The city’s mental-health care system is a “paradox,” with data revealing a “mixed picture” of mental health and well-being in the community, according to the Tulsa Regional Mental Health Report.
The release of the report last week put into stark numbers the alarming brain-health issues confronting the community. But the report also noted that Tulsa is nationally renowned as a “‘beta city’ for pioneering and problem-solving” in brain science research, early childhood systems development and housing programs for homeless people with mental illness.
The report notes that in some respects it’s difficult to “distinguish strength from challenge.”
For instance, the state ranks fifth in the nation in mental health care providers per capita. Tulsa County has 421 providers per 100,000 people — twice the national average.
But that must be viewed through the prism of what the report called a long-standing nationwide shortage of psychiatrists, especially child psychiatrists. The report says there are too few clinical specialists in the Tulsa region, presenting a challenge even for those who are able to afford care to find “consistent, high-quality mental health care.”
University of Tulsa President Gerard Clancy, leader of the study’s steering committee, recalled how interviews with clinicians put into perspective the overwhelmed nature of the system. Clancy said there isn’t enough prevention and early intervention, nor beds in the substance-abuse or psychiatric systems.
“Most of us that are psychiatrists on a regular basis get calls in the evenings and the weekends from someone desperate for a bed. ‘I can’t find a bed.’ And it’s not uncommon for us to call the hospital and say, ‘When will a bed open up.’
“And they say, ‘It’s three days from now at 6 p.m.’ It’s like a reservation for a hotel room to be able to get a bed sometimes for a psychiatric condition.”
The dearth of bed space is on both the public and private side.
Terri White, commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services, said Tulsa is the only city of its size to have so few private psychiatric beds that serve indigent or Medicaid populations.
“We have a multitude of private partners (in Oklahoma City), and in Tulsa you don’t have near that same number,” White said. “Everything falls to the state in Tulsa, unless you have private insurance.”
About 90,000 adults in Tulsa County need treatment for severe mental illness, but there are only resources to treat about 17,000 of them, White said. Almost 40,000 adults are struggling with chemical-dependency addiction, with only 4,000 to 5,000 able to be served.
That chasm in the system is illustrated through transports by law enforcement agencies seeking emergency treatment, which White said has nearly doubled the past five years.
Law enforcement agencies in Tulsa County made 1,960 transports of people experiencing a mental-health crisis in fiscal year 2016, of which nearly 40 percent required leaving Tulsa County or the entire region, according to state data.
“Focus group participants frequently mentioned the lack of in-patient beds across greater Tulsa as an obstacle to moving from crisis to recovery,” according to the Tulsa Regional Mental Health Report.
In general, the report attributed fault to the state’s Legislature for “chronic underinvestment” in mental-health care despite “compelling evidence of the need for more care.”
Periodic financial crises within the state Medicaid system and the mental health agency, the state’s unwillingness to expand Medicaid, limited in-patient beds in the public and private sectors, and rising costs of providing evidence-based services also have “undermined Tulsa’s capacity to meet the community’s significant behavioral health needs” — especially the uninsured or under-insured.
“As a result, many people with serious mental illness in Tulsa are sicker than they should be, and many are overwhelmed with poverty, hunger, homelessness, addiction, chronic illness, and a history of incarceration, unemployment, and social isolation,” the report states.
Good research should influence policy
Both Clancy and White offered praise for Tulsa in spite of its shortcomings.
White said Tulsa has a commitment to these issues that other cities in Oklahoma have yet to even consider.
“Tulsa is a leader in the mental-health, substance-abuse and brain-health field,” White said.
Clancy acknowledged the Laureate Institute for Brain Research in Tulsa as a “world star” in understanding the roots of mental health.
“We need to be able to take good research and have that influence policy and have that influence funding going forward as well,” Clancy said.
Clancy said Tulsa has “some of the best innovations” but not the scale necessary to “move the needle.”
He referenced drug, veteran and mental-health courts. He also gave a nod toward the Community Response Team — a program that combines a police officer, fire paramedic and professional counselor as a one-stop shop on the streets for mental-health help.
Clancy said these programs are working great but are only about 5 percent of the size they need to be. Public funds must be shifted from prisons and jails toward care to advance good ideas and pilot programs into the mainstream, he said.
“Tulsa is unique and special,” Clancy said. “One of the reasons a lot us are here is because things like this can get done.
“When Tulsa puts its mind to something things can get done.”