Agency Duties and Responsibilities
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is the state’s “safety net” mental health and substance use treatment services system. The department’s core mission is to provide prevention and treatment services for Oklahomans who are indigent and without a means to pay. ODMHSAS is the payer of last resort. In our state, as has been the case for decades, the need for services outpaces resources. Because of limited resources, services are primarily targeted to address the needs of the most seriously ill; this means for persons who experience ongoing, persistent medical issues associated with mental illness or addiction, persons who are in crisis or have been found to be dangerous to self or others. ODMHSAS provides services for both adults and children.
Treatment services include inpatient hospital and outpatient community-based mental health treatment services, forensic services, residential treatment and outpatient services to address substance use dependence and addiction, in addition to targeted services designed to address the needs of high-risk populations, criminal justice diversion (Smart on Crime) initiatives, and efforts to address other priority concerns. In addition, ODMHSAS provides prevention services at the state and local levels, in partnership with area health providers, schools, law enforcement, veteran’s groups and other community stakeholders. ODMHSAS manages the state’s behavioral health Medicaid services, and has rule-making responsibility for specific statutory certification processes (certifying approximately 3,300 treatment providers, organizations and individuals, throughout the state).
The department delivered services to just over 197,000 Oklahomans in FY 2018 and served all 77 Oklahoma counties through a statewide network of private providers at the community level. Over 93% of all persons receiving department treatment and recovery services were seen by one of the systems contracted community-based providers.
ODMHSAS is the State’s statutory authority responsible for prevention, treatment and recovery from mental illness, substance abuse and addictive disorders.
ODMHSAS is primarily state funded (approximately 71 percent of all funding). Federal funding from various sources comprises the majority of the rest of the budget. Medicaid is the most important non-appropriated funding source for individual client services, accounting for nearly 17 percent of the budget. Federal block grants and other federal grant funding account for approximately 11 percent of the budget.
The department has an outstanding record of competing for and winning competitive grant awards. This has allowed ODMHSAS to test, refine and implement many noteworthy and award-winning initiatives that are now key elements within the statewide prevention, treatment and recovery system. This has included such things as drug and mental health courts, Systems of Care, opioid treatment services including MAT and school-based suicide prevention initiatives. These awards also help support many of the department’s training and continuing education efforts for behavioral health providers statewide.
Below is a summary of some the department’s primary core functions:
Inpatient Hospitals – The department operates psychiatric hospital services for adults in Norman and a forensic hospital for adults in Vinita. The Norman hospital (Griffin Memorial Hospital) receives voluntary and involuntary court committed patients while the forensic hospital in Vinita (Oklahoma Forensic Center) serves only individuals sent for evaluation or treatment through the criminal court system. In addition to these hospital sites, smaller inpatient units are located at department facilities in McAlester, Ft. Supply, Tulsa and Lawton. These facilities provide acute inpatient psychiatric care for individuals who do not have access to other psychiatric inpatient care, or longer term care for individuals who are a danger to themselves or others and are unable to temporarily function in a community setting. The Oklahoma Forensic Center conducts forensic evaluations for the judicial system and provides inpatient care for persons found not guilty by reason of insanity.
Community Mental Health Centers – ODMHSAS is responsible for a statewide network of community mental health centers (CMHC) that provide a wide variety of services including case management for adults and children, crisis intervention, psychiatric rehabilitation, medication services, and other outpatient mental health services. Additionally, community based programs include assistance with such services as housing, employment, peer advocacy and drop in centers.
Community Based Structured Crisis Centers – The department supports Community Based Structured Crisis Centers for adults located throughout the state, including: Ardmore, Clinton, Muskogee, Norman, Oklahoma City, Sapulpa and Tulsa. Facilities in Ardmore, Oklahoma City, Sapulpa and Tulsa also operate behavioral health urgent care centers that provide 23-hour respite and observation to help prevent psychiatric emergency and keep people from needing admission to inpatient or crisis beds. These facilities also address substance abuse emergencies.
