Photograph by Aaron M. Conway
In 2010, Lindsay Ensor found herself in the ER after a failed suicide attempt. The emergency doctor treating her, after determining she’d survive, told Ensor that she was fine and could stay a few days in the hospital if she wanted. That was it: No suggestion of further treatment, no help for finding counseling resources.
It’s a story all too familiar for those battling mental illness. Despite being more prevalent than cancer, heart disease, and diabetes combined, mental illness is rarely addressed with the same urgency. For Ensor, that meant her PTSD and anxiety from childhood, coupled with postpartum-triggered severe depression, was treated by her general practitioner with nothing but antidepressants. “That medication was actually making things much worse,” says Ensor, who later learned she had Bipolar II disorder. Things spiraled until the day she found herself in the ER.
“My husband was actually the one who was like, ‘We need to look into mental health help,’” says Ensor. Shortly after, she landed at the Lindner Center of HOPE.
Photograph courtesy Lindner Center of Hope
The Lindner Center of HOPE’s origin story echoes that of other mental health care initiatives: A deeply personal brush with the devastating effects of mental illness inspired someone to take action. “Growing up [my wife Frances and I] had people in our lives who suffered from mental illness,” says Craig Lindner, co-CEO of American Financial Group and son of the late billionaire philanthropist Carl Lindner Jr. “From the time we were fairly young, we saw what the consequences could be if someone didn’t get the care that they needed.”
For him, that someone was one of his closest high school and college friends. “If I had to pick one person who I thought would be the most successful person I knew, it would be him,” Lindner says. “Then I watched mental illness start to ruin his life, beginning in undergrad. He couldn’t find the care he needed. He started treating his illness with alcohol. I was asked to do his eulogy when he passed away at 48 years old.”
For Frances, it was her brother. “He was brilliant; he was on scholarship to Notre Dame,” she says. “When he was around 18 years old, I just watched him go from healthy and intelligent to an obviously troubled young man. Back then, there wasn’t even a word for ‘stigma.’ I watched my mother try to seek out help from one institution to another, and there just wasn’t that quality of care. Mental health is on the bottom of the totem pole [now], and back then it was in the Dark Ages.”
When, later, a family member needing mental health care brought Craig and Frances to theMcLean Hospital in Boston, a doctor there told them about Paul Keck, M.D., at the University of Cincinnati College of Medicine. An award-winning psychiatrist, Keck has authored more than 400 scientific papers in leading medical journals. In the fields of psychiatry and psychology, he has ranked among the top 10 most-cited scientists in the world since 1996.
“When we heard that we had one of the top psychiatrists in the world right here in Cincinnati, given our experiences and the incredible blessings our family has had, we truly felt a calling to do something about it,” Craig says. “Frances and I went home that night and said, ‘Hey, this isn’t a coincidence, we’ve experienced [mental illness] with people who have been close to us, we have one of the top psychiatrists in the world in our backyard. There’s a message here.’”
The Lindners called Keck, and after an hour-long meeting during which the couple outlined their plan for creating a state-of-the-art mental health facility, Keck agreed to come on board as president and CEO. “He about spun out of his chair when we asked,” Frances says, laughing.
Photograph courtesy Lindner Center of Hope
Most experts agree that mental illness affects as many as one out of five Americans—with some arguing the number is as high as one in four. But while mental health is a much more open conversation now than it was 10 or even five years ago, barriers to getting treatment persist. The big three, says Lindner Center Chief Operating Officer and Chief Clinical Officer Paul Crosby, M.D., are: the cost of treatment; the shortage of providers (psychiatry is one of the most underserved medical specialties); and the stigma of needing, and seeking, mental health care. “Cost often prohibits both those folks who have to pay out of pocket and those who have insurance plans that don’t cover, or completely cover, mental health care,” Crosby says. “Then of course there just aren’t enough providers to meet the need.
“What we know about stigma is that it’s the single most important reason why people don’t seek treatment,” Crosby adds, noting that, on average, there tends to be a 10-year gap between symptoms emerging and someone actually getting the help they need—and fewer than half ever get treatment at all. “I think it’s difficult for folks to talk about because mental illness affects a person’s ability to be him- or herself, so it gets in the way of their ability to function interpersonally, socially, among family, professionally, and academically,” he says. “So it’s hard to recognize it in yourself if it’s happening to you. It also just makes it more personal to talk about and maybe more embarrassing for folks because there’s a lot more shame associated with it than other things like diabetes or heart disease or even cancer, for that matter.”
Ensor ran into the same barriers when she first began seeking treatment. “My insurance told me I could have 12 visits with a therapist. And if I wasn’t fixed in 12 visits, sorry,” she recalls. “[That made me think] for so long that if I’m getting better, I should keep getting better, I shouldn’t have the ups and downs that I was having.”
To combat these hurdles, this year the Center launched its Challenge of Hope fund-raising campaign, meant to both bring awareness to mental illness and to encourage the community support needed to keep a facility of this caliber running. To launch the effort, the Fath family donated $50 million, to which the Lindners added $25 million—together comprising the largest personal contributions ever to a mental health facility in North America.
“Frankly, [a mental health center is] a difficult financial endeavor—reimbursements are typically at a big discount to the actual cost if you’re going to provide a continuum of care,” Craig says. In fact, reimbursement from most major insurance carriers and the federal government currently doesn’t cover even half the real costs of providing mental health treatment. “We would really like for the hospital to be funded in a way that allows us to continue to build and expand our services and truly create the top mental health center in the U.S.,” he says.
