Jay Chaudhary || November 13, 2024

Welcome to my journey as Senior Fellow for Mental Health and Community Wellness at Sagamore Institute. I’m excited to make this transition after spending five years as Director of the Indiana Division of Mental Health and Addiction, where I made policy for—and led the execution of—an overhaul of Indiana’s behavioral health system.

The genesis of this project is something that I heard former Indiana Governor Mitch Daniels say at Sagamore Institute’s 20^th anniversary celebration. He said that, while he was very proud of the reforms he instituted to make government more efficient and Indiana more attractive to businesses, he knows that his administration—and all the administrations since—have not gotten “the people part of it right.”  Hoosiers and Indiana communities are lagging behind on many important indicators—health, public health, mental health, educational attainment, wage growth, among many other things. Living in Indiana is cheap, but it does not appear to be particularly easy. Indiana has a nationally renowned business environment and a globally recognized entrepreneurial ecosystem, but the spoils of that success have not trickled down to many Indiana communities. As Gov. Daniels said, “the people part” is a lot harder.

During my time at the state, I quickly learned that there was a clear hierarchy within Indiana state government—economic development, and everything else.  The economic development strategy for Indiana for the last 20 years is a two-pronged approach: creating “favorable business conditions” through tax and regulatory reform while providing robust economic incentives to attract good employers to Indiana.

By some measures, this strategy has been a success. Indiana’s business climate is generally considered one of the best in the country, and the Indiana Economic Development Corporation reports record investments, seemingly every quarter. The question is, then, why aren’t more people and communities in Indiana thriving?

My project here is to explore ways to to apply the economic development strategy to the “people part.” What are “favorable thriving conditions” for families and communities? What are projects, programs, and policies that promote—or are barriers to—happier, healthier, and more connected communities? Where can government take a more active role? As importantly, where can government get out of the way?

Obviously, the answers to these questions can be paralytically broad and amorphous—almost anything and everything has an impact on overall thriving. So, given my experiences and interests, I’ve decided to focus on three areas:

Access to Behavioral Health Care

I will build upon my previous work of advocating for increased and equitable access to behavioral health care, focusing on the two main dimensions of systematic barriers to accessing care: policy (including state/federal fiscal policy) and quality of clinical and operational practices.

The fundamental barrier to access to care is more demand for care than the system currently has the capacity to provide. The reduction in stigma for mental health care is a wonderful development but does lead to increased demand for care. We are currently experiencing an explosion of demand for mental health care colliding with decades of underinvestment in the system, causing significant challenges with access to care. State and Federal policy changes are a necessary part of closing this gap.

The mental health field (including providers, payers and regulators) must also do things differently. There is considerable room for improved operational efficiency (including smarter use of technology) and higher fidelity to quality clinical practices. The mental health system is not an easy one to utilize or to work in.

The answer to the question “more or better?” is “yes, and.” I will use this project to advocate for better policy and highlight promising clinical and operational opportunities.

Exploring a broader definition of “mental health”

Access to “traditional” mental health treatment modalities (therapy + medication) is extremely important and effective for a lot of people, especially when backed by evidence and science. However, during my time in charge of Indiana’s “traditional” mental health system, I developed a pervasive sense that we were failing to leverage other potential solutions.

New and promising research shows that more holistic interventions—such as nutrition, exercise, better sleep, exposure to nature, psychedelics, and others— can have a significant impact on a person’s mental health.  While there is room for education to improve individual choices around these areas, I am planning on focusing how structural barriers limit people from harnessing these potentially powerful tools.

Social Drivers of Thriving

The most common objection I heard during my time at the state was “this is fine, but if you really want to make a dent in mental health, you need to focus on prevention.”  When I followed up (because I totally agreed!), people would invariably talk about more education about mental health and drug use. Mental health literacy and common-sense drug education are important components in a comprehensive behavioral health strategy, but they are not prevention. Prevention is about people living better lives—less childhood trauma, more economic security, and stronger connections with other people and communities. In other words, “Prevention” is just another way to say “social drivers.”

Social Drivers of Health (I prefer the less fatalistic term “drivers,” rather than the more common “determinants”) are non-medical factors that impact health outcomes. According to widely accepted literature, these factors account for anywhere from a plurality to a majority of health outcomes for individuals and communities—more than genetics or the quality of healthcare available.

Social drivers are strongly influenced by policies—housing policy, criminal justice policy, healthcare policy, environmental policy, employment policy, and many others. Interventions and policy changes that address social drivers can produce remarkable results on health and overall well-being.

Mental health is no different—any prevention strategy must account for these powerful forces. If our goal is thriving people and communities, we must examine the social, political, and economic factors that play a huge role.

There are no bright-lines between these areas—a key part of a thriving community includes access to traditional and holistic mental health care.  My goal is to be open-minded, pragmatic, and unfettered by partisan or philosophical divides.

My strategy and approach to this work is simple: I want to talk to people who are smarter and more knowledgeable than I am. Have an idea or strategy that you want to talk about? Please reach out to jay.chaudhary@sagamoreinstitute.org and let’s get to work!