Mental Health Care Faces State Budget Woes

By Jeff Raymond, The Oklahoman

Jun. 9–A standstill budget is actually a loss for many state mental health providers.

Already considered a threadbare corner of medicine, mental health care faces pressures from climbing food, gas and medication prices.

“They have just over the years been stripped down to absolute bare bones. It’s not that they were fat or inefficient before. They literally kind of live hand to mouth,” state Rep. Wallace Collins, D-Norman, said of state-run Norman’s Griffin Memorial Hospital and other mental health providers.

Collins has been recognized as an “Outstanding Legislator” by the state chapter of the National Alliance on Mental Illness and has long pushed for greater mental health parity and funding.

With a last-minute $2 million infusion, the budget for the Oklahoma Department of Mental Health and Substance Abuse Services for the coming year is the same as last year’s — roughly $209 million in state-appropriated dollars. Almost 96 percent goes directly to services.

“We appreciate the difficulties the legislature faced this year in funding and we know that many agencies are impacted by the fiscal outlook. A standstill budget, in many ways, means a step back in providing services in the face of increasing demands for these services, as well as inflationary pressures such as those experienced in the areas of transportation and energy costs,” agency spokesman Jeff Dismukes said.

Small profit margin Costs for Integris Mental Health’s 102-bed psychiatric hospital continue to increase throughout the year.

When state funding isn’t increased, it has a “tremendous impact,” said Jim Igo, vice president of Integris Mental Health.

“The profit margin for mental health services is already very small, and a standstill budget means having to do the same service with a standstill rate but having to pay for the increased operating costs,” he said. “Standstill budget, in reality, is a misnomer because the additional costs are passed on to the provider.”

Karina Forrest, executive director of the state chapter of the National Alliance on Mental Illness, noted almost two-thirds of those who need mental health treatment don’t receive it.

Legislators, she said, don’t recognize that the state will pay for services one way or another.

“They will end up in the emergency room. They will end up in prison. They will end up homeless on the street,” she said. “If we just put money on the other side of the fence, we might just see that the state doesn’t have to be (ranked) 50 in everything.”

How does state compare? The Oklahoma Department of Mental Health and Substance Abuse Services is “woefully underfunded” compared to others nationwide, she said.

In 2004, state mental health agencies’ per-capita spending averaged $93.04, according to the Kaiser Family Foundation, a Menlo Park, Calif., health policy nonprofit. Oklahoma’s spending was $39.79.

Also, according to the Agency for Healthcare Research and Quality, about one-fourth of community hospital stays among adults in 2004 involved mental health or substance abuse.

“There is an across-the-lifespan need, and we’re not addressing it,” Forrest said, citing medical and lost-work costs from those who aren’t chronically mentally ill.

With many mental health providers in the state operating at a deficit, “to continue to operate, what ultimately happens is the care is cut back,” she said.

What about next year? Al Friedman, chief executive of Red Rock Behavioral Health Services, said the percentage of money in the state budget going to mental health from 1990 to 2000 dropped every year even as agencies such as the Department of Corrections grew.

“So you can see that we got very, very far behind,” he said.

Friedman doesn’t know what effect the standstill budget will ultimately have, but he expects Red Rock to see more people for free because it can’t — and won’t — turn anyone away.

“We see people who, basically, in many cases, no one else will see,” he said.

Collins sees next year’s budget being worse.

“Somebody needs to stand up for these people,” he said.

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