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<h3 class="wp-block-heading" id="h-the-gist">The Gist</h3>



State Rep. Greg Steuerwald, R-Avon, has garnered bipartisan, widespread support for a bill that aims to ensure Hoosiers receive mental health treatment in medical settings instead of inside their local county jails.



<h3 class="wp-block-heading" id="h-what-s-happening">What’s Happening</h3>



The majority of Indiana’s jails have been overcrowded for years because they have become the de facto mental health facilities in most counties.



When law enforcement officers encounter someone experiencing a mental health crisis, they typically have two options: bring them to the emergency room or take them to jail.



In addition, sheriffs are seeing a big spike of people being held because they were arrested on non-violent, low-level crimes that were driven by their addiction or other mental health issues. Drunken driving, possession of a drug or syringe and drug dealing are common examples.&nbsp;



Taken together, jail overcrowding can lead to poor health outcomes for incarcerated Hoosiers, but especially so for ones who have a mental illness. It’s also costly for county budgets because of how expensive it is to keep someone locked up and to pay for their health care. That’s money that could otherwise support other local government services, such as roads or parks.



“Our system was literally broken,” said Steve Luce, a former sheriff who is now executive director of the Indiana Sheriffs&#8217; Association. “The jail is not set up to take care of these individuals. It’s for pretrial individuals. Our facilities cannot handle these types of individuals over time.”



<figure class="wp-block-image size-large"><img decoding="async" src="https://stateaffairs.com/wp-content/uploads/2023/01/Greg-Steuerwald_o-1024x683.jpg" alt="" class="wp-image-33807"/><figcaption class="wp-element-caption">Rep. Greg Steuerwald, R-Avon (Credit: Rep. Greg Steuerwald) </figcaption></figure>



Steuerwald began working on a new bill in January 2022 to address the problems. That’s when he started meeting with Gov. Eric Holcomb&#8217;s office and Indiana Supreme Court Justice Christopher M. Goff.&nbsp;







He also convened representatives from all corners of the criminal justice and health care systems, which resulted in support from groups that are often opposed to each other in the courtroom. Associations representing judges, public defenders, prosecutors, police officers and sheriffs testified in support during a House committee last week.



House Republican leadership introduced Steuerwald’s bill — <a href="https://iga.in.gov/legislative/2023/bills/house/1006" target="_blank" rel="noreferrer noopener">House Bill 1006</a> — at the start of the current legislative session as one of their priority bills.



<h3 class="wp-block-heading">Why It Matters</h3>



Roughly 20,000 people are held inside Indiana&#8217;s county jails on any given day, according to data contained within state inspection records. The population turns over quickly because jails are primarily temporary holding facilities, so the number of Hoosiers who end up behind bars each year is even higher.&nbsp;



If only a handful of counties were struggling to keep up with crowding and health care concerns, perhaps the state would not intervene.&nbsp;



One in five Hoosiers, though, experience a mental health issue each year, according to the <a href="https://www.in.gov/fssa/dmha/files/INBHC-Report.pdf" target="_blank" rel="noreferrer noopener">state’s Behavioral Health Commission</a>.&nbsp;



And jail overcrowding is widespread — with at least 70% of the people in Indiana&#8217;s jails believed to have a mental illness or addiction, according to estimates by Indiana sheriffs.&nbsp;



Many simply need access to drug treatment and medicine, such as buprenorphine or methadone, which are used to treat opioid addiction. Even then, a great burden is placed on sheriffs who run the jails. They are tasked with finding medical providers and, in some cases, clearing space for health care and programming inside cramped, aging jails that weren’t designed for either. The alternative is <a href="https://www.indystar.com/in-depth/news/investigations/2021/12/16/indiana-jails-keep-growing-monuments-states-failures/7887583002/?source=SPLASHPAGE&amp;utm_campaign=DeathSentence&amp;utm_medium=onsite&amp;utm_source=storytellingStudio" target="_blank" rel="noreferrer noopener">another expensive proposition</a>: asking local taxpayers to build bigger jails.&nbsp;



Additionally, a smaller but not insignificant number of people in jail have been diagnosed with a severe mental illness.&nbsp;



“With those individuals, they obviously require so much more one-on-one when you&#8217;re taking care of them in the jail because they&#8217;re susceptible to being taken advantage of and they have so many requirements,” Steuerwald told State Affairs. “It just takes an inordinate amount of resources in a jail setting.”



Resources — particularly staffing — are already hard to come by inside many jails. Staffing shortages are exacerbating other challenges around mental health and addiction.&nbsp;



And then when counties fail to provide the necessary resources, the outcomes can be devastating.&nbsp;



A <a href="https://www.indystar.com/in-depth/news/investigations/2021/10/12/how-trip-to-indiana-county-jail-could-be-death-sentence/5483328001/" target="_blank" rel="noreferrer noopener">yearslong IndyStar investigation in 2021</a>, for example, found that Hoosiers were dying inside county jails on average every two weeks over more than 10 years. Not all of those deaths were the result of gaps in mental health treatment, but many were. The leading cause of death was suicide, IndyStar found, which <a href="https://www.indystar.com/in-depth/news/investigations/2021/10/12/suicide-in-jails-why-preventable-deaths-occur-at-alarming-rate/7887547002/?source=SPLASHPAGE&amp;utm_campaign=DeathSentence&amp;utm_medium=onsite&amp;utm_source=storytellingStudio" target="_blank" rel="noreferrer noopener">amounted to 42% of the deaths</a>. Three in four of those deaths occurred in jails that were flagged by state inspectors as overcrowded, understaffed or both.&nbsp;