Substance Use Treatment and Recovery – As the alcohol and drug authority under Title 43A of the Oklahoma State Statutes, the department is responsible for comprehensive planning and program implementation in the areas of education, training, prevention and treatment for individuals and families affected by alcohol, drug abuse and gambling. This includes the delivery of residential and outpatient substance abuse services such as medically supervised detoxification, non-medical detoxification, residential treatment, day treatment, sober living, DUI school, Drug Court and other outpatient services. Approximately one-hundred private non-profit contractors and state operated facilities provide substance abuse programs. The intent is to provide a continuum of services to individuals with substance abuse disorders so they become sober and productive members of society. ODMHSAS serves all 77 Oklahoma counties. Referral/assignment to the appropriate level of care is based on an initial medical assessment.
Services for Children and Youth – The department contracts for a variety of mental health services for children, including family based, in-home services, outpatient services and wrap around services. Contracted providers are located in communities throughout the state. The Children’s Recovery Center (CRC) in Norman is the only state-operated facility dedicated to providing inpatient and residential treatment services for children and youth. The facility provides crisis services and inpatient care for both mental health and substance abuse.
The Oklahoma Systems of Care (SOC) program is a nationally recognized initiative that covers that serves nearly 5,000 youth (and their families) across the state. Youth receiving services through SOC show decreases in school suspensions and detentions, decreases in contacts with law enforcement, decreases in self-harm and suicide attempts, decreases in problem behaviors and clinically significant improvement in functioning. Over 70% of the youth coming into SOC, diagnosed as “clinically impaired,” show significant improvement within six months.
There is a tremendous need to expand children’s services throughout the state and programs such as Systems of Care, which cut through red tape and focus attention on the needs of the children and their families to provide the appropriate level of services. Systems of Care is targeted to impact children, ages 6-18 years, with serious emotional and behavioral problems at home, school and in the community, and, it has been proven as a model system.
Criminal Justice Diversion Treatment Services (Criminal Justice) – The department provides a variety of services targeted to work with the criminal justice system and aid in appropriate diversion of eligible offenders into treatment programs that provide significantly better outcomes, reduce taxpayer cost and change lives. Primary examples of key services in this area include:
Screening and Assessment–By serving as central screening hubs, county jail-based screenings save diversion program resources and avoid duplicative assessment processes. To date, county jail-based screenings have been established in 37 countiesand nearly 27,000 felony defendants(26,329) have been screened, with nearly 23,000 (22,768) final dispositions recorded. Screening is in the process of expanding statewide for all felony level offenses, made possible by additional funding appropriated state funding beginning in FY19. Measured outcomes of the program to date include:
- Offender Screening has reduced the average time an offender spends awaiting sentencing by 57 days. Resulting in $15.5 million in jail day savings.
Counties without offender screening experienced an increase in the percentage of non-violent prison receptions that was approximately twice that of counties with offender screening.
An 87% decrease in the length of time offenders spent in jail, from 31 days pre-implementation to 4 post-implementation. (Tulsa County)
A $2.2 Million reduction in the cost to incarcerate offenders, from $2,532,717 pre-implementation to $326,802 post-implementation. (Tulsa County)
A 72% decrease in length of time from arrest to Drug Court Admission, from 221.5 days pre-implementation to 61.7 days post-implementation. (Pontotoc County)
Drug Court – The annual cost of drug court is $5,000 compared to $19,000 for incarceration. That alone is a significant benefit, but what really tell the story are the improved outcomes. A study of over 4,000 drug court graduates demonstrated that these graduates earned more than $204 million in legal wages and paid an estimated $6.1 million in taxes over a five year period. Had these graduates been incarcerated, instead of in drug court, it would have cost the state an additional $191.6 million(average sentence of three years each). Drug Court graduates experience significantly lower incarceration rates than DOC released inmates (7.9% compared to 23.4%). In addition to a 95.4% drop in unemployment and a 119.3% jump in monthly income; a 81.1% increase in participants who are able to again live with their children; and, a 116.7% in participants with private health insurance.
Mental Health Court– There are mental health courts in only 16 counties serving approximately 500 participants at any given time. Another 17 counties have requested courts. Recent appropriations will allow for the addition of approximately 186 mental health court slots statewide. Like drug court, there are much lower rates of incarceration for mental health court graduates compared to released inmates and released inmates with a Serious Mental Illness (3.2% compared to 23.4% and 41.8% respectively). The cost for mental health court is approximately $5,400 annually, per participant. Incarceration would cost between $19,000 and $23,000 (person with a serious mental illness) annually.
