana residents can speak to a trained mental health counselor by calling 2-1-1 or the toll-free number 866-211-9966, entering their zip code, and selecting the Be Well Crisis Helpline option. In addition, the Be Well Indiana website includes additional resources, including blog posts and videos with tips for maintaining mental health and self-screening resources.

In addition, 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 seeking help.

“Everyone goes to the library,” Thomson said. “All this stigma of parking your car in front of the only mental health facility in the county has been removed. Nobody knows what you’re doing. Whether you’re borrowing books or going in to have some computer time. You can have your mental health appointment privately and without stigma.

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

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

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

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