As further recent evidence of the shortfalls of mental health care, Oklahoma announced on March 25, 2016 that the state will face $13 million in cuts to mental health care. The Oklahoma Department of Mental Health and Substance Abuse Services had already announced earlier this year $9.8 million in cuts, bringing the total to $22.9 million in cuts announced in 2016 alone. Accounting for federally matched funds, the Agency has said that it is effectively down $40 million, leading to over 73,000 Oklahomans facing reduced services.
In prior instances of major cuts to mental health services in Oklahoma, the state saw marked increases in the rate of suicide, and there are anticipated to be impacts on both private providers and the inmate populations. $7 million of these cuts are to private community-based providers of mental health services, and there are to be reductions in reimbursement rates for inpatient and residential treatment programs.
This is particularly salient because Oklahoma is one of the states with the highest rates of serious mental illness (those in most need of urgent treatment), with a national rate of serious mental illness among adults of 4.0% while Oklahoma's rate is 5.24%, outranked only by West Virginia (5.48%). Moreover, with a national average of 18.2% of any mental illness, Oklahoma's rate of 21.88% is outranked only by Utah. An estimated 57% of the Oklahoma prison population suffers from a mental illness or exhibit symptoms of mental illness, and while Oklahoma outpaces almost every state in rates of mental illness, it also spends less per capita on services than do most states (only Arkansas, Idaho, Texas, and Puerto Rico spend less per capita). Needless to say, these newly-announced cuts will only amplify this disparity. Oklahoma also ranks as having the 11th highest poverty rate in the United States, an issue particularly salient given that money is a frequent barrier to treatment. Thus, this is a particularly dangerous context in which to be seeing funds reduced.
The realities of governance are such that policies are the product of partisan bargaining, and that some services need to be cut in order to make ends meet. However, when we consider that the long-term ramifications of untreated mental illness -- especially untreated serious mental illness -- range from homelessness to addiction to incarceration, it is incumbent upon us to remind lawmakers that cuts to mental health services may necessitate distribution of more funds toward prisons, crime control, and substance abuse treatment (mental health and substance abuse often co-occur), not to mention managing higher costs for treatment of medical conditions given the greater prevalence of physical illness in the medically ill population. Thinking more proactively toward preventive care, both medical and mental health, may aid states in managing these various illnesses and avoid the more costly interventions when it may be too late.