And at least 19% of the deaths were <a href="https://www.indystar.com/in-depth/news/investigations/2021/10/12/death-sentence-major-findings-of-indiana-jail-deaths-investigation/7887659002/?source=SPLASHPAGE&amp;utm_campaign=DeathSentence&amp;utm_medium=onsite&amp;utm_source=storytellingStudio" target="_blank" rel="noreferrer noopener">directly tied to substance use</a>, including overdoses.&nbsp;



<h3 class="wp-block-heading">What’s the Legislation?&nbsp;</h3>



One of House Bill 1006’s priorities is focused on mental health referrals for people who are in jail.&nbsp;



The bill would enable sheriffs, prosecutors and defense attorneys to petition the court to request a mental health assessment on someone who has been booked into jail.&nbsp;



After an assessment, a judge could refer a defendant to a mental health provider as a condition of release prior to a trial or plea agreement. The goal is for people to receive the treatment they need and for counties to absorb fewer costs associated with the burdens of overcrowded jails.&nbsp;



And if the defendant is accused of committing a violent crime, the services would occur inside a secure facility, such as ones operated by the Department of Correction or the Division of Mental Health and Addiction.&nbsp;



“We wanted to make sure they got treated but in a secure environment,” Steuerwald said. “We&#8217;ve made provisions for anybody with a mental illness to be treated.”&nbsp;



Nothing in the bill would interrupt the prosecution of a case, but Steuerwald said he expected someone’s mental health treatment would be factored into any considerations about plea agreements.



Just as importantly, counties would not be on the hook for paying the costs of mental health assessments. The state budget would pick up that tab, enabling smaller and rural counties to participate.&nbsp;



Asked if he’s faced any pushback from his colleagues in the House or Senate, Steuerwald told State Affairs: “None.”&nbsp;



“I&#8217;ve had full support from the speaker and Ways and Means from the very beginning of the process,&#8221; he said. &#8220;When I said the sheriffs are making this request and it&#8217;s long overdue that we help them, everybody has been supportive and said, &#8216;Go ahead.’”



It’s unclear how much money is expected to be saved in local budgets or added to the state budget; the legislation does not specify, and neither the Indiana Sheriffs’ Association nor the Association of Indiana Counties were aware of those numbers.&nbsp;



State Rep. Jeff Thompson, the House budget writer, told State Affairs that he could not immediately recall the exact costs but did not anticipate any concerns over the amount.



The bill has a second priority clarifying language around immediate and emergency detentions, which are the processes used to detain someone against their will. For example, a law enforcement officer may use an immediate detention to bring someone threatening suicide into a medical facility.&nbsp;



The bill also would ensure that hospitals receive payment for detentions by noting in the law that the treatments are medically necessary. Right now, Steuerwald said, hospitals aren’t always being paid for the care.



<h3 class="wp-block-heading">Receiving Treatment</h3>



Even some supporters of the bill acknowledged one limitation, though.



Many Hoosiers lack adequate access to care for mental health and addiction. It’s particularly acute in rural areas, where treatment beds and providers have been scarce for years — for people both inside and outside of jail.&nbsp;


<div class="wp-block-image">
<figure class="alignleft size-large is-resized"><img loading="lazy" decoding="async" src="https://stateaffairs.com/wp-content/uploads/2023/01/headshot_matt-pierce-820x1024.jpeg" alt="" class="wp-image-33798" width="231" height="288"/><figcaption class="wp-element-caption">Rep. Matt Pierce, D-Bloomington (Credit: Indiana House Democrats)</figcaption></figure></div>


State Rep. Matt Pierce, D-Bloomington, voted for the bill but raised that concern.&nbsp;



&#8220;What I&#8217;ve been hearing for the last 10 years since we did <a href="https://www.indystar.com/story/news/politics/2015/02/02/county-jails-ready-onslaught-addicts-mentally-prisons/22698401/" target="_blank" rel="noreferrer noopener">criminal code reform</a> is prosecutors and sheriffs saying, ‘I really wish I could put these people somewhere else where they could actually get their mental health or substance abuse disorders treated, but I just don&#8217;t have anything around here,’” Pierce told State Affairs. “And then we complain about the jails being overcrowded.”



Pierce wants to see the General Assembly help fund an expansion of treatment for mental health and drug addiction.



Jay Chaudhary, director of the state&#8217;s Division of Mental Health and Addiction, spoke to Pierce’s concerns during a House committee meeting last week.&nbsp;



“Do we have capacity right now to handle this? I don&#8217;t think so,” Chaudhary said. “If we wait until we have capacity to tackle these issues, we&#8217;ll just be waiting forever.”&nbsp;



<h3 class="wp-block-heading">What’s Next?</h3>



The bill is also supported by the Indiana Council of Community Mental Health Centers; Mental Health America of Indiana; the Coalition of Advanced Practice Nurses; and the Indiana Hospital Association.&nbsp;



It received unanimous support in the House on Tuesday with a 99-0 vote. It next heads to the Senate for consideration. Steuerwald said senators Freeman, Crider and Koch are sponsoring it.&nbsp;



Have questions or comments about the upcoming legislative session? Contact Ryan Martin on <a href="https://twitter.com/ryanmartin" target="_blank" rel="noreferrer noopener">Twitter</a>, <a href="https://www.linkedin.com/in/byryanmartin/" target="_blank" rel="noreferrer noopener">LinkedIn</a>, <a href="http://www.facebook.com/ryanmartin87" target="_blank" rel="noreferrer noopener">Facebook</a> or at <a href="mailto:ryan@stateaffairs.com">ryan@stateaffairs.com</a>.)



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Header image: Indiana lawmakers hope to fix overcrowded jails and mental health treatment. (Credit: Brittney Phan)

‘Our system was literally broken’: How Indiana lawmakers hope to fix overcrowded jails and mental health treatment

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‘Our system was literally broken’: How Indiana lawmakers hope to fix overcrowded jails and mental health treatment

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