Surrounded by dozens of representatives from across the state, including from hospitals, law enforcement and other state agencies, the Oklahoma Department of Mental Health and Substance Abuse Services outlined budget cuts that were described as “unprecedented” and “devastating.”
“This is a really difficult day for our department and for the behavioral health network across the state of Oklahoma. It is an especially difficult day for the families and individuals who rely on our life-saving services,” said Terri White, commissioner of ODMHSAS.
The agency announced Wednesday afternoon it will start implementing a 23 percent cut to its budget on Nov. 1 if the Legislature doesn’t appropriate additional funds by then. The cuts will involve eliminating all outpatient services statewide.
The announcement to eliminate services comes after ODMHSAS lost $75 million of its budget. The agency reported it’s losing an additional $106 million in federal matching funds.
Eliminated services will include all state-funded outpatient services for people who have no insurance and behavioral health Medicaid-eligible patients. Drug courts, mental health courts and other court-related programs will no longer be funded.
The state’s Systems of Care program, a comprehensive mental-health program for children and their families, will be discontinued.
Mental health advocates and state leaders who attended the news conference announcing the service cuts said they expect eliminations to strain law enforcement agencies, hospitals and the economy.
Cuts of these magnitude are “unprecedented,” said Dr. Jason Beaman, chair of the Department of Psychiatry and Behavioral Science at Oklahoma State University Center for Health Sciences.
“It would place us in 100 out of 50 (states) in mental health services here in Oklahoma,” Beaman said.
Mental health advocates have said Oklahomans lack access to outpatient care. After ODMHSAS made recent cuts to its programs following state budget shortfalls, options decreased across the state.
Low-income people who depended on state mental health programs have few options and often seek treatment in emergency rooms or crisis centers.
Oklahoma is facing a $215 million state revenue shortfall because of the reversal of cigarette “tax” of $1.50 per pack. A fee on tobacco purchases was passed in the final days of the legislative session, but the Oklahoma Supreme Court ruled in August — the same month it was to go into effect — that the fee was actually a tax, and therefore unconstitutional under laws governing tax increases. Under a constitutional amendment passed by voters in 1992, tax increases require approval by three-fourths of both Legislative chambers.
The tax was estimated to bring in more than $200 million for the state’s budget.
The Legislature was called into special session on Sept. 25, but has been unable to come to an agreement on how to deal with the budget shortfall.
White said the agency will begin running out of money on Dec. 1.
“We will not have enough money to pay all of our bills,” White said. “We are $6 million short. By Jan. 1, we are $17 million short. By Feb. 1 we are $30 million short. It goes on from there. By June 1, we are $75 million short of paying for the required services currently provided by the state of Oklahoma.”
ODMHSAS reported the cuts will affect almost 189,000 people who are currently receiving outpatient services. Seven-hundred treatment agencies and more than 8,500 therapists, case managers, doctors and nurses will also be affected.
The only services the agency will provide are acute inpatient for adult and children; crisis care for adults and children and medication.
For Family & Children’s Services, the largest outpatient community in Oklahoma, the cuts will be “catastrophic.” The organization provides treatment for almost 18,000 adults with serious mental illness and 4,200 children with behavioral disorders health every year, it said in a statement.
“Without legislative action, all these services are in jeopardy,” the statement said.
On Monday night, The Tulsa Psychiatric Association penned a letter to Tulsa Mayor G.T. Bynum outlining how deep cuts to the Department of Mental Health and Substance Abuse Services could affect the city.
“Without this funding, a majority of Tulsans will not have access to psychiatrists, psychologists, therapists and other services,” the letter states. “These agencies include one of the few places for children to receive mental health help.”
People who have severe mental illnesses will lose access to medications, the letter says. The loss of mental health services would strain the Tulsa Police Department.
“As individuals attempt to self-medicate, there is likely to be a rise in drug use and subsequent criminal activity.”
As of Wednesday evening, Bynum had not yet received the letter, a spokeswoman said.
Melissa Baldwin, director of justice and policy for Mental Health Association Oklahoma, also called the cuts “catastrophic.”
