(upbeat piano music) - [Brandon] Indiana's maternal mortality rate worsens, untreated mental illness costing the state billions, plus a housing availability crisis and more, on Indiana Week In Review, the week ending September, 30th, 2022.

- [Narrator 1] Indiana Week in Review is made possible by the supporters of Indiana Public Broadcasting Stations.

- [Brandon] This week according to a new state report, about 90 Hoosiers die every year during pregnancy or up to a year after.

At least 20% of those deaths are directly related to pregnancy and the vast majority are preventable.

WFYI's Farah Yousry reports the rate of maternal deaths is rising.

- [Farah] The latest maternal mortality report from the Indiana Department of Health examined data from 2020, and found the rate of maternal deaths directly related to pregnancy nearly doubled compared to the two years prior.

The counts include deaths that happened during or up to a year after pregnancy, from conditions like preeclampsia, as well as mental illness.

Racial disparities have persisted over the past three years, peaking in 2020 with black women dying at higher rates than white women.

The report suggests that decreasing barriers to treatment from substance use disorder could make a dent in pregnancy associated death rates.

It also recommends expanding access to contraception, mental health support, and publicly funded early childcare.

- Will lawmakers adopt a holistic approach to improving maternal mortality?

It's the first question for our Indiana Week interview panel.

Democrat Ann DeLaney, Republican Mike O'Brien, Jon Schwantes, host of Indiana Lawmakers, and Casey Smith, reporter for the Indiana Capital Chronicle.

I'm Indiana Public Broadcasting State House Bureau Chief Brandon Smith.

Mike O'Brien, lawmakers started to spend some money on this during the special session, though everybody agreed not enough, although lawmakers also said, "Wait for the budget."

But they rejected several of the measures that were recommended by the report, including greater access to contraception, comprehensive sex education.

Will that change?

- Yeah, I think it will.

I think the house Republicans in particular have already identified contraception investments there as a priority for 2023.

So I think we'll learn more about that in the next couple months.

But I do like how this has shapen up for this session, with the governor kind of doing a big picture, public health, plan for investment.

Cause we don't fund this, we're getting these numbers cause we don't, and Ann's banged on it forever, cause we never, we haven't prioritized public health and the governor has pretty much just acknowledged that.

And so that's gotta change.

Or we're just gonna, we're gonna, 50 forever.

We're gonna have the worst maternal mortality rates in the country if we don't make this a priority and invest in it.

And I think the creation of this report, the next, you know, what we're gonna talk about a little bit on mental health and then generally the Governor's Commission on health and the hundreds of millions of dollars that the governor's preserving to invest in that report and make that a reality are all part of this effort.

- I asked you a question last week on a completely different issue about something being a catalyst.

What's the catalyst for the general assembly to act on an issue or make a change?

Are we finally seeing things come to a head?

- I hope Michael is right.

I don't have an awful lot of faith in them though.

They've been in charge for 18 plus years.

Okay.

And what's happened?

You know, we're down either 48th, 49th, or 50th in public health expenditures.

This is a serious problem.

Obviously, maternal health is a serious problem and it's, but it's part of a much bigger problem, with diabetes and drugs and all kinds of issues that are out there that we don't put the money in.

We have the money now, we have it.

And they need to get over the notion that the states a bank and spend it.

Because what they do is incremental.

And, you know, generations go by, we're still waiting for preschool for everybody.

We're still waiting.

They just need to do it.

Take the money when we have it and put those resources where they need to be so that we stop being 49th or 50th out of the states in public health.

- If you're someone who wants to see this happen, which I would hope is most people, if not all people, what's gotta help you in your hope for the next session is, Ann just sort of alluded to this, there's gonna be a lot of money to spend from everything we can tell, right?

- Yeah.

There's a big budget surplus.

Obviously, they've got a lot of money to spend during the special session.

They didn't do like, didn't put it all anywhere.

They did use some of it.

So, in the next session, budget setting session, there's gonna be a lot of discussion about what to do.

I think maternal health is gonna be a big one, obviously education, with the new abortion bill that went through during the special session, they've gotta decide how they're gonna follow up to that.

And lawmakers have said that they are planning to, so.

- Complicating some of this, a couple of the things I mentioned.

So it's whether it's access to contraception or particularly comprehensive sex education, which every study in the world will tell you helps tremendously.

There's ideological issues to get over there.

It's not about are we gonna spend this money, which lawmakers are often reluctant to do.

It's getting over the religious rights objection to those sorts of things.

Is there enough momentum?

Are these sorts of numbers enough to overcome those ideological objections?

- I think a lot of the burden will be carried by the governor.

