States in Crisis:
The Grassroots Response
Those dependent upon Oklahoma's publicly funded mental health system have known it for years. However, it still seemed shocking when we read the recently published Disintegrating Systems: The State of the States' Public Mental Health Systems by the Bazelon Center for Mental Health Law. There, in the middle of the report, was this statement:
Public mental health services are demonstrably Oklahoma's lowest public priority. The percentage of state appropriations has been steadily declining…mental health services [received] the smallest increases of any public function during this decade.
Yes, we knew this was the case. One only needed look at the increasing waiting lists at mental health centers or watch the escalating numbers of persons with mental illness being locked up in our jails and prisons. You could also analyze appropriations trends, showing that mental health received over $2.20 for every $100 appropriate in 1986. In 1998, mental health was receiving a mere $1.60. However, since research by Oklahoma's State University's Center for Health Policy Research completed the report that documented this embarrassing statement, we thought we had turned the corner.
With the exception of a painful and rushed transition to community services for one of our state's remaining state psychiatric hospitals, the last three years were actually kind to our cause . Aggressive advocacy by our organization led to mental health parity, implementation of PACT teams, enhancements in the resources available for new generation medications, and enhancements to our state's service structure to support children and adolescents. We were winning battles and our mental health agency was following our leading, submitting a budget to the Governor that included consistent growth to programs supported by our organization.
After the tragedy of September and the ongoing recession, Oklahoma was one of the last states to remain upbeat about revenue collections. Then, the bottom of the barrel fell out of our state economy too. First, word on the street was that minor cuts were looming. Then, desperation as the cuts moved from minor to crippling.
Advocates pulled together and effectively communicated the desperate plight of our state's mental health care. To Governor Keating's credit, he proposed a "hold harmless" action for the mental health agency's budget. We joined education as the only major department not subject to the budget cutting knife.
A brief sigh or relief, and then….
First, the bad news erupted from the Oklahoma HealthCare Authority, our state's Medicaid agency. Projecting a revenue short fall in the current fiscal year of $21 million, the agency posed significant cuts to programs that directly affected our constituents. At the same time, the agency pleaded with the Oklahoma legislature to find supplemental money to keep the agency operating. Fortunately, the legislature was convinced to restore moneys, sending the OHCA ¾ of their supplemental request and avoiding some very painful cuts.
This dance with OHCA is an annual one. Our state policy leaders will likely punish the agency next budget cycle, requiring a comprehensive audit of operations and threatening to dissolve the agency. With OHCA responsible for 55% of the public mental health services delivered in our state, the battle is critical.
For our mental health authority, the hold harmless call of the Governor could not hold water. Just this week, the agency (as did all state agencies) received a 6 1/2 % cut for the balance of this year. As for next year, the pain could be much greater.
OSU had it right when the criticized our state for keeping mental health behind the curve in terms of appropriations. We made ground up in correcting this neglect, but the penalty for avoiding tough decisions earlier is going to catch up with us soon. Unfortunately, it appears that mental health soon will not even be on the radar screen of our state's leaders unless NAMI acts now.
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