Since its rollout two years ago, South Dakota's Suicide and Crisis Lifeline has seen a slow but steady uptick in use, but the state says there are still missed opportunities. South Dakota's 988 crisis line received nearly 6,500 calls in the first half of this year, according to state data - that's nearly a 40% increase from the same time last year.

Vanessa Barnes, assistant director, Department of Social Services Division of Behavioral Health, said many people aren't aware that the line can be used for various crises, and the office is pivoting its marketing accordingly. Barnes said a perception study done last year shows nearly half of surveyed South Dakotans had heard of the lifeline, but only 28% chose 988 as the number they would call for mental health-related distress, substance use or suicide crisis help.

"So the biggest thing is just making sure that people know that 988 is available, but that it's more than just a suicide hotline and it can be used for substance use and for loved ones as well," Barnes said.

To further spread education, the Department of Social Services, Division of Behavioral Health is hosting its third annual suicide prevention conference in Sioux Falls in early August. If you or someone you know is in crisis, help is available by calling or texting 988.

Barnes said last year the South Dakota Legislature appropriated state dollars to fully fund the helpline, which is currently hiring to meet rising caller demand. According to a recent report from the nonprofit Inseparable, South Dakota's in-state call answer rate is 86%.

Angela Kimball, chief advocacy officer with Inseparable, said the report encourages systems of accountability.

"This allows legislators to oversee the system over the long haul and to set up the structures for continuous learning, continuous system improvement," she explained.

By Amy Felegy for Arts Midwest.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the Arts Midwest-Public News Service Collaboration

Rocky Casillas Aguirre found himself swimming in panic attacks in 2020. He wasn't sleeping; he saw all kinds of therapists and a couple of sleep doctors.

Then, he found meditation.

What followed has transformed Casillas Aguirre's life and career.

"I took refuge in art and meditation and mindfulness practice, all of which I'm now doing full time," the Northfield, Minnesota-based artist says.

With a full eight hours of sleep checked off each night, Casillas Aguirre now spends his time creating-not what-if scenarios in his mind but comic books, short animations, and art with impact.

He's a self-taught graphic designer, comic book writer, and animator with a master's degree in biology. ROKATURAS is Casillas Aguirre's studio-slash-business.

Its personified stars are unlikely friends Twitch and Weenie (read: a relatable flame and a hot dog, with mystical powers of course). They're silly, sure, but they pack a practical punch.

"Twitch flame, he represents the little spark in all of us, like the inner child that lives in all of us who is curious and sees the world with awe and amazement," Casillas Aguirre says.

His children's book Where Did Anxiety Go addresses anxiety symptoms kids might feel. Inside are meditation exercises that ask readers to "breathe in and... breathe out." Characters reiterate "I am safe, there is no need to be scared" in tricky situations.

The themes manifest throughout ROKATURAS's online presence, which caters to a broader age range.

"What are you doing today after work?" an animated pink brain asks into a lime green telephone in a video about burnout Casillas Aguirre posted to his Instagram account.

"Laying down," Twitch responds gravely. "Laying down..."

Doing his P(art)

Casillas Aguirre is a Latino artist from Tijuana, Mexico, where he visits his grandparents often. He says Mexican cultural traditions like Day of the Dead inspire his artwork and ground his sense of self.

"I'm also an LGBTQ artist, or a transgender artist, so the exploration of identity and mental health are things that are really important to me and core to all of the work that I do and the messages that I try to deliver through my art."

Casillas Aguirre says he sees stigma around mental health in his Latino community. It prevents people of all ages from getting help. So he's doing his (p)art-which includes continuing his self-published comic book series. He's also looking to expand production of his video shorts with an animation team.

"In the process of creating art, I was de-stressing and healing myself while simultaneously creating art that is trying to create safe spaces for people to talk about mental health, especially parents with their kids."



Amy Felegy wrote this story for Arts Midwest.

With Christmas less than a week away, experts are giving advice on how seniors and the community can fight against social isolation.

