This is the second in a series of Oklahoma Watch Q&As with state policy makers and other top officials and community leaders. In a previous Q&A, Oklahoma Commissioner of Health Terry Cline explores why the state refused federal money to expand Medicaid.

It’s no secret that Oklahoma consistently ranks near the bottom in state surveys of physical health indicators such as obesity, diabetes and smoking. It’s less well known that Oklahoma also has some of the highest rates of mental illness and addiction.

Gov. Mary Fallin cited those statistics and the Sandy Hook massacre when she asked lawmakers to provide a $16 million funding boost next year to the Oklahoma Department of Mental Health and Substance Abuse Services headed by Commissioner Terri White.

If the Legislature adopts Fallin’s plan, White’s department will use the added funding to open a new mental health crisis center, target prescription drug abuse, launch suicide prevention programs and expand counseling for disturbed children and their families.

In an interview with Oklahoma Watch’s Warren Vieth, White explains why Oklahomans report more mental illness and addiction problems than residents of other states. She discusses what the state can do to prevent tragedies like Sandy Hook and why she thinks her agency deserves a bigger slice of the state budget.

White, 39, is an Edmond native who received her bachelor’s and master’s degrees in social work from the University of Oklahoma. A former fiscal and policy analyst for the Oklahoma Senate, she has headed the mental health department since 2007.

How prevalent are mental health problems in Oklahoma?

We’re No. 2 in the nation in the number of adults struggling with mental illness. A lot of people are surprised when they hear that.

Think about our overall health rankings, though … We have high rates of all diseases in Oklahoma. So it’s not surprising that we have high rates of mental illness and addiction.

The brain is simply another organ in the body. When you’re in a very unhealthy state, when your population is unhealthy and has high rates of diseases, of course you’re going to have high rates of brain diseases as well.

We’re also a state that believes in people pulling themselves up by their bootstraps. In most cases, that’s a great way to approach things. But it has allowed for some misunderstanding about what mental illness and addiction are.

Has the stigma of mental illness contributed to the problem?

The stigma around mental illness and addiction is what has allowed us to get to the point in Oklahoma where for so many years, for decades, we have not provided the resources needed to address these issues.

No one should feel shame for having a medical condition. When people show up at the emergency room because they’re having a heart attack or a stroke, we don’t make them feel ashamed. We really have got to get to the day when all Oklahomans understand these are diseases like any other diseases.

Are there other causes?

We have incredibly high rates of trauma in Oklahoma… child abuse and neglect, domestic violence, the number of people that we have incarcerated… Those are huge contributors to whether someone is going to develop mental illness and addiction.

What thoughts went through your head when you learned about the Sandy Hook shootings?

What tragedies like this bring to light is what the consequences can be when people don’t receive the help they need.

When mental illness and addictions are treated, people live full and productive lives. They have families. They run companies. They represent us as our elected officials … People with mental illness and addiction can do anything when they have treatment.

Realistically, is there much policy-makers can do to address the problems that may have led to an incident like that?

Absolutely. That isn’t to say that there is a guarantee that a tragedy like this won’t ever occur again … But we can certainly lessen the chances significantly.

First, we need to do screenings. We’ve got to identify people who are at risk. How often does your physician ask you if you’re using drugs and alcohol or if you’re suffering from depression? It’s not happening. People aren’t being identified.

Second, we’ve got to make people more aware of what mental health and addictions really are. That’s where mental health first-aid training comes in. It helps people understand general information about mental health.

Would screening occur in schools?

We have some amazing partnerships already with schools. But we have many, many schools we still haven’t reached. The need is still huge.

Is Oklahoma doing all that it could to make sure guns don’t wind up in the hands of people with serious mental or emotional problems?

There is a national registry for persons that have been identified with mental illness. Our state could submit names to that. However, our state law currently prohibits us from doing so. There’s legislation this year to allow Oklahoma to begin submitting names to that database. It’s a joint effort between the district attorneys’ council, our agency, the administrative office of the courts and the (Oklahoma State Bureau of Investigation).

Have you had any personal experience or exposure to mental illness or addiction in your life?

I have family members who have struggled with the issue of addiction and mental health, primarily addiction. We’ve had a lot of alcoholism in my family.

If you ever meet someone who says that they have not been touched by mental illness or addiction, either personally or in their families or with a close friend, they simply don’t realize it. One in four Oklahomans struggle with mental health and addiction issues in their lifetimes.

What would you consider your biggest success so far?

A real change in the culture and a commitment to evidence-based, data-driven practices, as well as a commitment to stretching our dollars as far as possible. Some people would put those together and call it being cost-effective.

It’s the right thing to do for taxpayers in every case, but it is critical when you’re an agency that historically has been as underfunded as we have.

Mental illness is the third-leading cause of chronic disease in this state, yet we are funded 46th per capita to treat mental illness. We have one of the lowest rates of spending in the nation.

What is your biggest worry? What keeps you awake at night?

Probably my biggest worry is just how huge the treatment gap is in Oklahoma.

Every night there are people going to bed in this state who didn’t get the help they need … On any given day we have 600 to 900 Oklahomans who’ve actually made the step to ask for substance abuse treatment. They’ve had an assessment. They need residential inpatient services, and every single bed in the state is full.

How does Oklahoma’s suicide rate compare with other states?

We’re 13th highest in the nation, which is absolutely unacceptable. Suicide is a preventable cause of death.

If you think somebody might even be considering it, ask the question directly: Are you thinking of killing yourself? People will often answer honestly … If you ask that question, then get them on the phone with a professional or the crisis hotline, you can save a life.

How do you make the case that your department deserves a bigger share of the state budget than others?

Why do we deserve a bigger piece? It’s not simply because we’ve been historically neglected. It’s because we are the biggest public health problem, the most costly when left untreated, and we are the entity that is committed to using evidence-based programs with proven outcomes so that taxpayers know that every dime spent here is going save them a dollar somewhere else.

We’ve gone from 2,200 employees when I started to about 1,800 employees. We have lost services in local communities. Our waiting list has increased. We lost about 96 substance abuse treatment beds. We have had over $3 million in cuts to our private provider network over the last several years.

But some legislators seem to believe that government is just too big and that the solution is to shrink government across the board.

If the goal is to shrink government and spend less … put the dollars here. We can save you money in corrections, we can save you money in uncompensated health care, we can save you money in foster care.

If you really want to shrink the state budget, then you invest here to prevent these negative consequences that are costing you millions of dollars.

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