A Letter from the President

Advocacy

2017 Indiana General Assembly Adjourns Sine Die!

The Indiana General Assembly adjourned Sine Die with a new Budget and numerous bills dealing with mental health and addiction issues, many of which are the result of MHAI Public Policy priorities and advocacy. HEA 1001, the 2017 Budget, continues to fund the Recovery Works program, a signature MHAI program passed in the preceding biennial budget session. Recovery Works provides treatment in lieu of incarceration for individuals involved in the criminal justice system and the 2017-2018 Budget Bill funds the program at $40M, a $10M increase over the $30M in the last biennium. Recovery Works is limited to individuals with behavioral health care needs who have committed a felony and HEA 1006 creates a study to consider expanding the program to include appropriate misdemeanants in that early intervention will lead to lower costs and better outcomes.

MHAI has taken a leadership role in a number of bills that would create a systemic, comprehensive, and integrated approach to behavioral health treatment, regardless of the setting or service system silo. These bills would insure that services are provided utilizing all the tools in the tool box, including therapy, detoxification, all forms of Medication Assisted Treatment, recovery supports and residential services. MHAI was instrumental in the passage of the priority bills below:

RECOVERY RESIDENCES

Substance use is a public health epidemic with devastating consequences. Alcohol remains the most widely used substance across all populations and ages. According to state epidemiological profiles on substance use, 51.5% of Hoosiers ages 12 and older consumed alcohol in the prior month, and 21.8% engaged in binge drinking. Most admissions to substance abuse treatment were due to alcohol with more 38% receiving treatment for alcohol dependence. In 2014, a total of 8,018 alcohol-related collisions occurred in Indiana; 153 were fatal. Alcohol is also a common factor in drowning accidents (34%) and suicides (23%).

The opioid epidemic, which includes addiction to painkillers and heroin, has garnered national attention as teens and young adults with short histories of drug and alcohol use are dying at record rates. An early epicenter of the opioid epidemic, Scott County in southern Indiana, was discovered because of the unprecedented outbreak of HIV in the community.

Comprehensive initiatives to reduce opioid overprescribing, new restrictions imposed on pain clinics, new policies requiring more consistent use of states’ prescription drug monitoring programs, and Drug Enforcement Administration’s work with state law enforcement to conduct widespread raids on pill mills has resulted in a much greater demand for the supply of opioid medication. Unintended consequences of these initiatives include an increase in heroin-related overdoses as individuals seek alternative methods of pain relief and increased crime. Indiana had more pharmacy robberies from the beginning of 2013 to May of 2016 than any other state. Indiana logged 367 robberies and California – with a population of about six times larger – came in second place with 310 robberies in the same time period. In 2015, 175 robberies occurred, 132 in Marion County alone, more than the entire state of California for the previous year, creating yet another point of focus for a legislative response.

As a disease, addiction has biological, psychological, behavioral and social components. Treatment of the disease is critical, but ongoing recovery support is equally important. Recovery housing plays a vital role in the social and behavioral aspects of this disease.

Recovery housing, an evidence-based practice recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA) and Housing and Urban Development (HUD) must meet standards of quality in order to be effective. The National Alliance of Recovery Residences (NARR) has developed quality standards for recovery housing that includes comprehensive nomenclature, national standards to promote quality, and a certification program. It has 20 state affiliates, including the Indiana Affiliation of Recovery Residences.

Under HEA 1001 (Kirchhofer) and HEA 402 (Merritt), the Division of Mental Health and Addiction will require a certification program such as NARR to insure quality for Recovery Residences that receive state dollars in Indiana. It is anticipated that this effort will attract additional resources for Recovery Residences in Indiana. MHAI was a strong proponent of this effort. HEA 1001 and HEA 402 passed the Indiana General Assembly and now move to the Governor for signature.

ADDICTION TREATMENT TEAMS (ATT)

Opioid medications used to relieve pain are beneficial to many, but are often over-prescribed as is now well documented. The overuse and misuse of these medications in the United States over the past decade has contributed to thousands of overdose deaths. According to SAMSHA:

  • 7 million Americans reported current non-medical use of prescription drugs in 2010
  • 2 million people reported using prescription painkillers non-medically for the first time within the last year—nearly 5,500 a day in 2010
  • 1 in 4 people using drugs for first time in 2010 began by using a prescription drug non-medically
  • 6 of the top 10 abused substances among high school seniors are prescription drugs.