A United Health Foundation report ranked Maryland 27th in the nation for the risk of social isolation to its seniors. One study by AARP found more than 30% of seniors have felt lonely over the past five years during the holidays.

Lois Meszaros, licensed psychologist and executive council member of AARP Maryland, said there are common signs to warn family, friends or seniors themselves they may be experiencing isolation. One of those, she said, is shrinking social circles.

"They're complaining of their world shrinking," Meszaros observed. "They're no longer working, so they're not doing things with coworkers. Friends have moved away to warmer climates or to be closer to grandchildren."

Meszaros pointed out other signs of loneliness include a lack of interest in previously loved activities and unexplainable physical ailments. One example is a senior complaining of a sore arm or leg, despite doctors not being able to find anything wrong.

For anyone who might acutely feel the loneliness of the holidays, Meszaros noted there are ways to fight isolation. She suggested reaching out to family members and friends on the phone or going for walks in the neighborhood. Even if they don't feel like accepting an invitation, Meszaros advised they should go. Look for events at churches, senior centers and libraries.

Some older adults don't seek out help. For family members, friends or neighbors concerned about a senior in their life, Meszaros emphasized there are a number of ways to help them.

"Providing transportation, providing help with technology, I see these as things that are really needed," Meszaros observed.

She added it is helpful for older adults to have technology and learn how to use it, to keep feeling connected with others.

By Mary Claire Molloy for Mirror Indy.
Broadcast version by Joe Ulery for Indiana News Service reporting for the Mirror Indy-Free Press Indiana-Public News Service Collaboration.

Misty Coburn wasn't surprised to learn about allegations of sex abuse at Options Behavioral Health Hospital.

As a nurse, she saw the warning signs everywhere. Staff, who were outnumbered and undertrained, didn't watch patients closely. That amplified danger in the Lawrence mental health facility's mixed gender units, where men and women roomed next to each other. They were forced to keep their doors open - and there was always a fear someone might slip through.

That's why Coburn sounded the alarm in 2022 about a male patient's violent history. During admission he told staff, according to a police report, about spending years in prison for raping an elderly woman in a coma. She died soon after the attack.

The man, Derek Hutchison, was wanted in another county for failing to register as a sex offender. Coburn told her bosses about the warrant, but she said they still kept him at the facility.

"There was a whole argument over whether to call the police," the 51-year-old nurse told Mirror Indy. "I was told we weren't going to get involved."

What happened next continues to haunt Coburn. Staff found Hutchison in the bathroom with a female patient.

Hutchison told nurses they'd had consensual sex, according to a police report. But the woman had severe mental illness. Her brother, who is not being named to protect her identity, told Mirror Indy she has schizophrenia and does not have the mental capacity to consent.

"They should have kept him away from everybody," the brother said.

What happened wasn't an isolated case, a Mirror Indy investigation found. It's part of a troubling trend of widespread allegations of abuse at the facility, involving both adults and children, patients and a therapist.

Nine rapes have been reported since 2020, according to police records, and officers have been called at least 560 times for numerous problems - responding, on average, to an incident every three days.

Six former employees described to Mirror Indy a facility in constant uproar as staff failed to supervise patients, leaving them to have sex and assault each other. When fights broke out or patients ran away, they relied on police to contain the chaos.

It got so dire that Lawrence police held four meetings with Options leadership about safety concerns, said Travis Cline, deputy chief of investigations.

"We've told them they need security in there," Cline said. "(Staff) need to pay more attention."

Seven former patients, meanwhile, told Mirror Indy they did not receive the therapy or mental health treatment that Options advertised. Instead, they described being held against their will for insurance money, assaulted by staff, coerced into taking naked photos or threatened with court orders when they tried to leave.

After learning several of Mirror Indy's findings, Marion County Prosecutor Ryan Mears pledged to "further investigate Options and the parent company and ensure that patients are not being taken advantage of."

