Editor’s note: If you or someone you know is experiencing thoughts of suicide, call or text 988 to connect with a mental health specialist. 

The Frontier is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in select states across the country.

After her arrest for a small amount of methamphetamine in 2017, U.S. Army veteran Krysten Gonzalez signed an Oklahoma County Mental Health Court contract agreeing to behavioral health treatment in exchange for the chance to stay out of prison.

The requirements were extensive: She promised to make every court hearing, treatment appointment, support group and probation check-in. She couldn’t use drugs or alcohol and would undergo regular drug testing. She could be searched at any time. She was required to pay $960 in probation fees. And she couldn’t associate with anyone who had a felony conviction.

Gonzalez was sexually assaulted during her time in the Army and endured years of depression, anxiety, post-traumatic stress disorder and struggles with substance use, said Derek Franseen, an attorney for Gonzalez’ family who is suing the county on her behalf. The court listed Gonzalez as homeless. Between 2016 and 2018, she was charged with possession three times, obstructing an officer and breaking and entering a stranger’s house in Midwest City to ask if she could use the bathroom. 

The mental health court agreement was difficult for her to manage. Without permanent housing, transportation or a cell phone, court officials say the requirements can be challenging for people with serious mental illness. If they miss appointments or don’t maintain sobriety, they can fail the program and end up in prison. 

A judge issued warrants for her arrest when Gonzalez missed court dates. She was booked into the Oklahoma County Detention Center in October 2018 and held without bond while the county searched for a bed at an inpatient mental health treatment facility. She was still waiting in January 2019 when she died by suicide alone in her cell at age 29. 

Oklahoma County officials launched a new program this spring to pull people with mental health conditions and eligible offenses out of the jail entirely and send them to community-based treatment. The goal is to divert people from jail entirely, but the program has no funding yet.

The Court-Ordered Outpatient Treatment Program — CO-OP for short — has less supervision for participants than mental health court. Participants don’t have to come back to court every week, and their criminal charges are typically dropped up front. When a person isn’t complying with program requirements, law enforcement takes them to a treatment provider for a new assessment instead of back to jail. 

“(Gonzalez is) the type of individual who probably would have been approved,” said Oklahoma County Public Defender Bob Ravitz. “She probably would have gotten out of jail and been alive, in my opinion.” 

CO-OP already has about 130 active participants since it began at the start of April. 

In recent years, officials have recognized people with mental illness are often held in jails or prisons but don’t receive effective treatment there. Public pressure has pushed state and local governments to create new programs and expand access to care. But a workforce shortage, stigma around treatment and years of financial neglect keeps people across the state from reaching treatment. 

Without funding and dedicated staff, the county employees who run CO-OP are fighting to keep up with their other responsibilities and what they describe as exponential growth in the program. Some of the mental health providers that treat CO-OP participants aren’t fully staffed either.

“Once we started, the floodgates just opened with referrals,” said Madison Mélon, an attorney with the Oklahoma County Public Defender’s Office who supervises diversion programs. “We just keep going because getting connected to services in the community in whatever capacity we’re able to facilitate is better than them languishing in the jail.” 

Keeping people with mental illness out of jail 

Gonzalez’ death sparked the Oklahoma Disability Law Center to investigate mental health care access at the Oklahoma County jail. Last year, the U.S. Department of Justice announced it was investigating whether Oklahoma fails to provide community-based mental health treatment and how the Oklahoma City Police Department responds to mental health calls after the Law Center and the ACLU of Oklahoma filed a joint complaint.

Nick Southerland, an attorney with the Law Center, helped Oklahoma County officials create the CO-OP program. 

“While we believe that the CO-OP program is a step in the right direction when it comes to keeping people with mental illness out of jail, we are still working to ensure that people who are in jail receive the care that they need,” Southerland said.

Every county in Oklahoma is experiencing a shortage of mental health professionals, according to 2023 data from the Rural Health Information Hub. Oklahoma has underfunded mental health programs for years. State mental health funding declined 11% over the past decade when adjusted for inflation, a state oversight report found in 2022. 

Many Oklahomans don’t access care until a crisis happens. If that crisis lands them in a county jail, they are 13 times more likely to die from suicide than the general population, said Elizabeth Hancq, director of research with the Treatment Advocacy Center, a national nonprofit that pushes for better access to mental health treatment. 

Oklahoma County has one of the deadliest jails in the nation. Forty-three people have died in the jail since August 2020, according to jail records and medical examiner data. Nine deaths were suicides. Another six had a documented mental health issue but died because of other health problems, according to court documents, medical examiner reports and family statements reviewed by The Frontier. 

The jail typically has around 150 people on mental health observation at any given time, jail administrator Brandi Garner told the facility’s oversight body in August. Nearly half of the 2,200 people with low-level offenses screened at the detention center between October 2022 and June 2023 reported current or past mental health needs, according to numbers provided by a jail diversion program. 

The longer someone is at the jail, the more their mental health deteriorates, said Donna Hanson, the jail’s health services coordinator. People with a severe mental illness typically return to incarceration more frequently than those without a mental illness, according to a 2018 study by the U.S. Government Accountability Office.

People with mental health conditions can sit in the jail for months because they can’t post bond or are waiting for a mental health evaluation. Most people in the jail are being held pre-trial.

The facility has struggled for decades with overcrowding, leaks, mold and bed bugs. In 2021, inmates took a correction officer hostage and said they weren’t allowed to shower and toilets were backed up. Staffing shortages have made it difficult for inmates to access what little mental health care is available. 

