Editor’s note: This story describes mental health issues. If you or someone you know is struggling with mental health issues or thoughts of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en español: 1-888-628-9454) or the Crisis Text Line by texting HOME to 741741. Local resources are available by dialing 2-1-1.
The months after Kelsi Gatliff’s eight-year marriage ended in 2019 felt like a spiral.
The now-29-year-old lost full custody of her young son and moved in with a friend in Stillwater. She began drinking more and struggled with severe depression. Gatliff stopped wanting to ever leave the house. A concerned friend called police to check on her in June.
“You don’t want to bother other people even though you feel like dying,” Gatliff said. “I struggled immensely.”
When the Stillwater police officer arrived, she handed Gatliff an iPad that she could use to talk to a mental health professional. After a short assessment, Gatliff agreed to a brief stay at an in-patient facility. Once she finished in-patient care, mental health professionals gave her an iPad to use for continued remote counseling. She says the iPad was a lifeline to appointments with a therapist.
“When you’re depressed, you don’t want to get out of bed. You don’t want to move half the time,” Gatliff said. “This is life saving for me.”
This is how Grand Lake Mental Health Center Chief Operating Officer Josh Cantwell expects crisis calls to go in northeast Oklahoma. Grand Lake is the primary mental health care provider for a dozen counties in the area. The center has been distributing iPads to law enforcement and patients since 2016 to make treatment and mental health assessments more accessible.
The approach has drastically lowered the number of people in the area who are hospitalized for a mental health crisis, which providers say can be expensive and disruptive to a person’s life. Being hospitalized is the highest level of care, Cantwell said, and can mean staying involuntarily at a hospital for five to 10 days.
Over 1,100 people in Grand Lake’s service area were hospitalized for a mental health crisis in 2015, Cantwell said. But no one in the center’s service area was hospitalized in the first six months of 2021 because other, less intense care options were more widely available and services were reaching people more quickly.
State law allows police to take people in crisis into protective custody and transport them to the nearest emergency room for a mental health assessment. But police can sometimes wait for hours at the hospital for an assessment, leaving some law enforcement agencies reluctant to take people into protective custody. Using iPads shortens the process.
“It used to be that everybody was just putting up with each other enough to get the people some help,” Cantwell said. “It was very tough. … But it seems like it’s lining up now.”
The Oklahoma Legislature invested more than $15 million in this year’s budget to expand the state mental health department’s comprehensive crisis response system, which aims to deliver services earlier in order to divert people away from the criminal justice system or hospital stays.
The money will provide additional iPads for law enforcement agencies across the state, as well as build new mental health crisis centers and expand mobile crisis services to adults.
“It’s all about there not being one single solution to serving individuals in crisis, but really about having a lot of tools in our hands to be able to serve individuals where they are,” said Nisha Wilson, the chief clinical strategy officer for the Oklahoma Department of Mental Health and Substance Abuse Services.
“Historic” investments
The state has long underfunded mental health programs because of budget shortfalls. Programs were cut, and providers were hard to find, especially in rural areas. State officials said this year’s funding is “historic” and the largest investment in crisis services ever made.
“We’re grateful for it,” said Heath Hayes, a spokesperson for the state mental health department. “We know that earlier access to treatment services and access to the right levels of care get people into what we call recovery sooner and quicker.”
Up to 80 percent of patients who encounter the state’s current crisis response system don’t need more intensive care or involvement with law enforcement, three mental health department officials said.
The largest chunk of new state dollars — $7.5 million — will be spent on building four mental health crisis and urgent care centers. The state currently has eight urgent recovery care centers, Hayes said.
The centers are “emergency rooms for mental health,” Hayes said, allowing individuals to get short-term crisis care for up to a few days, including medication, food and case management, which can connect them to other resources such as housing.
Grand Lake Mental Health runs one crisis center and three urgent care facilities in the state. At their 18,000 square-foot facility in Pryor, the back half of the center is split into two sections by a nurses’ station with glass dividers. Offices and the lobby are at the front of the building.
More than a dozen hospital-style reclining chairs are positioned on one side of the glass divider. State law allows people who are involuntarily admitted to stay in the recliners for up to 23 hours and 59 minutes before they must be released or transferred to a bed. The other side has a central seating area and five small rooms with single beds for longer stays. Police can use a special entrance to drop people off at the center, said Nicholas Allgood, clinical director of crisis services for Grand Lake.
