Proposed budget will add to the cost of mental illness in Oklahoma

Terri White, Commissioner of the state Department of Mental Health and Substance Abuse Services (ODMHSAS), has frequently said that mental health has never been adequately funded in Oklahoma. The state ranks 44th in the nation for mental health spending per capita, and hundreds of thousands of Oklahomans aren’t receiving needed treatment for mental illness. The Legislature’s proposed 2017 budget shows no sign of bucking either trend.

Oklahoma’s midyear revenue failures prompted nearly $23 million in cuts by ODMHSAS. Just over $4 million was cut from agency administration, while the rest fell in three areas: cuts to providers, reductions in services, and a postponed mental health court expansion. These cuts eliminated or reduced services for tens of thousands of Oklahomans, moved those services further out of reach for thousands more, and meant less preventive screenings and early intervention.

The FY 2017 budget restores $7 million of the Department’s mid-year cuts, but it still leaves the agency $16 million below this year’s initial funding level and even further below what is needed to pay for services in the coming year. Lawmakers’ failure to meet core funding needs for mental health care will leave thousands of Oklahomans without access to needed care.

Cuts mean fewer options for mental health and substance abuse treatment

Combinations of cuts and payment delays to providers make up the largest share of the cuts. Reimbursement rates for private mental health and substance abuse treatment providers were cut between 3 and 30 percent. When we reduce payments to providers, it can cause them to stop contracting with ODMHSAS, so there will be fewer options for patients in need of help. For providers with a high volume of ODMHSAS contracts, these cuts and payment delays can destabilize their businesses and threaten access to care for all of their patients.

ODMHSAS also limited access to services to cut spending. A cap on Medicaid psychotherapy services will mean reduced services for more than 73,000 Oklahoman – by far the largest group directly impacted by this year’s cuts. ODMHSAS also postponed an expansion of Systems of Care, a highly successful program that works with children with complex mental health and substance abuse problems who are also being served by other agencies, such kids in the Department of Human Services’ child welfare system. The ODMHSAS cuts also limited treatment plan updates to once per client every six months, so treatment programs will be less able to respond to changing patient needs.

Postponing mental health court expansion will add to prison costs

[pullquote]“The state’s jails and prisons will continue to struggle with providing mental health treatment they were never designed for. It means more Oklahomans in need of help will instead find themselves caught in a system that continues to punish them long after they’re released.”[/pullquote]

Drug and mental health courts are notably cheaper than incarceration – it costs $5,400 per year for one person in mental health court, compared to $23,000 per year for incarceration of someone being treated for serious mental illness. Mental health courts have also been shown to be very effective at helping people stay out of trouble – three years after treatment, fewer than 4 percent of mental health court graduates were incarcerated, compared with 41 percent of released inmates with serious mental illness.

That’s a significant cost savings, but because of cuts, a planned mental health court expansion has been postponed. That means the state’s jails and prisons will continue to struggle with providing mental health treatment they were never designed for. It means more Oklahomans in need of help will instead find themselves caught in a system that continues to punish them long after they’re released.

Fewer alternative court systems aren’t the only way that mental health cuts are increasing pressure on the criminal justice system. The cheapest option by far is to provide preventive mental health care that keeps people out of the criminal justice system altogether – but provider cuts and care volume reductions will make it harder for Oklahomans to access that care.

The bottom line

Earlier this year, ODMHSAS proposed a policy change that would have ended payments to private counselors for children covered by SoonerCare. The outcry from those affected was swift and intense, and Governor Fallin eventually rejected the measure. Opponents of the measure suggested other cuts that could have been made instead, but the broader issue was that – as later cuts showed – there were no good options. Like the Department of Human Services, ODMHSAS is long past the point where they can make cuts without directly affecting access to care. It’s not the way the pie is sliced that’s the problem – it’s that the pie has never been big enough.

Supporters of the proposed budget have suggested that the limited appropriations offered to mental health and substance abuse services are the best the Legislature can do under the circumstances. But that simply isn’t true. Lawmakers had a number of opportunities to raise revenues to make these critical investments in Oklahomans – like using some of the nearly $250 million left in the the Rainy Day Fund and like stopping an income tax cut that they’ve allowed to happen at the worst possible time. They just chose to ignore these options.

In March, Commissioner White warned that midyear cuts could lead to an increase in the state’s suicide rate. By failing to restore the midyear cuts or provide additional needed funding, the proposed budget gives us no reason to expect otherwise.