Tell City is a small town nestled along the Ohio River, in Perry County, Indiana - a state that, according to Mental Health America’s 2023 report, ranks among the nation’s worst for mental wellness, with one of the highest prevalence rates of mental illness and substance use combined with one of the lowest rates of access to care. 

The impression might be of a typical Midwestern outpost with tidy porches, faded signage, and quiet air. But the pastoral stillness conceals the churn of multiple crises. In this case, a community-wide mental health emergency, unfolding with a long, slow implosion.

Sheriff Alan Malone, who has patrolled Perry County for more than thirty years, describes a transformation in the calls his department receives.

“We’re not dealing with a domestic anymore,” he tells TRT World. “We’re dealing with a domestic that includes mental illness. Before, we never had that, or maybe we didn’t recognise it. Now we recognise it a lot.”

This recognition is one of the cruellest ironies of American public health. Only once the systems have come close to the point of collapse do their foundational absences become visible.

The backdrop is a familiar one to students of rural decline, and academic studies have directly linked the kind of economic distress found here to a rise in “deaths of despair” from suicide and overdose. The county’s median household income sits at $61,099, substantially lower than the national average. Nearly 40 percent of local jobs are in manufacturing, a sector whose instability has become the norm since the 1980s.

The opioid crisis swept through the region a decade ago, hollowing out lives and families in ways that were visible and measurable. What has replaced it is quieter: an epidemic of depression, anxiety, compounded by the profound isolation of the recent Covid pandemic and unresolved trauma.

“It’s hard in my world,” says Jared Stimpson, the CEO of Perry County Memorial Hospital (PCMH), in an interview with TRT World. “A hospital is created to take care of physical health. We are not there for mental health.”

This statement, offered with the kind of frankness that captures the central dilemma. Stimpson is referring to a health care system in which the allocation of services is determined not by need, but by profitability. 

System designed to fail? 

A decades-old reimbursement model prioritises surgical procedures and physical diagnostics. The dynamic is a core challenge plaguing the healthcare system in both developed and developing nations. The result is a devastating bottleneck.

This is not just a local American story. The struggle of this small Indiana community serves as a stark warning and a vital lesson for communities across the globe. It is a dispatch on what happens when the systems designed to protect us fail, and what it looks like when a community decides it must learn to save itself.

The local health department, facing demand it cannot meet, is reduced to managing a kind of administrative triage. To understand the crisis deputies face on the street, you must first understand the crisis created on spreadsheets and in policy documents. It is not an accident; it is a result of design.

A supervisor at the county health department sees the daily fallout. “Historically, we have had issues getting people referred to a mental health provider,” says Tara Lucas, the county’s Public Health Nurse Supervisor, to TRT World. In a rural resource desert like Perry County, this is the primary challenge. Providers who accept Medicaid, the state’s low-income insurance programme, fill their panels rapidly. Once full, no new referrals are accepted.

This systemic failure forces residents into an impossible choice: go without care entirely, or face a waitlist that stretches for months. “That leads to a very long wait time,” Lucas says. “Maybe they will say, okay, we can take them in December. If it’s June now.” If the crisis is an emergency, the only option is the hospital emergency room, a temporary fix for a chronic problem.

“At what point does society say, we need a mental health facility in every town?” Stimpson asks, articulating the fundamental question. “You treat the physical health, but mental health is huge.” 

Portrait of transgenerational trauma

What emerges is a portrait of a community attempting to compensate for structural abandonment with improvisation and local goodwill.

In a county where only 14.3 percent of adults hold a bachelor’s degree, the school system becomes the community's single most important engine for opportunity — and often, it's only safety net. For the children of Perry County, school is often the only mental health facility or network they will ever know.

Tara Bishop, the superintendent of Perry Central schools, has watched the need explode. “We hired our first school social worker in 2000. Now we have six, with the same number of students,” she tells TRT World. Trauma, poverty, and substance abuse, which she sees as deeply woven into the fabric of the community, are often passed from parent to child. In a recent year, a full 25 percent of all students received school-based mental health counselling.

“There's a lot of people here who have dealt with trauma and they're raising children not having healed their own trauma, and then that bleeds on to their kids,” Bishop says. “And anything that gets between them and learning becomes our problem too.” For children with the most severe needs, she says, the system is a dead end, failing families in their darkest moments. 

Some families, Bishop says, are beyond even the limited support schools can provide. “I feel so sorry for parents who have a child with serious mental illness,” she says, “because there’s no help for them.”

And so trauma compounds itself across generations. “There’s a lot of people here who have dealt with trauma and they’re raising children not having healed their own trauma,” she adds. “And then that bleeds on to their kids.”

Finding help on invisible paths

This cycle of unhealed trauma manifests in the adult population. Sometimes, those scars are fatal. On a summer night in 2023, the crisis erupted into irreversible tragedy.

Tell City Police Sergeant Heather Glenn was responding to a domestic violence call at the local hospital when she was shot and killed by the suspect involved in the call.

Sheriff Malone, who knew Glenn as a friend, was one of the first to arrive at the scene of “chaos.” While the immediate aftermath was about violence, Malone reflects on the deeper cause. “Once you think about it, the suspect probably had some mental illness issues,” he says, soberly.

