By 2024, 90 of Indiana's 92 counties were federally designated as mental health workforce shortage areas. The untreated mental illness crisis, costing the state over $4 billion annually, sparked a collaborative effort to address these shortages. Spearheaded by the Indiana University School of Medicine’s Bowen Center, with funding from a Lilly Endowment grant, a groundbreaking initiative known as “The Playbook for Enhancing Indiana’s Mental and Behavioral Health Workforce” emerged. Two prominent contributors to this initiative were IU School of Nursing faculty members Dr. Linda Kay Romines, clinical assistant professor and coordinator of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) track and Sheila Wright, clinical assistant professor and experienced PMHNP.
Wright and Romines were selected to provide their expertise on the project, playing critical roles in developing strategies aimed at bolstering Indiana’s mental health workforce. Their work centered on addressing a vital question: how can Indiana increase the number of qualified professionals to meet the growing demand for mental health services?
The Playbook’s core focus was on identifying barriers that hinder the production of mental health professionals, including licensed clinical social workers, therapists, psychiatrists, and mental health nurse practitioners (NPs). For Wright and Romines, one of the largest obstacles to producing more psychiatric-mental health NPs was the scarcity of clinical preceptors.
“Preceptors are essential for our students to gain the 525 clinical hours they need to graduate,” explained Wright. “But in Indiana, we don’t offer preceptors any incentives like tax credits, so those who take on students do it purely out of goodwill.”
Romines echoed this sentiment, adding, “It’s a challenge when organizations don’t make it easier for preceptors to mentor students. Often, preceptors aren’t given any relief in their workload, making it difficult to accept more students. Finding clinical sites for students to gain psychotherapy experience is even harder.”
Wright pointed to the unfortunate rise of for-profit placement services as another issue complicating the process for students. “There’s a booming business in services that reach out to students who are desperate to find clinical placements. These companies charge exorbitant fees, which ultimately fall on the students. It’s a problem that’s only growing, and we need to address it.”
Despite these challenges, both Wright and Romines emphasized that their involvement in the Playbook project was an essential step forward. “Just having people together to discuss these issues was beneficial,” Romines noted. “We’re not seeing the full impact yet, but the dialogue was critical. One key takeaway was hearing from the state’s licensing agency that they are working to reduce the time it takes for new graduates to get their licenses. That’s progress.”
Wright stressed the importance of securing legislative support for mental health initiatives, particularly advocating for tax credits for preceptors and full practice authority for nurse practitioners. “Indiana is far behind other states when it comes to full practice authority for NPs, which affects access to care in rural areas. We need champions at the legislative level to push for these changes.”
Romines added, “The Playbook is just the beginning. We need continued action to push for tax credits and better support for preceptors. Our program is one of the largest in the state, and we’re doing our part to produce more NPs. But we need help.”
In the closing session of the Playbook’s Launch event, held at Lucas Oil Stadium, Romines was a speaker in the panel discussion, reflecting on the project’s significance and the road ahead. Both she and Wright are optimistic about the Playbook’s potential to create lasting change, but they acknowledge the need for further advocacy and collaboration to fully realize its recommendations.
“We need organizations and individuals to take this forward,” Wright said. “The Playbook provides a roadmap, but we need everyone—legislators, educators, healthcare organizations—to get involved and help solve this workforce shortage.”
As Indiana grapples with a severe shortage of mental health professionals, the work of Sheila Wright and Linda Romines is paving the way for meaningful solutions. Their contributions to “The Playbook” represent an important step in addressing the state’s mental health crisis by enhancing the pipeline of qualified providers. However, the journey doesn't end here. Wright and Romines emphasize the need for continued advocacy, legislative support, and collaborative efforts to implement the Playbook’s recommendations fully. With their leadership and the collective action of stakeholders across the state, there is hope that Indiana can build a stronger, more accessible mental health care system for all Hoosiers.