Vulnerability and the Mentally Handicapped
Lori L. Lindsey-Clarkston
Lakeview College of Nursing
RN 404 Nursing in Community Health
April 24, 2011

	The vulnerable population to be discussed here is mentally ill and mentally handicapped individuals in the state of Indiana.  Developmentally disabled is defined as a lifelong disability attributable to mental and or physical impairments, manifested prior to age eighteen. The synonym is developmental delay often a consequence of a temporary illness or trauma during childhood (Wikipedia, 2011).  Mentally ill is defined as a derangement or abnormality of function (medical dictionary, 2011).  Mentally ill; bereft of reason, delirious, demented, deranged, disabled, disordered, frenetic, incoherent, maniacal, of unsound mind, neurotic, paranoiac, phobic, psychotic, raving, insane (medical dictionary, 2011).  
The main state hospital for Indiana is located in Logansport Indiana, the hospital opened in 1888 under the name Longcliffe Asylum the name was changed in later years to Northern Indiana State Hospital for the Insane with the highest patient census of 2448 and since the 1970’s Logansport State Hospital.  In 1994 the facility was closed due to reported abuse and poor housing conditions; several patients were displaced or turned out to society without help or support that they needed. Many became homeless or were jailed (Associated content, 2011).  After a facelift overhaul the hospital was reopened with beds available for short term care facility for the mentally ill for acute episodes. Recently the hospital was again downsized and individuals were turned out to society without help or support.  Many are still waiting or floundering homeless without necessary medications and are jailed for petty crimes (Kokomo Tribune, 2010).  
	The Division of Mental Health and Addiction which is part of Indiana Family and Social Service Administration has been working since 1994 to improve access to community based care for specific patient populations (DMHA, 2010).  In the most recent years patients have been receiving more appropriate treatments, increasing opportunity for success in community integration, while being closer to support systems such as family and friends (Eckhart, 2011).  The change will be gradual be has been more aggressive since March 2011.  Nationally states spend seventy percent on average for mental health, addiction and community based services.  Indiana currently spends about fifty percent on these types of services. These services allow patient less restrictive settings which improve the quality of life (IIB, 2011).  For mentally retarded or developmentally disabled individuals transfer to a group home with the intention of gaining skills to live independently in the community with assistance (IED, 2011).  
There are many choice programs that will be outlined here.  Community and Home Options to Institutional Care for the elderly and disabled is a state funding service.  The program pays for services provided by care management through the agency as a last resort. All other services are paid out of pocket by patient if not covered by Medicaid or Medicare.  ASPIRE Indiana is a residential service as an adjunct to treatment program for adults with chronic mental illness.  Residential services include group homes, intensive cluster apartment living, short term supported living apartments, community based care management.  Christole Incorporated Group Homes is a twenty four hour supervised living community that helps build behavior, community access, and socialization skills.  The homes specialize in autism.  The homes are evaluated by Family Social Service Agency Bureau of Developmental Disability Services. The program also provides Medicaid waiver services to individuals living independently in the community and provides supported living services for mentally challenged adults.  Damar Services is a community living and support service for individuals living in the community, residential support, transportation, and habilitation services are provided. Gateway Services provides support to individuals living independently in the community; for services to start Bureau of Developmental Disabilities has to make a referral.  Tanagram Community Living Services provides assistance to achieve greater independence, financial management and planning, healthy lifestyle education, diet, nutrition, and exercise programs.  The program provides assistance with activities of daily living, vocational programs, companionship, and twenty four hour seven day support depending on the need and funding support of the individual as they are living in the community or residential setting (INCPL, 2011).  
Through these many programs individuals can be served, unfortunately those who end up in jail or other places do not receive the appropriate services. Others who are homeless do not have an advocate to help them get the services they need.  When facilities like Logansport State Hospital close or downsize there should be a triage service to send individuals in the right direction so that independence can be gained or appropriate services can be initiated.  Unfortunately the main hindrance to the above happening is funding.  Individuals need a patient advocate to assist with obtaining appropriate funding.  
The average cost for the types of services needed per individual is 1,436,810 dollars per year on the national level.  In Indiana the cost per individual is about 956,000 dollars per year.  These numbers include residential services, medical expenses, medication, legal fees, and housing cost. Some individuals are denied services they have been receiving due to loss of insurance or benefits provided by the state.  Budgets for such services provided through waiver hours have been cut which affects services provided.  
The economic status of the United States affects these individuals. Services are not provided and demise of the individual occurs, this adds to the census for homelessness, unmanageable individuals, mortality and morbidity rates increase.  The solution I believe is advocacy and family involvement. Until the mindset of providers change the deficit for these individuals will continue to decline.  
References
http://en.wikipedia.org/wiki/developmental_disability   retrieved April 24, 2011
http://medicaldictionary.thefreedictionary.com/mentally-ill   retrieved April 24, 2011
http://associatedcontent.com/article/1893128/victorianhospital.html   retrieved April 24, 2011
http://kokomotribune.com/local/X279771804/355-will-lose-jobs-at-logansport-state-hospital  
     Retrieved April 24, 2011
http://indianaeconomicdigest.com/main.asp?sectionID=31&subsectionID=135&articleID=55169 
     Retrieved April 24, 2011
http://imcpl.org/cgi-bin/irnget.pl?Group%20Homes,%20Disabled%20People   retrieved April 
     24, 2011 
http://www.state.in.us/fssa/  retrieved April 24, 2011