Prevention Services – Prevention services include oversight and delivery of initiatives targeting communities throughout the state. The department oversees a network of contracted Regional Prevention Coordinators, located in 17 Oklahoma communities and serving the entire state, to conduct localized prevention efforts. The department also oversees the delivery of targeted statewide initiatives such as Prescription for Change/OKImReady (campaign to reduce opioid/prescription drug abuse), opioid overdose prevention and naloxone distribution, collaborative work with sister agencies regarding Oklahoma’s Prescription Monitoring Program (PMP), statewide suicide prevention initiatives (QPR, school-based services, awareness and outreach), 2M2L underage drinking initiative and other underage drinking prevention efforts, SYNAR compliance enforcement and reporting, Mental Health First Aid, SBIRT (Screening, Brief Intervention and Referral to Treatment) partnership with primary care and hospitals, the suicide prevention initiative, alcohol server training and numerous other successful efforts.
Oklahoma Behavioral Health Medicaid – During the FY12 legislative session, responsibility for the behavioral health portion of Medicaid was shifted from the Oklahoma Health Care Authority to ODMHSAS. The shift of behavioral health Medicaid responsibilities has resulted in incredible savings to the state. Annual Medicaid growth prior to the transfer was at 14%, a rate that has been slashed by more than 90%. In FY14, ODMHSAS reduced program growth to 7%. In FY15, that number fell further to 5.4%. Beginning in FY16, growth was held to below 3%, and has remained below 3% in every year since. Had Medicaid growth continued at the annual 14% rate, the FY18 state share would have been in excess of $348.9 million. Under ODMHSAS administration, state share was only $149 million (a cost avoidance of almost $200 million in FY18 alone). The growth rate in the current fiscal year is targeted to be below 3% and the agency is focused on maintaining that rate under 3% in FY2020.
Rule-Making, Certification and Policy –ODMHSAS provides administration, direction, planning and technical assistance for a statewide system of community-based mental health and substance abuse treatment providers. It sets standards, policies and goals for programs and monitors programs to ensure required criteria are met. Additionally, the department performs evaluations and data analysis and maintains an automated information system of clients receiving services. Over 93 percent of all persons receiving department services were seen by one of the systems contracted community-based providers. There are over 300 contracted treatment providers in the ODMHSAS statewide network, along with more than 800 behavioral health Medicaid agency and individual providers. Additionally, ODMHSAS certifies approximately 3,300 treatment providers (organizations and individuals) throughout the state.
The ODMHSAS was established through the Mental Health Law of 1953, although publicly supported services to Oklahomans with mental illness date back to early statehood. Until the mid-1960s, the primary means to treat mental illness was institutionalization in large state hospitals. On an average day in 1960, nearly 6,400 Oklahomans were in the state's mental hospitals.
During much of that period, Dr. Hayden Donahue, long-time Oklahoma mental health director and Central State Hospital superintendent, was one of about a dozen American psychiatrists actively involved in promoting a burgeoning “community mental health movement.” His grant proposal to the National Institute of Mental Health, written while he was superintendent of Central State Hospital, resulted in the nation’s first federally-funded community mental health center being built in Norman in 1968. In the mid-1970s, the concept of "deinstitutionalization" prompted states to increase efforts to utilize outpatient services through these facilities. This approach has proven to be an effective means of recovery and a less costly method to provide services as compared to long-term inpatient care in a hospital setting.
Oklahoma has become a national leader in several areas of community based services including the implementation of programs for assertive community treatment, alternative criminal justice initiatives such as drug and mental health courts, and comprehensive services for children and families.
ODMHSAS programs are helping people: reunite with their families; increase employment prospects and monthly income; stay out of jail or reduce involvement with the criminal justice system; reduce homelessness; break the cycle of addiction; and, achieve numerous other successful outcomes, such as obtaining higher education, increasing productivity on the job, stopping tobacco use, etc.
Experiencing mental health or substance use disorders can be as frightening and debilitating as any major physical health disorder. The good news is that treatment works. There is hope, and there is help.