And he has indicated, as Michael said, not just recently, but now for probably close to a year, that he has been angling toward this coming budget session.

He's had task forces and commissions that have been impaneled to come up with provocative solutions that do command big price tags.

And if he follows through on that, then I think some of the members of his caucus in the house, in the Senate, may come along kicking and screaming.

Keep in mind though, that this is, you mentioned in the introduction, this is, disproportionately affects people of color.

It's an urban issue, perhaps because of drugs and other factors.

So you have- - [Brandon] It's also rural issue.

- It is a rural.

- [Brandon] There's no healthcare.

- Right.

- It is a rural issue, but for some of the issues where it's seen, it's a city problem and you have a lot of members of the caucus who don't see it that way.

- [Brandon] Don't see it that way.

- And in fact, sometimes you almost sense as if, well I must be against it because that's gonna help Indianapolis or that's gonna help some other urban core and they're not real Hoosiers.

The notion, I mean, you know what I'm saying?

So that, the governor, I think will have to twist some arms.

But the irony in this, I'll just say, because of the refunds that were given and the give back.

- [Ann] They better do it.

- Both that which was already instituted, automatically triggered, and that which was on top of that.

There's more of an onus, I think on the leadership party to deliver and not say, "We just don't have enough."

Because then you juxtapose that with the fact- - I don't care what you're.

- That they gave away a lot of, or gave money back.

- I don't care what your religious attitude towards this is.

You cannot ban abortion and restrict access to either contraception or the knowledge of how fetuses are fertilized.

I mean, we've got to do a better job of telling children about this and realistically recognizing the fact that they are having sex, whether we like it or not at that age.

- Every generation since the beginning.

- Since the beginning.

(Brandon laughs) - All right, time now for viewer feedback.

Each week we pose an unscientific online poll question.

This week's question, should Indiana expand access to contraception and comprehensive sex education?

Yes to contraception.

Yes to sex ed.

Yes to both.

Or no to both.

Last week's question, should Indiana fully legalize cannabis?

76% of you say yes, 24% say no.

If you'd like to take part in the poll, go to WFYI.ORG/IWIR and look for the poll.

Untreated mental illness costs Indiana more than 4 billion a year.

WFPL's Aprile Rickert reports, that's according to a two year study released this week by the Indiana Behavioral Health Commission.

- [Aprile] One in five people in Indiana experiences mental illness, with 20% untreated according to the report.

Those numbers are higher in some populations with 40% of incarcerated people and nearly half of unhoused people being affected by mental illness.

The commission recommends increasing funding by 60% over the next four years to build a more sustainable infrastructure.

To improve workforce rates they recommend reducing licensing barriers and providing student loan and tuition reimbursement for mental health workers.

- Ann DeLaney, a mental healthcare provider shortage is not an Indiana specific problem.

- Right.

- How much can state government realistically do in this area?

- Oh, I think they can do a lot.

I, you know, we recognize it as a profession.

We don't wanna dumb it down.

We don't wanna take away the kinds of licensure issues that are, make these people professionals.

But we could step up and say, "Look, if that's your goal, you know, we'll give you tuition credits" or we'll pay your tuition" or we'll do loan forgiveness."

There are all kinds of things we could do to encourage people to go in this.

This is a serious problem.

It's a tremendously serious problem in our jails and our prisons and our sheriffs don't want to be mental health counselors.

- They can't be.

- They can't be.

- Yeah.

- And if we could find a way to deal with that, that takes them out of the prison system, which by the way is the most expensive way of treating it, we could actually maybe have a better prognosis for those people.

At the same time we alleviate the overcrowding in the jails and the horrendous task that we're putting on our elected criminal justice people, so.

- We just talked about maternal health and how we need to do a lot better on health overall.

The Public Health Commissions Report that the governor convened, it wasn't specific to one part of health, it was the public health system needs- - Is broken.

- To improve and it needs a lot of money.

This would help that in some ways.

But we talk all the time about workforce training, right?

And how the, you know, there's been a push and pull of how much should the private sector be paying for it?

How much should the government be paying for it?

But the government has been paying for it in a lot of cases.

- Oh yeah.

- Shouldn't we think of this the same way?

We'll help you pay for this training that you need in order to become a mental health provider.

- For sure.

We've done that in other professions.

- So, why are we having - You know and provided those, - trouble getting those over - and provided - the hump on something - those incentives.

- like that?

- This may, I mean, what's a catalyst to bring legislative action?

It's usually recognition of a substantial problem at a substantial cost.

And that's what they discovered in this commission report.

I did, I talked to a member of the commission today and I said, "What are you gonna do?"

