Terri White, commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services, and Michael Brose, executive director of the Mental Health Association of Oklahoma, speak at Wednesday's "Oklahoma Watch-Out" forum in Tulsa. Credit: Jennifer Matthews / Oklahoma Watch

While there have been some moves in Oklahoma to better address the state’s high rates of mental illness and substance abuse, the surface has barely been scratched, experts said Wednesday.

Terri White, commissioner for the Oklahoma Department of Mental Health and Substance Abuse Services, and Michael Brose, executive director of the Mental Health Association of Oklahoma, formerly the Mental Health Association in Tulsa, spoke to a crowd of around 75 at Oklahoma Watch’s second “Oklahoma Watch-Out” community forum event, held Wednesday evening at the Circle Cinema in Tulsa.

Mental illness is the third leading cause of chronic disease in Oklahoma behind pulmonary conditions and hypertension, White said, but mental illness is often looked at as somehow different from other diseases.

“We are an incredibly unhealthy state,” White said, citing the state’s low health rankings in several categories. “What’s not surprising is that we have high rates of mental illness and addiction, because mental illness and addiction are diseases just like any other disease, and I think that may be one of the most important things we’ve got to grasp as a state.”

New mental health parity requirements by the federal government and efforts within the Oklahoma have helped advance coverage and treatment of mental illness, Brose said. The Affordable Care Act also will expand access because mental health is one of the essential benefits every plan must have. Yet there is still a long way to go, Brose said.

“We treat things downstream in Oklahoma,” Brose said. “We’ve got to move things upstream and be more preventative, try to identify things earlier in early childhood, be able to give access to care. If we really embrace this, we can move that needle.”

Although the state has many resources for those seeking help for mental illness and substance abuse, it lacks some important types of providers and has a large gap for people being able to access available resources, White said.

“There are people today who have lots of resources and they still can’t get the help they need or the right fit, or have family members who aren’t willing to get help or talk about it because of the stigma,” White said. “This is a multi-faceted issue, it’s not just one silver bullet.”

On the issue of suicide, Brose said it is an issue avoided by most people, a stigma that can prove deadly for those considering suicide as a way out. Training people in the “Question, Persuade, Refer” intervention method can help people learn how to broach the subject with someone who might be thinking of suicide, and possibly save a life, he said.

“We’ve got a lot of work to do,” Brose said. “We’re losing people to self-harm.”

Prisons and jails have taken the place of state hospitals for the mentally ill, Brose added.

“They’re our new institutions,” Brose said. “We’re all celebrating the closing of state hospitals and now we have them in jails.”

Diversionary programs, such as drug courts, have not only been shown to be less expensive than the “tough on crime” approach of locking up people addicted to drugs, White said, but also more effective as well.

“Drug court is $5,000 a year per offender. Prison is approximately $19,000 a year per offender. It’s clearly less expensive,” White said. “Five years after graduation for people in drug court, less than 25 percent of them have been re-arrested. For people who served their prison sentence for the same crimes, five years after release, over 50 percent of them have been re-arrested.”

Gov. Mary Fallin’s recent efforts to increase funding for state mental health and substance abuse services have helped Oklahoma’s current situation, White said, but the state still faces a stark lack of services for those people, brought about by decades of underfunding.

“We don’t have enough services. Law enforcement is driving all over the state, hundreds of miles, trying to find beds for people,” White said. “We have outpatient waiting lists with criteria and we turn people away every day because ‘gosh, you’re just not sick enough and we can only serve the most ill, so come back when you’re sicker.’ Because that’s a really great way to do health care, right?”

People who attended the event brought up various personal dilemmas. One man said he had reached out to mental health professionals and gotten little assistance for a stepson who refused to get treatment for mental health problems. A woman who is a counselor at a rural high school said many parents of mentally ill students refuse to allow the school to make a referral for treatment because of the stigma of mental illness. In some cases, the parents themselves have mental health issues, she said.

Another woman, referring to White’s and Brose’s calls for more funding and preventative investment, wondered how much additional funding would be available for mental health services had the state chosen to accept federal funds to expand Medicaid under the Affordable Care Act. Brose responded, saying he supported expansion.

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