"It is clear that a comprehensive investigation of the entire organization is warranted," Mears said in a statement, adding that what's happened at Options is "disturbing."

The conditions were the result of a company culture that repeatedly pursued profits over patients, the employees told Mirror Indy. The staff had a mantra, Coburn said: "Get heads in beds."

In an email, a spokesperson for Options' parent company, Tennessee-based Acadia Healthcare, said the facility does not tolerate abuse and decisions about patient care are based on medical needs, not money. The Lawrence facility remains accredited after 11 inspections from state and federal authorities in the past two years, he said.

"The handful of allegations cited do not accurately represent the standards of care and practices at Options Behavioral Health," spokesperson Tim Blair wrote.

Acadia declined to comment on the nine reported rapes, citing patient privacy. Staff, Blair said, go to "great lengths" for patient well-being, including proper placement and monitoring in the facility.

But the facility's management did not require additional monitoring of Derek Hutchison, the registered sex offender who was a suspect in one of the reported rapes, according to Coburn and another former employee. Nor did the facility's management separate him from other patients, the employees said.

Hutchison, 36, has not been arrested or charged in the investigation. Police told Mirror Indy the woman did not agree to a sexual assault exam. In an interview with officers, she was incapable of forming complete sentences.

Hutchison did not respond to a Mirror Indy request for an interview. He is currently incarcerated at the Indiana State Prison for failing to register as a sex offender before he checked into Options.

"Options should have made sure he was never around women," Coburn said. "He knew to pick someone who was unable to say, 'He did this to me.'"

The incident was terrifying, Coburn said. But the nurse was more shocked by what happened next.

A 'red flag' for state investigators

Coburn took daily notes on the facility's failures.

On pages shared with Mirror Indy, the nurse documented how her colleagues slept on the job or left the unit: "Patients in rooms, but no staff."

Options, she wrote with three exclamation points, would hire "ANYONE." That included employees who weren't properly trained to help people experiencing severe mental illness. Most of the time, she said, they made it worse. "Staff antagonizing patients," Coburn wrote in one entry. "Frequent escalation to violence."

Her handwriting became increasingly frantic: "Administration fails to help the situation."

Coburn kept the notes as evidence, waiting for the day she could advocate for people harmed at the facility. She also made sure to document her patients' conditions in their charts.

But when documenting the incident involving Hutchison, Coburn said Options CEO Natasha Schafer told her not to use the word "assault" in the female patient's chart.

"Natasha said it would be a red flag for the state to investigate," Coburn said. "She called the incident consensual."

Schafer, who is now the CEO at another Acadia facility in Columbus, Ohio, told Mirror Indy that Coburn's statements were "egregious," "defamation" and "not factual."

When asked why so many rapes were reported at Options under her leadership, Schafer said she had to speak to a lawyer and hung up.

Acadia did not respond to Mirror Indy's request for comment about Schafer.

After learning from Mirror Indy that her former CEO denied the interaction, Coburn defended herself against the accusation of defamation. "I didn't say anything that wasn't true," Coburn said.

Coburn also shared her notes about the incident: "Rape on unit b," she wrote. "Director (Natasha) aware."

Four former employees said they believed Coburn's description of her interaction with Schafer. It wasn't hard for them to imagine management doing whatever it took to keep the facility open for more profits.

'Keep the beds full'

Ashley Reed-Kimble, who quit her position at Options in February 2024, said the facility's leadership sees every patient - including someone convicted of sex crimes - as dollar signs.

She ran the facility's intensive outpatient unit. But she was in morning meetings with the inpatient staff. There, she said, the clinical director would review a spreadsheet of patient names to find out how many more days the facility could get paid by insurance.

"I never saw anybody talk about clinical issues," said Reed-Kimble, 39. "They decided yes or no if a patient stays based on insurance."

A second former therapist, who is not being named by Mirror Indy because she fears retaliation from Acadia, said facility leadership pressured staff to extend patient stays.

"Even if we thought clients were ready to leave, they wanted us to hold them longer to keep the beds full," the therapist said. "If their insurance keeps paying, they're going to stay."