“There’s a huge humanitarian issue here for people whose lives will seriously be lost due to suicide, due to opioid addiction, but also it’s an economic issue for the business communities, which they’re very concerned,” Baldwin said. “For me, it’s a very harsh public safety issue.
“You’re going to see homelessness and crime rates increase when people don’t have access to services, and people are unemployed, and then the unemployment rate is going to go up, which is going to impact all these other core functions of government.”
Joy Sloan, chief executive officer of Green Country Behavioral Health Services in Muskogee, said the elimination of services will destroy the people’s live who depend on them.
“Once our infrastructure is impacted, it’s going to have to be rebuilt,” Sloan said. “It cant be rebuilt overnight. If our Legislature fails to act, our infrastructure crumbles. … There will be total devastation if our Legislature fails to act.
“I just cannot comprehend why our Legislature will just not do its job. Do the job they were simply voted to do.”
Steve Buck, executive director of the Office of Juvenile Affairs, spoke on behalf of his agency as well as on behalf of the Oklahoma Department of Human Services. He said he often sees young people who do not have access to behavioral health services.
“I know that today that 50 percent of the young people in the care of my agency have an existing open file from behavioral health services,” Buck said. “I know also that a minimum of one-third of their parents are actively involved or have a recent history of some level of treatment or engagement.”
Buck said behavioral services are often the preventative measure that keeps children from drifting into the juvenile justice system.
“During my career, I’ve had a lot to talk about and think about what lack of access to behavioral health care looks like. I narrow it down to three Cs,” Buck said. “There’s three Cs to lack of access to care are: Coffins, cells and cardboard.
“We will lose lives if we cut out outpatient services. There will be people who will take their lives, and that’s a tragedy.”
More people will be incarcerated or experience homelessness, Buck said.
Craig Jones, president of the Oklahoma Hospital Association, said the cuts will cause a ripple affect through Oklahoma’s communities.
“What’s going to happen to hospitals across Oklahoma, is that their already stressed emergency department are going to be even more stressed because of these patients, these individuals finding themselves in more critical situations and ending up in the emergency department, a place that is ill-equipped to handle the needs that would otherwise would receive through these other services,” Jones said.
Representatives from the Association of Chiefs of Police outlined the impact the cuts will have on law enforcement.
“I’m here to tell you that too many Oklahomans begin their crisis in the backseat of a police car, and that’s not the way it should be. But that’s reality,” said Johnny Kuhlman, deputy chief at the Oklahoma City Police Department.
“First responders receive training and they understand the importance of getting services to these individuals. Services that a lot of times are unfortunately not available.”
In 2013, the Oklahoma City Police Department responded to more than 10,000 mental health calls, Kuhlman said. In 2016, that increased to more than 16,000. This year the agency anticipates more than 18,000, he said.
Under state law, law enforcement is the appointed body to transport people going through a mental health or substance use crisis to and from mental health facilities when they are deemed a danger to themselves or others.
The duty is taxing to police departments, as it requires additional resources. The Tulsa Police Department has also seen an increase in these types of calls.
Oklahoma Department of Corrections director Joe Allbaugh released a statement Wednesday evening about the importance of mental health and substance use services.
“In FY 2017, our resources only allowed us to treat 28% of those who needed addiction treatment before they released that year,” he said. “Of those under our supervision, approximately 50% are assessed with mental health and/or addiction treatment needs.”
Fifty-eight percent of people in DOC custody have a history of or are currently receiving treatment for mental health needs, Allbaugh said. Oklahoma’s prisons are at 110 percent capacity.
“Under the proposed scenario, these individuals will not receive treatment,” Allbaugh said. “Speaking on behalf of the Oklahoma District Attorney’s Council, Richard Smothermon, stated the cuts would effectively eliminate drug and mental health courts. He said this would leave the 4,600 participants with no alternative other than prison.
“If this occurs, it is clear the prison population will grow at an even faster rate than previously predicted.”
White said the agency is hoping the Legislature will come to a budget agreement before the cuts need to be implemented.
“I truly believe that the governor and the legislators of Oklahoma do not want to see $75 million of cuts implemented in the Department of Mental Health and Substance Abuse Services,” White said. “There is time to avoid this, but the only way for that to happen is for an additional appropriation to take place.”