Drugs, alcohol, starvation, self-mutilation – he did it all and lived to tell about it

Spencer Medcalf uses his life experience to help others as IU Health expands virtual care for addiction and mental health treatment.

Spencer Medcalf knows what it feels like to land in an emergency department desperate for help. Not so much for physical injury but for mental health/addiction treatment.

“I have been one of those people who have presented with those co-occurring psychiatric needs in hospitals and essentially handed a piece of paper and released with no real help,” he said. “You’re just as lost, if not more lost, as when you showed up.”

That’s why he is excited about IU Health’s decision to expand virtual behavioral health services to its hospitals and other centers around the state. The service, announced last month, provides round-the-clock virtual access to psychiatric evaluations and addiction assessments for emergency department patients.

Medcalf is now part of the solution to the growing need for emergency and acute psychiatric care. He works as a peer recovery coach in the behavioral health virtual hub, located at 714 N. Senate Ave., Indianapolis.


The 27-year-old marked two years of sobriety April 25 after years of abusing alcohol, pain pills and heroin.

He started outpatient counseling when he was 13 and went through in-patient treatment seven times. On top of recovering from addiction, he also is a recovering anorexic and self-mutilator.

“I haven’t felt the need to self-harm or starve myself in two years. I’m very proud of that and I think it’s important to be transparent because it’s not always just addiction. There’s a lot of co-morbidities, co-occurring disorders. I’m not ashamed of those things; I’m open about it.”

It took a village to help Medcalf get sober, he said. And he’s so grateful for that support that his mission in life is to help others on that same path.

“For a long time, I blamed a higher power for all the trauma I experienced, and now it makes sense,” he said. “I had to go through those things to be able to help people today.”

He and six other coaches work in the virtual hub, ready to be connected to smaller IU Health emergency departments when patients are deemed in need of a psychiatric evaluation. Nurses in the EDs of outlying hospitals will connect patients with a care team or coach in Indianapolis via a live video feed on a cart that can be rolled into a room as needed.

Use of virtual services will allow patients in need to stay where they are and significantly cut the wait time for an assessment. Traditionally, patients at smaller or rural hospitals who need a psychiatric assessment are transferred by ambulance to a bigger hospital, causing long wait times for treatment, additional costs and transportation issues once they are released.

The initial virtual ED encounter might take anywhere from five minutes to 30 minutes, Medcalf said. But the care doesn’t end there. A series of follow-ups are scheduled, depending on the initial assessment.

The behavioral health hub also offers 24/7 access to social workers and therapists, so even if patients are not admitted to a hospital, they have access to a safety plan, acute treatment and follow-up care.


The virtual care will give more Hoosiers, particularly those in rural areas, better access to behavioral health care and will alleviate some of the strain put on emergency departments, said Dr. Anne Gilbert, medical director of Behavioral Health Virtual Services.

“For many who don’t have access to a primary care physician or don’t know where to go, the emergency room becomes their entry point for treatment,” she said.

The virtual care component has been a boon to the patients and to emergency room physicians and nurses, she said.

The behavioral health initiative is part of IU Health’s strategic plan to improve the health of Hoosiers by focusing on mental health.

“Our clinicians in the emergency department have identified behavioral health as a critical need and are excited about this innovative approach to psychiatric care,” said Dr. Cherri Hobgood, chair of the Department of Emergency Medicine at IU School of Medicine. “We are confident that it will help us better serve our patients during a time of crisis.”

Medcalf and other peer recovery coaches began working virtually with patients in Frankfurt in Clinton County last fall. At first he was apprehensive about taking on the role, wondering if people would engage with a computer screen.

Turns out, it’s engaging enough that people will talk, and yet it’s less intimidating for those who might be reluctant to tell their story to a person in the same room with them.

Dr. Gilbert is pleased with initial feedback on the expansion, which includes Arnett, Frankfurt, Jay, Blackford, Paoli, Tipton and Bedford hospitals. Coming soon are Saxony, White, North and West hospitals.

“It’s been even more impactful than I expected at this early stage,” she said. “What’s been valuable too is often there is a dual diagnosis – people with addiction having suicidal thoughts.”

After a peer recovery coach finishes his or her assessment, it might be determined that the patient needs to talk with a psychiatrist. “We have master’s therapists in the hub – if we decide they can go home, we’ll work with them on some therapy for a safety plan and follow-up plan. We can do that all in one consultation on one cart,” Dr. Gilbert said.

Additionally, social workers are getting to understand different barriers in placements in the state, she said. “So it’s been enlightening for the system to know where we have reasonable psychiatric support and where we may need to partner or need to add services.”

Dr. Gilbert was able to get real-time reaction from one patient she was assessing in northern Indiana. She asked how he liked the virtual care platform, and he told her at first he thought it was going to be “weird,” but then acknowledged that he didn’t think he would have been able to talk so freely if she were sitting in the room with him.

Medcalf, who nearly died after overdosing more than once, tells anyone who will listen that recovery is possible for someone suffering a substance use disorder.

“I’m not special. I just finally listened and took suggestions,” he said. “My story might be traumatic, but you can achieve recovery. You just have to reach out and accept help. Any of our coaches or social workers would be happy to help.”

– By Maureen Gilmer, IU Health senior journalist
Email: mgilmer1@iuhealth.org
Photos by Mike Dickbernd, IU Health visual journalist
Email: mdickbernd@iuhealth.org