Funding Service And Delivery

CHAPTER I

Introduction:

The Bureau of Justice Statistics, [BJS], (2005), found that “mental illness is the second leading cause of disability and premature death in the nation and one in four Americans will experience some type of disability from a diagnosable mental illness in any given year” (n.p).

The United States Census Bureau, [USBS], stated in 2007:

Oklahoma’s population was 3,617,316. Approximately 1,308,505 live in rural areas and 15.7 percent of those are living at or below poverty level. Of the total population in Oklahoma, the percentage of the mentally ill is 10.4 percent, and is the highest in the nation, which averages approximately seven percent.

This means 376,201 persons were diagnosed or were treated for a mental illness in Oklahoma last year.

According to the National Alliance on Mental Illnesses, [NAMI], state-by-state report card (2006), they concluded:

Oklahoma earned a “D” for its failure to make the mentally ill population a statewide priority. Oklahoma is ranked forty sixth nationally per capita in funding for the treatment of mental illness, and that lack of support for the mentally ill translates into an overall economic impact of $1.8 billion annually.

While no numbers can calculate the distress accompanying mental disorders, the economic impact can be calculated and the numbers are astounding.

The National Center on Addiction and Substance Abuse [NCASA], (2001), concluded that “disability payments (SSI or Medicaid) to the seriously mentally ill, treatment costs, loss of

productivity, and the burden on the criminal justice system all contributed to this economic impact” (n.p.).

Since 1986, the state of Oklahoma has downsized two mental health inpatient hospitals, attempting to redirect resources to community-based services. Oklahoma downsized Western State Hospital at Fort Supply in 1986 and Eastern State Hospital at Vinita in 1999. By downsizing these facilities, this strategy has only proven to be chaotic, and exposed state disorganization and lack of service capacity. The state is now failing to provide an adequate number of psychiatric beds. Ironically, large sections of both hospitals were converted into prisons.

In 2005, while discussing Oklahoma’s current mental health system, Terry Cline, who was commissioner at the Oklahoma Department of Mental Health and Substance Abuse Services [ODMHSAS] from January 2001 until 2005, stated, “Oklahoma’s mental health system needs a radical transformation. Not a restructuring, not a tweaking, not an expansion, not a realigning, but a complete and total transformation.” Furthermore, “a transformed mental health system should focus on building people’s resiliency and promoting their recovery with the overall goal of вЂ?a life in the community’ for everyone with substance abuse and mental health issues”.

Many rural Oklahomans, who are in need of acute care psychiatric hospitalization, drive from two to six hours to the nearest receiving hospital. The federal government continues to aggravate the situation by maintaining a long standing ban on the use of Medicaid money to fund state mental health hospitals. Honberg, (2006), found that “consequently, approximately two million severely mentally ill people will not receive any psychiatric treatment or services in the United States in any given year” (p. 39).

As Oklahoma resources and accessibility to those resources continue to experience deficits, Oklahoma’s mentally ill find themselves in emergency rooms, homeless shelters and county jails or prisons. Honberg, (2006), also stated “mental illness is the number one public health crisis in the United States today and is frankly unfair and very poor public policy to saddle criminal justice systems with responsibility for responding to people with mental illnesses in crisis” (p. 39). As a result, jails and prisons have now become the new “psychiatric hospitals”. Prisons have taken the place of the two state-run mental hospitals that were downsized since 1986.

According to the Oklahoma Department of Corrections [ODOC], (2006):

Oklahoma has one of the highest incarceration rates in the nation; ODOC now houses over 9,610 inmates with a documented history of current symptoms of serious mental illness. Of those, approximately 5,500 meet most medical definitions of current serious mental illness that require treatment. Sixty eight percent of females and fifty four percent of males with mental illnesses had been incarcerated for non-violent crimes. The percentage of all offenders with mental illness who had no prior crimes (i.e., first-time offenders) was forty seven percent. While the total population of incarcerated offenders increased nineteen percent, the number of inmates requiring psychotropic medications increased 289 percent. Oklahoma is now beginning to experience an influx of persons with mental illnesses in county jails and prisons.

Oklahoma’s downsizing of the two state mental hospitals took advantage of the newly developed and less expensive medications that would allow persons with mental illness to function in the community rather than being warehoused in hospital settings. Unfortunately, the resources and planning necessary to turn this theory into action were not in place. As a result, many individuals with mental illness found themselves in conflict with the law as a direct consequence of their untreated mental illness. Thus jails and prisons soon became major providers of mental health treatment, the “New Asylums”.

Beginning in the 1950’s, across the U.S., a movement began toward deinstitutionalizing the mentally ill, a policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions. Deinstitutionalization was based on the principle that severe mentally ill should be treated in the least restrictive setting, therefore resulting in a number of homeless mentally ill. As defined by President Jimmy Carter's Commission on Mental Health, (1979), this ideology rested on "the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services” (p.