And so the answer's always been money.

It's not that we don't know what to do, it's that we're not- - [Ann] We're not willing to.

- We're not willing, we're not willing to do it.

There have been important changes recently, Representative Steuerwald either this session or the one prior as a follow up to criminal justice reform and putting level six felons in local jails where there are no services.

You're right, I mean the sheriffs don't wanna be on the front lines, having to identify what's really going on with these people.

Why are they here?

Why are they committing crimes?

The vast majority of those are drug offenses some related to mental health.

So they turn that off.

They said if you've got a mental health problem in a local jail, you can send that person into DOC where they can at least - At least there's service.

- put service.

- It is more expensive, but at least there is service.

- But it's more expensive and there are services there.

Is there a better way to do that of cour, sure.

I'm certain there is, but, and again, this is the catalyst for action cause now we know what a substantial cost it is to all Hoosiers.

- Yeah.

I keep bringing up this idea of what is the catalyst because so many issues lately it's problems we've been talking about for a long time.

What is it that that gets us- - Eighteen years.

- Yeah.

What is it that gets us over the hump?

Is something like an economic cost going to be more of a wake up call for lawmakers?

- Sure.

I think if they see that it is affecting the state's bottom line and the state's ability to attract jobs that, companies that are willing to create jobs and good paying, well paying jobs, then people will take note.

And once they see that this, and it is, I don't think there are people, ostriches out there that think that this is only certain segments of the population, either impoverished individuals, I think certainly there's more of a difficulty in obtaining care among those at lower income levels, but this is equal opportunity affliction.

And I mean look at the military and we certainly know that the general assembly historically has been very supportive of Hoosiers who have served in the armed services.

And I mean not a month goes by now that we don't lose many, many, and this goes back for the 20 years we've been, you know, battling in the Middle East, we were losing as a nation, far more service men and women to suicide.

- [Brandon] Yeah.

- Than we were ever to combat.

So there are constituencies that really touch all portions of the state.

There are some things that the state can do.

You've talked about them in terms of incentivizing individuals to go down this career path and perhaps helping them fund their education.

- And then stay here.

- And stay here.

And then also the state controls to a certain extent, you know, telehealth, the access in terms of regulation about where somebody can receive care.

Can you receive it via Zoom or Teams- - [Brandon] There's been some loosening of those restrictions.

- And across state borders.

Can you get care from somebody in New York City or somebody in Miami?

- It's still, and it's still fairly recent that the stigma around mental health and seeking those services is not stigmatized.

- Right, right.

- I mean my generation.

- Yeah I mean it's not completely overcome.

- The ones that come after me are much more, recognize mental health and the benefits to seeking help.

- I just asked you in the last topic about how we have so much money, so is it gonna be a lot easier to say yes to spending on maternal mortality supports?

But, so I'm gonna flip it this way, which is, okay, so we've gotta do the Public Health Commissions Report cause that's gonna help broadly, but that's the public health system.

Then we have to do things to help maternal mortality.

We also have to do things for mental health.

Is the problem that some of this is gonna run to is, the list is getting really long on the things we need to spend lots of money on?

- I mean, we have billions in surplus though, so there's a lot to work with here.

And so when budget writers go in the next coming months to figure out what they're gonna throw money at, I mean, I think they have a lot of, they have a lot of money to work with.

- [Brandon] Yeah.

- At the same time though, I mean we're talking about money on one hand, but there needs to also be a really large focus, you know, FSSA and DOC in the last month, we're talking about the lack of mental healthcare professionals.

They have to even, you know, or for transitional care to get people out into lower recidivism.

And so, but there aren't, we don't have enough workers here.

And it's not even necessarily all the time that we don't have enough people going into school with what we heard from some of the experts, it's that we have a hard time keeping those folks here.

We're leaching.

And so it'll be a question too about if, what type of other policies are going into affect in the state, if that's also impacting folks coming here, getting educated or, you know, then leaving afterwards.

- [Brandon] Then staying or leaving afterwards.

- It's also cost us money.

So, I mean, the argument is this is costing us $4 billion to do nothing.

- Yeah.

- So it's costing us more than that.

- If we- - I mean look at the overcrowd in the jail.

- Yeah, sure.

- Well, yeah, I (indistinct).

- Some, some of the- - So investing to bring that cost down is.

- Tertiary.

- We keep talking about county jails and correctional facilities and that is a problem.

But let's pay attention to another brewing crisis or it's like, not brewing, it's already there.

College campuses and young people.

And public health people have been saying this since the first, I mean, announcement of COVID.

I mean it was already bad, don't get me wrong.

But then the pandemic really exacerbated a long standing problem with young people.