Staffers assess a person’s needs, then take their belongings into the facility’s storage unit.
“Some people bring their whole life, and that’s all they’ve got,” Allgood said.
When Gatliff stayed at Grand Lake’s facility in Stillwater, she said she was surprised by how well her time there went.
“I expected it to be like any kind of mental health facility, especially here, to have horror stories,” she said. “When I left here, I had an entire team of people behind me that were not going to let me fail, and they weren’t going to go away.”
The state will build the new crisis centers where demand is high and areas where law enforcement have to transport individuals long distances for services, Hayes said.
Shawnee is high on the state’s list of possible locations. Jon Greenwood, director of Gateway to Prevention and Recovery, said a center there would allow rural areas east of Shawnee access to services that are typically only available in the Tulsa and Oklahoma City metropolitan areas.
“When you think about how rural it gets beyond Shawnee, this will be a game changer,” Greenwood said.
Officials believe the additional centers; a new law that allows the state mental health department to transport people to facilities further than 30 miles away instead of police; and an additional $2 million in funding will ease the burden on law enforcement to handle crisis calls.
Another $3 million in state funding is dedicated to increasing the number of mobile crisis teams to respond to mental health calls for adults across the state. Oklahoma already has a statewide system that responds to mental health calls for children and young adults up to age 25 in crisis.
The team serving Cleveland and McClain counties has already responded to 500 calls since the beginning of 2020, said Brianna Norman, the lead licensed behavioral health professional for the central Oklahoma mobile crisis team.
Crisis teams are available 24 hours a day, seven days a week, and respond either with a phone call or on location, Norman said. Typically, teams respond to calls within an hour. The goal is to de-escalate a situation before someone ends up involved with law enforcement or at a hospital. If a person needs more intensive care, the teams connect them to a crisis center or another provider.
Between January 2019 and January 2021, the youth mobile crisis system responded to over 13,000 calls, mainly for teenagers and young adults experiencing depression, family conflicts, suicidal ideation, and children who displayed violent behavior, according to a recent state report.
The service has allowed most young people to stay in their homes and with their families, Norman said. But adding adult mobile crisis services will require additional training and collaboration, she said.
“The types of crises are going to range very differently,” Norman said. “(Expanding) will really help to provide the full array of services for all people.”
Lawmakers have dedicated $2 million to expand the use of iPads that allow law enforcement officers in the field to connect individuals in crisis with therapists. More than half of all officers already have iPads, and state mental health officials hope the funding will be enough to cover all officers as well as some fire departments and emergency responders.
Another $500,000 will pay for contracts to provide crisis intervention services for law enforcement officers, which can also be delivered through the iPads.
Ray McNair, president of the Oklahoma Sheriff’s Association, said he’s heard from several sheriffs that the iPad program has helped lower the number of people deputies take to jail.
“We have found when they get the opportunity to talk to a therapist, (the therapist) can sometimes convince them to go in and take their medication. They can convince them to do what they need to do,” he said.
Next steps
These efforts have more quickly delivered mental health treatment to thousands of Oklahomans in need and saved the state and local governments millions of dollars in jail or hospitalization costs. But communication with local officials and shortages of mental health beds are still barriers, especially after the COVID-19 pandemic caused an uptick in the number of people needing mental health and substance abuse services, officials said.
The state already offers many mental health services, but some providers, potential patients and local government officials aren’t aware of what the mental health department currently provides, said Jeff Dismukes, a department spokesman.
As these programs expand, Dismukes said the state will boost its public awareness campaigns to better inform the public.
But Oklahoma will continue to have a limited number of mental health beds until the new crisis centers are eventually built throughout the state.
Crisis teams sometimes struggle to find an open in-patient bed in the state, Norman said. A shortage of beds can mean some people end up in hospital emergency rooms or go to a facility outside of Oklahoma.
That current shortage is why providers feel like this year’s financial investment is so profound — new in-patient facilities will be built and out-patient services will be expanded.
“The way the system’s going to work a year, two years, three years from now?” said Durand Crosby, chief of staff for the mental health department. “All of these things combined are going to reduce a lot of the pressures that communities are feeling.”
For Gatliff, her iPad allows her to connect with a counselor remotely as she tackles her depression. In the three months since she first visited one of the state’s crisis centers, Gatliff said she’s making progress.
“There is a stigma around mental health, and dedicating money to it and showing that this is a real problem makes it palatable for people,” Gatliff said. “I think it is the most important investment the state could possibly make.”