Acadia is facing similar allegations across the country.

The company paid nearly $20 million in September to settle with the Department of Justice over claims that it detained patients longer than medically necessary to bill their insurance and failed to provide proper staffing, leading to patient assaults and suicides. Now Acadia is facing inquiries from the FBI, federal prosecutors in New York and a grand jury in Missouri.

It is unclear if state or federal authorities are investigating the 10 Acadia facilities in Indiana; neither the U.S. Attorney's Office in the Southern District of Indiana nor the state's Attorney General's Office would say.

At the Options facility in Lawrence, two former employees told Mirror Indy about a rule that only two patients could be discharged from a unit each day. It was part of an effort, they said, to make sure the facility continued generating revenues.

In a 2021 email obtained by Mirror Indy, the facility's clinical director at the time, Julie Plantz, demanded to know why three patients "could not have stayed one more day" - even though they had been discharged on a therapist's recommendation.

In an interview with Mirror Indy, Plantz said she was following orders from a long line of Options CEOs as well as Acadia leadership. She told Mirror Indy that she refused to be their "scapegoat" and said she resigned from Options this month.

"There were pushes to keep the number of discharges down," Plantz said. "That would come from the CEO, but it was also a directive from corporate."

Acadia did not respond to Mirror Indy's request for comment on specific allegations from Plantz or other former employees.

In an email, a spokesperson reiterated that decisions about patient care and length of stay are based on medical necessity and made by licensed providers. The company has publicly claimed media reports about its practices are false.

Employees on the ground tell a different story. Coburn said she and other nurses were pressured by management to embellish patients' charts. That meant saying a patient was aggressive or not sleeping - even when neither statement was true - to increase the odds that insurance would approve the patients for longer stays.

"They were telling people to make the charting sound good," Coburn said.

Advocates concerned about lack of prosecutions

Lawrence police said they were shocked by the volume of calls coming out of Options.

They investigated all nine of the reported rapes. Three of the cases were presented to the Marion County Prosecutor's Office for a charging decision, according to a spokesperson for Mears.

Lawrence police said they didn't send the additional six cases to Mears' office because victims changed their stories or wouldn't cooperate with the investigation.

Advocates were concerned to learn so few of the cases made it beyond the police department.

"Once that process stops, there's really no more investigation," said Melissa Keyes, the executive director of Indiana Disability Rights, a state agency that has investigated at least eight complaints of abuse, neglect or rights violations at Options since 2023. "I think it's pretty harmful police didn't even try to give it to the prosecutor's office."

It is unclear if Mears will also look to examine those six cases. His spokesperson did not comment on any individual case.

Of the three rape cases that were previously presented to Mears' office, only one resulted in prosecution. It involved a 12-year-old boy who was sexually assaulted in the middle of the night by his 17-year-old roommate.

The case was resolved in juvenile court, police confirmed, where there was a true finding of child molestation. The victim's parents later filed a lawsuit accusing the facility of negligence, court records show.

Options settled with them outside of court.

Acadia did not respond to Mirror Indy's question about why its facility housed young patients with such a large age gap together.

Four Acadia employees accused of child sex abuse

It wasn't just patients accused of abuse.

In 2020, Erika Atkinson was 35 when she was arrested and charged with child seduction in connection to her relationship with a 17-year-old boy at the facility. She was his therapist.

Options fired her, but it was too late.

Atkinson told police that the two had kissed and touched each other for months, according to court records, during "sessions" in her locked office. In court records, investigators said she slipped the young patient a cell phone - a prohibited item at the facility - and sent him dozens of messages, including a topless photo.

Atkinson, who now works as a therapist in Georgia, said in an email that details from court records about her case were "not accurate." She would not say more, including which specific allegations from police reports and court records were inaccurate.

Court documents show the child seduction charges were dropped after Atkinson took a plea deal. She was convicted of obstruction of justice for asking the victim not to cooperate with police in the investigation.