Faster access to treatment

The new CO-OP program relies on the Labor Commissioner Mark Costello Act, an Oklahoma law that allows a person to be court-ordered into mental health treatment if they are a danger to themselves or others and may not pursue treatment on their own. Lawmakers approved the act in 2016 after Oklahoma Labor Commissioner Mark Costello was killed by his son who had a history of severe mental illness. 

CO-OP is designed to be a one-year program in civil court where a person agrees to attend mental health treatment in exchange for being quickly released from the county jail and having their charges dropped up front. This means the process can move quickly. Officials say their goal is to identify and accept a person into the program within 48 hours. 

Jail staff send a list of people who they’ve identified as having a serious mental health condition to Mélon in the Public Defender’s Office. She looks over their charges and treatment history, and sends the names of potentially eligible people to the District Attorney’s Office for final consideration. Other lawyers or judges can also refer people to the program.

People with low-level misdemeanors or felony charges can be accepted into the program, as long as they don’t have a history of sexual misconduct or serious violence. Jeff Massey, an assistant district attorney in Oklahoma County, said he talks with any crime victims, looks over possible damages a person might have to pay back and whether the person has charges from another county before admitting them into the program. Roughly 30% to 50% of applicants sent to Massey get approved for the program, he said. 

People in the program have charges like trespassing, disorderly conduct or assault and battery on a police officer or health care worker, said District Judge Sara Bondurant, who presides over the CO-OP program. When people are in a crisis or dealing with a chronic mental illness, these are the types of charges that can keep them in jail, Bondurant said.

So far, the program has about a 50% to 60% compliance rate, Massey said. 

Program officials expect many CO-OP participants to also be experiencing homelessness. About a quarter of unhoused people in Oklahoma City self-reported having a severe mental illness, the city’s most recent count of people experiencing homelessness shows. And in January, at least 11% of individuals in the county jail were homeless, according to a report by the Oklahoma County Criminal Justice Advisory Council. 

“It’s important that people do understand that these are individuals who are not hardened criminals,” said Michael Hanes, associate clinical director at Hope Community Services, one of CO-OP’s mental health providers. “I hope we can get the community to understand and have compassion for this population, and that incarceration is not the answer.”

People experiencing homelessness face additional barriers to care, providers said. Even if they’re in a program like CO-OP where they have access to a mental health provider, without a safe place to live, managing mental health long-term will be difficult. 

Many providers that work with CO-OP try to provide wrap-around services, so participants aren’t just getting mental health treatment but are also being connected to housing services or collecting important personal documents. 

Yet that level of staffing requires money, which many providers and court programs are missing, and time to work with people until they are ready to engage fully in recovery. 

The Oklahoma County Crisis Intervention Center has a “no wrong door” policy, providing services or resources to anyone who comes to the facility as many times as they show up, said Lauren Stover, director of the center. The crisis center works with CO-OP to provide services and assessments.

“You never know what you say differently or provide differently that could finally be the thing that clicks for them,” Stover said. 

Lack of funding

A collection of sticky notes and pieces of paper with names and dates help Mélon, the public defender who runs diversion programs, keep track of the growing number of CO-OP participants. 

 Mélon and one other public defender take on the brunt of managing CO-OP referrals and patient appointments. She gets to work early to meet with potential participants at the jail. Anywhere from 50 to 100 CO-OP emails ping her inbox every day. She bounces between tasks for CO-OP and seven other diversion programs. 

“Thinking that ‘I’m not going to be thrown in jail, and I’ll get another opportunity’ is really meaningful to people,”  Mélon said. 

One CO-OP participant had charges stemming from a public suicide attempt on “the worst day” of their life,  Mélon said, but is now receiving treatment with minimal court contact. That success makes the work meaningful, she said. 

CO-OP was inspired by a similar program in Tulsa that has diverted over 600 people from the local jail since 2020, according to the Tulsa County District Attorney’s Office. 

The Tulsa program has nearly $1 million in grant funding to spend on full-time staff, data management and treatment. It’s considered an effective program with around 90% of participants engaging in their treatment plans consistently, said Stan Lane, the program coordinator. 

As Oklahoma County’s program continues to grow, officials say they’ll struggle to manage without additional funding or staff. The intake process can take a few days to more than a week, with people waiting in jail in the meantime. The State Department of Mental Health covers treatment costs for most participants through Medicaid.

“Only time will tell if we have the appropriate provider network to handle all of these people,” Mélon said. “It goes back to the money issue.”

Outpatient treatment programs are growing in popularity across the country, and many begin without funding like CO-OP, Hancq said. That can make it difficult for programs to keep up with demand, especially if treatment providers are spread thin, she said. 

Oklahoma County could apply for federal grants to fund the program or might be able to tap into money that voters approved through State Question 781, a citizen-led ballot measure in 2016, said Timothy Tardibono, director of the Oklahoma County Criminal Justice Advisory Council. 

The ballot measure called for state money saved by reducing penalties for some drug and property crimes to be divided between counties statewide for mental health treatment. Lawmakers have dragged their feet on putting money into the fund but have finally agreed on spending more than $12.5 million over the next year. 

With future funding, the CO-OP program hopes to help people in a mental health crisis to avoid jail altogether. Police would instead take people in crisis to a local mental health center, where they would immediately be connected to an attorney and approved for treatment without ever being booked into jail. 

Until then, people in crisis at the jail are relying on a small team to find them and connect them to resources. Officials say the program won’t turn away eligible applicants despite capacity concerns.

“If we have 1,000 participants, I’ll spend my time doing this,” Bondurant said. “That would be absolutely fine. Because this is so important and so critical in our community.” 

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