And these are not people have had any brush with the criminal justice system.

These are people who are trying to get good grades and are trying to build careers.

And that is an underreported crisis, I think where we're seeing that.

- The co-chair of a new Indiana housing task force says under current conditions it would take the state 20 years to meet the housing needs of lower income Hoosiers.

The taskforce is meant to recommend policy changes the state can pursue to address its lack of affordable and available housing.

It's first meeting Thursday included a lot of data, almost none of it good news, For Hoosier households earning less than $50,000 a year there's a gap of 419,000 available housing units.

Over the last seven years, the median home price increased 76%, while the median household income grew just 15%.

What's to blame?

Builders point to the pandemic, increasing costs, workforce availability shortages, and in their view unnecessary regulations.

Gina Leckron is the state director of Habitat for Humanity of Indiana.

Her organization is the largest builder of entry level homes in the state.

She says some communities adopt aesthetic regulations like requiring a two car garage or banning vinyl siding.

- [Gina] That is enough to price one of our families out of a home, just flat out prices them out.

- [Brandon] Darris Ross represents the Hoosier Housing Needs Coalition on the task force.

He says Indiana needs permanent emergency rental assistance and housing stability programs.

- [Darris] Paired with strengthening tenant protections to provide a bridge to short term housing stability and a pathway to affordable rental housing and home ownership.

- [Brandon] The task force is set to meet twice more and adopt recommendations by November 1st.

Casey, given the history in the last decade say, of what the legislature has done around housing and stuff with landlords, is the likeliest outcome, given what we started to hear at this task force, just gutting regulations?

- I think there are definitely gonna be more conversations about regulation.

This committee, this housing task force has a couple more meetings before they kind of hammer out what exactly they're gonna recommend.

There were talks this week about some federal regulations.

There's not a lot that can be done there from here.

There were discussions too about some prohibitive state and local regulations.

The legislature has been kind of hands off in terms of, you know, being too hot on affecting local.

It's, you know, they wanna leave local authority to the folks, those jurisdictions.

But I think we're gonna have to see more conversations there.

There were also discussions again though about money and incentivizations.

There was also this proposal about revolving loan funds, whether a statewide revolving loan fund or helping local, you know, governments and local jurisdictions implement these local loan funds, these small revolving loan funds.

Excuse me, that could help.

But I think there's, there's a couple more meetings that are coming up and we'll see.

- That we are, let's talk about just the regulation portion of this because there is evidence that regulations in some cases are driving up the cost, perhaps unnecessarily, not talking about health and safety.

Well, I hope we're not talking about health and safety regulations.

What we're talking about are, for instance, what was called aesthetic regulations.

So, well you can't use vinyl siding, you have to have a two car garage.

You can't, you can only have brick this color, things like that, that drive up the cost of a project unnecessarily.

But almost all of that is at the local level.

The legislature is fine to override local authority when it pleases them.

- When they want to.

- Are we getting closer to that happening on this issue?

- No, I think you're underestimating the pushback, the blow back on this, the NIMBY factor is gonna be, is lurking right below the surface and it's already sticking its head up.

I think if you ask Hoosiers, do we have a problem with affordable housing?

They'd say, "Yeah, we do."

Do we need to do something about it?

Even if it includes using tax dollars to address this problem and being really creative?

Yes.

I think we should.

Does this mean we should lessen restrictions in your neighborhood that you know, where you're so proud.

- Can we put up an apartment complex?

- And absolutely not and it's not gonna happen.

I mean, and we're seeing other states are ahead of us on this in terms of the fight.

California essentially is angling to do away with even single family residential zoning.

I mean you in the future, you won't even have single family residences or the notion you have to have a lot that's X, you know, quarter acre or this or that.

That's a no-no.

- Well, you just evoked California, so nothing is ever gonna happen here.

- Yeah.

- Well they won't and I don't think, yes, there will be money spent, but I don't think you will, I don't think the current makeup of the general assembly would allow for a lot of, would be perceived by some lawmakers as big footing.

- [Brandon] Yeah.

- [Casey] Yeah.

- Local control.

- To that point, there are a lot of solutions that are needed here.

One thing, taking over, you know, getting rid of these local regulations is not gonna solve the problem.

There are a lot of, there are a lot of problems here, but does a comprehensive, or does a set of solutions without forcing locals to relax some of these policies, is that gonna do the trick or do we have to say you've gotta stop being so restrictive?

- I think you've gotta stop, they have to stop being so restrictive, but I mean, you gotta, you think school board meetings are hot?

Go to a homeowner association meeting when they're trying to build an apartment complex across the street and the town counselors sit in the back of the room getting the, you know what kicked out of 'em.