“Community support also helps us attract some of the best doctors in the United States and the world, and to help us keep that center of excellence going,” adds Frances.
Photograph courtesy Lindner Center of Hope
Since the Center opened in Mason in 2008, it has treated more than 39,000 patients from all 50 states and at least 10 countries, averaging 125 outpatient visits per day. (Roughly 10 percent of patients utilize inpatient residential services.) It’s one of the first centers designed as a fully integrated system of care based on the best practices published by the Institute of Medicine, a private nonprofit that provides advice and analysis on medical issues (a part of the National Academies of Sciences, Engineering, and Medicine now called the Health and Medicine Division). Offerings run the gamut from outpatient services such as counseling, therapy, and psychiatric evaluations to inpatient residential care and cutting-edge neuromodulation treatment, otherwise known as Transcranial Magnetic Stimulation and Electroconvulsive Therapy. The Center is among the first (for TMS) and leading (for ET) providers of these treatments in the area.
Among other affiliations and accolades, including a partnership with UC Health and a collaborative clinical relationship with Cincinnati Children’s Hospital Medical Center, the Center is one of eight charter members of the National Network of Depression Centers; has a research team collaborating with the Mayo Clinic on a Bipolar Disorder Biobank, dedicated to finding genetic markers for the disease; and has been instrumental in bringing six new drugs for depression, bipolar disorder, and eating disorders to the market. It’s also a teaching facility, working with the UC College of Medicine to train nurses, medical students, psychiatric residents, social workers, psychology interns, and more.
“I don’t like to boast, but I don’t think there’s anything quite like this in all of North America,” says Keck. “It’s more than a hospital, more than an outpatient clinic, more than a research hospital. It’s really designed to provide all of it. The world of American psychiatry is pretty small, and I’ve been lucky enough to know people at the Harvard program and Stanford and Mayo,” Keck says. “I would stack our medical staff up with the best of them. We have experts in just about every area of mental health, and that expertise and quality of care is really critical to people getting well. That’s the differentiator here.”
The ultimate goal at the Center is to give people hope and let them know they aren’t alone. “We didn’t put our name on [the Center] for ego; we were thinking maybe this will encourage other people,” Frances says. “I call myself a stigma fighter. You can live with mental illness. And that’s what we do—we teach people how they can live normal lives.”
“We in the field and at the Lindner Center of HOPE are trying to model how to have that conversation to normalize talking about mental health,” adds Crosby. “We know that treatment is extremely cost-effective. Every dollar you spend on mental illness prevention [or treatment] saves you down the road. And if you have your own story, share it. One of the big ways to reduce discrimination stigma, for anything, is to know somebody who’s affected by it.”
The importance of having hope was really hammered home for Ensor in 2016, when a sudden flare-up of symptoms led to another suicide attempt. This time, the doctor told her, “I have no idea how you are still here and alive,” Ensor recalls. “At that moment, I was like, ‘I obviously have a purpose for being here if I survived that.’”
The episode sparked a desire to be a mental health advocate, and in addition to writing about her story, Ensor presents at conferences and speaks openly about mental illness. “It’s just getting out there and saying, ‘Hey, I’ve struggled too, and I understand and there are people who care about helping you get better,’” she says. “It also helps me, because when I’m in a room full of people who all are going through similar things, I realize they’re part of my journey as well.”
A critical component to treating mental illness is providing a continuum of care. Like other chronic illnesses, it can require ongoing management. Offering a full spectrum of resources for all ages—psychiatric services are available for children as young as age 2, with residential care starting at age 18—coupled with a multidisciplinary approach, was a key component of the Lindners’ aim for the Center.
The facilities spread across a peaceful stretch of wooded land, a former farm. From the grounds to the treatment rooms and residential halls, nothing about the place screams “sterile medical facility”—a deliberate choice, says Keck. Walking paths, yoga classes, a chapel, and life skills coaching illustrate the Center’s dedication to holistic healing, while structured outpatient programs covering everything from eating disorders to substance abuse and addiction showcase its wide-ranging specialties.
“Since opening, we have been responding to perceived community need,” Keck says. “[In the last 10 years] we’ve added a partial hospital program for adults; Hope Center North, our addiction program in response to the opiate crisis, where we’re literally saving lives; a second residential program that Dr. Crosby created at Sibcy and Williams house; and we recently launched a specialized adolescent rapid access diagnostic program, which is three and a half days of intensive assessment so we can help families and kids get help quickly.”
The staff also understand mental illness is “not a 9-to-5 disease,” Ensor says. “My providers make themselves accessible 24/7, which I think is unlike most places. In my first appointment with Dr. Keck, he gave me his e-mail and told me to use it at any time. There have been times he’s helped me through something at 10 p.m. on a weekend to get me through to our next appointment. I would not be alive had it not been for this place.”
Helping people like Ensor is why the Lindners wanted to create a place like the HOPE Center, and the flood of people who’ve approached them to express thanks for how the organization has changed the life of a spouse, child, family member, or friend has been staggering. It’s what sustains them through the difficulties of running an organization devoted to a cause still vastly underappreciated—and drives them to continue building awareness. And the tide is changing.
“I never dreamed we’d be helping people around the world, but here we are after 10 or 11 years and going strong,” Frances says. “I think someday in the near future mental health won’t be at the bottom of the barrel.”
“We just really felt we were being called to do something, to make a difference for other people who were impacted by mental illness,” Craig says.
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