Comprehensive treatment facilities are needed to provide comprehensive care, including inpatient and outpatient treatment, detoxification, all forms of medication assisted treatment and recovery supports. A workforce needs to be developed that would include additional psychiatrists, psychologists, masters level clinicians, and recovery support specialists. While critical and worthy of prioritization, progress needs to be made in the short-term—as people are literally dying as we put a comprehensive system in place. However, we cannot be satisfied with piecemeal treatment that varies by location and provider system.

Under HEA 1541, Addiction Treatment Teams will be developed to provide comprehensive treatment for opioid addiction and other substance use disorders in response to the workforce shortage. The Addiction Treatment Team will provide the patient with a substance use disorder with comprehensive treatment, as well as educational services, vocational training, and employment.

The Addiction Treatment Team will at a minimum consist of a prescriber, a therapist and a recovery coach who can provide therapy, MAT, and engagement and reentry services. To insure access to comprehensive mental health services, the Addiction Treatment Team would enter into a Memorandum of Understanding for purposes of referral with a mental health provider that treats patients with substance use disorder as well as a pharmacy.

DMHA will develop a funding mechanism to encourage the development and proliferation of Addiction Treatment Teams. These Addiction Treatment Teams will be able to supplement treatment infrastructure shortages in a permanent location, a temporary location or as a mobile unit. It is envisioned that priority would be given to:
(1) geographically high-risk areas,
(2) underserved areas,
(3) areas with high incidence of Neonatal Abstinence Syndrome and accompanying DCS out-of -home placement through CHINS
(4) areas with high forensic treatment needs and services provided through Recovery Works.

HEA 1541 (Davisson/Merritt) will create Addiction Treatment Teams and permit Indiana citizens to receive comprehensive treatment for individuals with Opioid Use Disorder, without having to wait for the resources and infrastructure to which Indiana must still commit. MHAI was a strong proponent of this effort. HEA 1541 passed the Indiana General Assembly and now moves to the Governor for signature.

ADDICTION LICENSURE

SEA 59 will create an Associates License for those seeking an Addiction License. Prior to its passage, students who graduated in the addiction field were oftentimes unable to get jobs because they did not have the ability to obtain an associate license. An associate license is already available in all of the other disciplines under the behavioral health board, except in the area of addictions.

The associate license would allow students to graduate with their degrees, get their associate license and be ready to work under a supervisor while getting their post-degree hours. Applicants who have been granted an associate license, would not be required to resubmit an Official Transcript, Verification of Course Work, Verification of Practicum, internship, or field experience, or Score Report. They would only need to apply for the LAC or LCAC licensure and submit an application, picture, fee, and proof of experience and supervision hours. Currently all licensure fees are $50.00 for each application. If the applicant has already taken the appropriate level examination for certification they would not have to retake the examination for licensure.

The associate level would provide pathway to full licensure and create a level of protection for the public as well as the employer/facilities. MHAI was a strong proponent of this effort. SEA 59 passed the Indiana General Assembly and now moves to the Governor for signature.

Mental Health America followed numerous bills throughout the Session. These bills are included at: http://www.hannah-in.com/Report_Custom.aspx?sid=GGmIhbVvwck%3d&rid=T2apAVfA7pc%3d

HOOSIER IDOL MOST SUCCESSFUL EVER!

The 2017 Indiana General Assembly demonstrated their many talents with their performances at Mental Health America of Indiana’s 2017 Hoosier Idol. A record setting crowd saw Representative Earl Harris take home the award this year. The evening began with a welcome from Governor Holcomb and included emcee Speaker Brian Bosma and judges Jim Shella, Abdul-Hakim Shabazz, and Gabby Gonzalez. This year’s other contestants included: Senator Erin Houchin, Representative Randy Lyness, Representative Shelia Klinker, Senator Mark Messmer, Representative Melanie Wright, Dr. Jennifer Walthall, Representative Candelaria Reardon, Senator Mike Delph and Attorney General Curtis Hill. For coverage, see: http://fox59.com/2017/04/12/indiana-lawmakers-belt-out-their-best-songs-for-hoosier-idol/.

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Mental Health America of Indiana (MHAI), originally chartered in 1916, was one of the first mental heath advocacy organizations in the nation to educate the public in the hope of eradicating the stigma associated with mental illness. More recently, the organization was the first mental health association in the country to include addiction advocacy in its mission, recognizing the importance of co-occurring addictive disorders to mental wellness.  Today, MHAI is the only organization in the state dedicated to all aspects of mental health and addictions--from cradle to old age--working to make mental health and addiction systems of care more accessible.

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