I mean, it is, these are not fun fights at the local level and for the legislature to come in and override a lot of that is gonna, is a problem.

I mean, the data was shocking in this, I mean, that we don't have, we don't have the housing inventory.

We don't, the housing inventory we had in 2008 is equal to what we had today.

But the listings are down like 400%.

- [Brandon] Yeah.

- I mean that was the biggest deal to me.

It's like, no wonder we have bidding wars for homes when they go on the go on the market, they're way out of market on price.

- The Realtors Association had this stat, at the start of 2011 there were 50,000 homes available for sale in Indiana, this year they're averaging 8,000.

- Yeah.

- And that's an 84% drop in a decade.

This is a holistic problem.

- Right.

- Does the legisla, if the legislature did do this though, if the legislature said you can't have a local regulation against multi-unit housing in certain circumstances, whatever, wouldn't that be taking the heat off of those local elected officials in a way that the state legislature's much easier to absorb?

- It would.

Or they could do that and they could give incentives to the locals, you know, not mandating, but saying, if you don't have those restrictions, this is what's available for you because a lot of the infrastructure costs and the land costs associated with this, or what drive up, what do we have a 76% in increase in the cost of housing.

- Yeah.

- I mean those kinds of numbers, when you look at the growth in income are staggering and we need to do something when we're, you can't go in a place anymore without seeing hiring wanted or help wanted or whatever.

And we're not gonna have the people here to fill those jobs if they can't live in a place that's decent.

So they really do need to use both a carrot and a stick and we ought to be using manufactured housing more.

- [Brandon] Yeah.

- In Indiana, since we create it here.

- Yeah.

There will be a serious conversation, it seems, about that.

We heard that starting this week.

But the Satanic Temple Religious Organization has filed a federal lawsuit to prevent Indiana's recent abortion ban from applying to its members.

WFPL's Aprile Rickert again, reports the lawsuit cites violations of religious freedom and constitutional protections.

- [Aprile] The lawsuit filed last week argues the ban violates the 13th and 14th amendments of the US Constitution.

Attorneys also say it goes against the state's Religious Freedom Restoration Act.

According to court documents.

members of the Satanic Temple believe that from conception to viability an embryo or fetus does not have a separate existence from the pregnant patient's body.

The religion also emphasizes the importance of personal freedom and believes a person's body is subject to their will alone.

Court records show there are more than 11,000 members of the Satanic Temple living in Indiana.

- Jon Schwantes, is this one more of a distraction than anything?

- Have you been to a meeting lately, Jon?

- I haven't been to a meeting, I did mention this group several weeks ago in the context of litigation in Texas, it's in a Houston court.

It's wending its way through.

Every group has the right, the law isn't written to exclude non-traditional faiths or non-Christian faiths.

However, just from a standpoint of, and I'll defer to the lawyer at the table here.

When you're trying to find the plaintiff, that's going to be the poster boy, the poster girl, the poster group.

(group laughing) Poster group to carry the day.

You know, you always wanna find the person who is sympathetic and that everybody can relate to.

And we already have lawsuits that have been filed on this same issue.

- With Christian denominations.

- With Christian denominations, Jewish, Muslim faiths.

- Muslim denominations.

- So it's already done.

There's certainly ample opportunity for the filing of a friend of the court brief here.

I mean, you can't say that they don't have a right to, to pursue litigation.

- No, of course not.

- But I think if I were the attorney here trying to coalesce public support for my position, I'd prefer having the- - The Satanic temple has popped up over the years in a number of lawsuits challenging sort of Judeo Christian, whatever, put into law.

But if you're someone who is interested in the outcome of this law, either being struck down or not, are you focused a little more on those state cases than you are this satanic one?

- Oh, absolutely.

This could simply be a, you know, raise the visibility to drive up the membership.

It could be the typical thing that Eric Miller's group used to.

- This is a catalyst.

(indistinct) - That's right.

That's Indiana Week in Review for this week.

Our panel is Democrat Ann DeLaney, Republican Mike O'Brien, Jon Schwantes of Indiana Lawmakers, and Casey Smith of the Indiana Capital Chronicle.

If you'd like a podcast to this program, you can find it at WFYI.ORG/IWIR or starting Monday, you can stream it or get it on demand from Xfinity and on the WFYI app.

I'm Brandon Smith of Indiana Public Broadcasting.

Join us next time because a lot can happen in an Indiana week.

(building band music) - [Narrator] The opinions expressed are solely those of the panelists.

Indiana Week in Review is a WFYI production in association with Indiana's Public Broadcasting Stations.