The county jail, meanwhile, has become Perry’s largest informal and de facto psychiatric institution. Malone offers a rough but telling estimate. “I bet you you're going to find 75 percent of people in my jail,” he says, “it has to do with drugs and mental illness.”

Among them is Kevin Herp, a local veteran whose journey follows a grimly familiar pattern. When he returned from war, his hardest battles were supposed to be behind him. Instead, his fight was just beginning. For a back injury sustained during his Army service, he tells TRT World he was prescribed pain pills.

When regulations clamped down, the supply from trusted physicians vanished. “Your body wants it,” Herp says, bluntly. “Now you gotta go find it on the streets.”

Others, like Katy Wilborn, arrive at crisis through more invisible paths. Wilborn, formerly editor of the local newspaper, found herself in the hospital in 2021 after what she describes to TRT World as a “three-day panic attack.” She attributes the episode to undiagnosed PTSD from a past abusive marriage. “I knew I had PTSD,” she says, “but I didn’t realise how bad my anxiety and stuff was until I ended up in the hospital.”

Her experience shows how the county’s limited resources affect everyone, forcing personal crises to a breaking point before help becomes an urgent necessity. She attributes this dangerous waiting game to a cultural wall of stigma that is hard to breach. 

“Getting help and getting medication is still stigmatised a lot,” Wilborn says. “People… still see it as weakness instead of strength.”

Fighting stigma through training

And yet, amid all this, there is something that might resemble hope, not the abstract kind celebrated in slogans, but the difficult, active kind: hope as work, as refusal, as a form of rebuilding. 

At the hospital, Jared Stimpson’s leadership is informed by his own life. After his son was diagnosed on the autism spectrum, his perspective on mental health was transformed. “I didn’t really care much about it… until that doctor said, ‘He’s on the spectrum.’ And then it just clicked,” Stimpson recalls. “My suggestion to people is, understand it and don't be afraid of that diagnosis.” This empathy is now policy.

That experience informed the design of “Renewed Horizons,” a new geriatric-psychiatric service launched with intentional euphemism.

“I didn’t want that stigma,” he says. “If I say, ‘Hey, I'm going to go to a behavioural health appointment,’ you're going to think differently than if I say ‘I have an appointment at Renewed Horizons.’” It’s a profound act of rebranding wellness itself.

In the schools, Bishop has moved from reactive to systemic prevention. “We stopped just focusing on the kids who were drowning,” she says. “We walked up the river to try to figure out why the heck they were falling in.” The school now provides a social-emotional curriculum to every child, using tools like "Feeling Buddies" to teach preschoolers the language of their own emotions.

The health department runs creative outreach programmes, from “Be Healthy, Take a Selfie” to new “Mommy and Me” walking groups. The revived mental health coalition, led by Herp and Lucas, is uniting providers, schools, and nonprofits in a common cause. Schools are training the next generation of social workers and counsellors, hoping to ease the provider shortage from within.

And the driving force behind this new momentum is Kevin Herp. After a previous mental health coalition disbanded, he took the initiative to build a new one. His authority comes not from a degree, but from survival.

“The best people to help somebody… is somebody that’s lived that life,” Herp says, defining his mission. “Because if you don't understand it, how are you going to treat it? I’m not going to judge you, because I’ve done everything that you’re about to tell me.” 

That lived experience fuels his vision for a permanent “Perry County Health Coalition,” a formal 501c3 nonprofit that can apply for grants and endure. His goal is to convert the coalition into a permanent nonprofit capable of seeking grants and building infrastructure. One of his first acts was to hold a public meeting at the courthouse, assembling all the county’s support services — many of whom had never met — at a single table.

Fragile process, hopeful progress

This grassroots progress, however, is profoundly fragile. The very state-level funding that was born out of the pandemic’s harsh lessons is now being stripped away.

“Anytime you want to make a change, you need funding,” Lucas says. And the funding is disappearing. After a short-lived increase in state support following the pandemic, Perry County’s public health allocation is now slated for a 78 percent reduction in 2026 and 2027. “We have a lot of fear that the programmes we have slowly built steam for are either going to have to be stopped or reworked.”

Recent Indiana legislation, including Senate Enrolled Act 1 and House Enrolled 1006, has expanded funding for crisis centers and created new pathways for those in mental health crises to receive treatment instead of jail time, aiming to improve care statewide. 

Yet, as seen in Perry County, the impact of these policies remains uneven, with rural communities still struggling to access services and facing looming funding cuts even as urban areas pilot new mental health initiatives. This disconnect highlights the urgent need for solutions tailored to rural Indiana’s unique challenges.

But the fight is far from over. As funding dries up and the deep-seated needs of the community continue to grow, the question remains: will communities like Perry County be left to fend for themselves, or will their hard-won innovations inspire broader, more sustainable change?

“It is refreshing that people are even willing to sit down and have a conversation about it,” Lucas says. “There was a time when you just didn’t talk about it. We’re moving in the right direction. It’s just very slow. But the fact that people are willing to recognise that there is a mental health problem, I think speaks volumes, because it hasn’t always been that way”

The hope resides not in policy but in persistence. A sheriff, a nurse, a superintendent, and a veteran, each quietly refusing to give up.