NAMIGrading the States: A Report on America's Health Care System for Serious Mental Illness
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Grading the States 2006: Oklahoma - Narrative

Oklahoma is slowly progressing and turning into a light of hope for the future, provided recent trends continue. To some degree, the fact that the state receives a "D" in this "report card" may be a reflection of how bad the system was before current improvements began.

Leadership from the Oklahoma Department of Mental Health and Substance Abuse Services (DMH) and the Oklahoma Healthcare Authority (OHCA) - the state Medicaid agency - along with modest increases in funding from the legislature have been the keys to overcoming decades of neglect. The state has been moving from an antiquated mental healthcare system to one based on proven, cost-effective practices focused on recovery.

In 2005, Oklahoma was one of only seven states to receive a federal transformation grant. The state's Medicaid program also has shifted definitions of services from the support to the recovery model. One needs to look back only as far as the late 1990s to see a system that was one of the lowest funding priorities for the state legislature.

DMH Commissioner Terry Cline's leadership is credited with helping make the difference, through receptiveness to change and a commitment to improvement in the quality of services. It also helps that he has Cabinet-level status - serving as the Governor's Secretary for Health, with oversight and liaison responsibility for DMH, OHCA, and other agencies.

NAMI has recognized Oklahoma nationally for model implementation of Assertive Community Treatment (ACT), which has grown in five years from zero teams to this year's 14.

The state's mental health statistics division is also recognized nationally as innovative and comprehensive - one of the most fundamental tools for effectivemanagement that many states surprisingly overlook.

Ironically, however, Oklahoma fared poorly in NAMI's test of basic information accessibility for consumer and families. There also are more serious problems.

Since 2000, the state has closed one of two hospitals, attempting to redirect resources to community-based services. The strategy's implementation has proven chaotic and exposed state disorganization and lack of service capacity.

Every system requires balance. There is a role for state hospitals for longer-term inpatient care, along with crisis centers and short-term acute and intermediate carefacilities in communities, as well as outpatient services like ACT, supported housing, and independent living. When community services are not available, the entire system backs up. The state is now floundering to try to provide an adequate number of psychiatric beds. Many Oklahomans who need psychiatric hospitalization face four-to-six hour trips to the nearest receiving hospital. The solution lies in building overall capacity.

One of Oklahoma's most critical challenges is to develop a specific strategy for providers and services in rural areas. The system is strongest in the Oklahoma City and Tulsa metropolitan areas, where 60 percent of the state's population is located. Rural families have less access to services and fewer options - complicated by high rates of co-occurring substance abuse. Shortages of qualified staff are common. Quality of services is often low.

In some cases, technology can overcome distance. In 2005, the Northwest Center for Behavioral Health worked with NAMI Oklahoma to place video and audio Internet connections in three counties for emergency commitment hearings, staff meetings, and other needs - resulting in almost tenfold savings in time and travel costs. The program reduced stress for some patients, who previously had to be transported in handcuffs, and allowed staff to spend more time with others.

Oklahoma has one of the highest incarceration rates in the nation, and, using even the most conservative definition, 21 percent of inmates in state prisons have serious mental illnesses. For women inmates, the figure is 40 percent.

Challenges are not limited to state correctional facilities. Some of the toughest ones involve jails in rural counties. The U.S. Department of Justice (DOJ) has recently confronted the jails in Garfield and LeFlore Counties for alleged violations of patient rights to mental health treatment.

The state is moving to decriminalize mental illness by establishing police Crisis Intervention Teams (CIT), expanding mental health training opportunities for rural police agencies, and developing mental health courts to divert individuals into treatment.

Long-term housing is also a significant concern for the state. As Oklahoma moved too aggressively in the early 2000s to reduce state hospital capacity, more and more citizens with mental illness ended up in residential care homes with few supports and poor treatment availability. Predominantly scattered across the eastern half of the state, advocates report concerns about neglect in such homes; there may be inadequate incentives to support recovery in residential care homes. Housing is becoming a priority for the state, but historically, it has been a significant shortcoming.

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