Acadia did not respond to Mirror Indy's request for a comment on Atkinson's case.

"Staff should have had eyes on the patient," said a therapist who worked at Options during the incident, who is not being named by Mirror Indy because she fears retaliation from Acadia. "He had a phone. How did they not catch it sooner?"

Four former employees said Acadia fails to properly vet staff - or monitor their access to vulnerable patients.

"They are extremely negligent in who they hire and promote," said Reed-Kimble, the former outpatient manager at Options.

Atkinson wasn't the only Acadia employee in Indianapolis accused of child sex abuse. Mirror Indy found three more cases involving staff at Resource Treatment Center, an Acadia facility for children and teens on the near southeast side.

In 2020, a behavioral health associate was arrested for preying on 14- and 15-year-old girls at the facility, according to court documents, taking them to "blind spots" where there were no cameras. He was convicted of sexual misconduct with a minor.

In 2023, another behavioral health associate was convicted of the same charge. She was removed from a unit multiple times for abuse allegations but the facility reinstated her, according to court documents. The staff member performed sex acts on a 15-year-old boy multiple times, police said, in exchange for letting him use the facility's phone to make calls.

Lastly, the CEO at Resource Treatment Center was arrested and charged with sexual misconduct with a minor in 2023. In court documents, police accused the man of sexually assaulting a 14-year-old boy who was unconscious from drinking. The incident did not happen at the facility and he is no longer employed by Acadia. The former CEO pleaded not guilty, and a trial date is set for 2025.

Acadia did not respond to Mirror Indy's request for comment on the three cases.

'None of us were qualified'

Former employees say understaffing created an environment ripe for abuse.

Options hires behavioral health associates to check on patients at least every 15 minutes and sometimes more frequently, depending on the person's condition. But two of these workers told Mirror Indy they were left alone with more patients than they could handle.

Paige McIntyre started working at the facility in January. She described night shifts where she had to watch up to 20 patients on her own.

"I worried about missing something all the time," McIntyre told Mirror Indy. "It wasn't possible for me to observe that many people."

Some of her colleagues, she said, would abandon their posts to smoke weed and sleep in their cars: "None of us were qualified."

McIntyre's last job was working at a hotel; Options did not require experience working in a mental health facility. In advertisements, they asked for people who had high school degrees and could pass a background check and drug testing.

The facility's training wasn't much help, McIntyre said: New hires spent a day putting each other in holds and restraints.

"We never learned how to de-escalate situations," she told Mirror Indy. "It was about how to take people down."

Options fired McIntyre in August, she said, for missing a shift to take care of her sick child.

Mary Buchanan, who worked as behavioral health associate for two months until November, said the facility regularly defied its own safety policies. Patients were never supposed to be unattended during the day, she said, but staff allowed them to go to their rooms alone - and when an incident broke out, she said the response was usually cruel.

"I've watched staff manhandle a little girl," said Buchanan, who said the facility fired her for requesting a medical accommodation while she was undergoing cancer treatment.

Acadia did not respond to Mirror Indy's request for comment about Buchanan and McIntyre's firings. The company denied being understaffed and said employees do receive de-escalation training. A spokesperson did not respond to Mirror Indy's questions about specific staffing ratios used at Options.

Still, many former patients told Mirror Indy they remain concerned about Options. They initially went to hospital emergency rooms while in crisis, hoping for care. But they said they were referred to the facility and placed in conditions that were unsafe.

Hospitals won't say if they've stopped sending patients to Options. But one thing's for sure: Many local therapists who know about the allegations aren't sending their clients.

That's been Amy Ikerd's policy since 2021, when she referred one client to Options because no other facilities in the city had beds available. The teen, already suicidal, came back with a distressing story: They witnessed a staff member punch a patient in the nose.

"I will not refer there," said Ikerd, who works at a nearby private practice in Lawrence. "I don't have faith that a client would be safe."


Mary Claire Molloy wrote this article for Mirror Indy.


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