Correction: A Tulsa World story incorrectly stated the current ranking of Oklahoma in the nonmedical use of prescription painkillers. Oklahoma ranks No. 8 according to an updated report by the U.S. Substance Abuse and Mental Health Services Administration, down from No. 1 a few years ago. This story has been corrected.
For most of his life, Billy Mays was known as a person who couldn't sit still, concentrate or keep a job for long.
He grew up among nine children in Calhoun, Miss., dropped out of school in 10th grade, held odd jobs and took care of his aging parents.
After they died 16 years ago, Mays moved to Tulsa to be near his sisters.
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He was 49 when he started smoking marijuana, then he escalated into cocaine use. His addiction hit quickly and led to two years of homelessness and time in the Tulsa Jail on complaints related to assault and drugs.
It was in jail when a doctor provided a mental-health evaluation — a first for Mays — and presented a diagnosis of schizophrenia.
"He told me what was wrong, and I agreed with it," Mays said. "I just took it. It sounded right."
With the help of the Mental Health Association and the Community Service Council program A Way Home, Mays is now on medication. He has been sober for two years and lives in supportive housing, where he also works as the janitor.
"I had low self-esteem," he said. "I couldn't hold a job or anything like that. I wanted to, but I was just hyper and couldn't stay still. When I take my medication, I think clearer and can focus better. I'm mellow."
The 56-year-old is not chatty, preferring to listen. He maintains an apartment, has a girlfriend and goes to casinos for entertainment.
"If I would've gotten help for my problem sooner, I might not have been on the streets," Mays said.
Need for services
Oklahoma ranks No. 2 in the prevalence of mental illness in the nation, No. 8 in addiction to prescription drugs, and it has the 12th-highest suicide rate, according to data from two federal agencies.
The state ranks fifth in the U.S. in overdose deaths from drugs, according to a report from Trust for America's Health.
Yet at least 70 percent of Oklahoma adults and 40 percent of youth are not getting treatment. It's higher for substance abuse problems.
Each day, 600 to 900 residents with an assessment requiring services do not get it, according to the Oklahoma Department of Mental Health and Substance Abuse.
This is leading people to spiral into crisis. They end up failing school, neglecting children, becoming homeless and landing in jails and prisons due to behavior from their untreated illnesses.
Much focus has been placed on the lack of treatment beds in Oklahoma, but that's a sliver of the issue.
"It's not just the need for beds, it's the need for every level of service," said Terri White, director of the state mental health and substance abuse department. "We hear about beds more because that's the focus of the crisis at that moment and law enforcement is involved in the transport. Don't misunderstand me, we need beds.
"But we also desperately need more outpatient services. Two-thirds of people who need outpatient services can't get them. The beds are critical, but so are outpatient services to keep people from ever going into a crisis — and that is much less expensive."
Advocates say the state is paying more for not providing services by the increased costs in child welfare, law enforcement, unemployment and lost wages and revenue.
"As a state, we have chosen to invest money in downstream systems like incarceration," said Mike Brose, executive director of the Tulsa Mental Health Association. "It's not working."
Police work overtime
Tulsa Police Officer Susannah Ralston has 14 years of experience and became the department's mental health liaison a few years ago.
TPD receives about 750 calls each month involving someone with a mental health issue, she said.
In fiscal year 2011, Tulsa police spent about 214 hours transporting patients at a cost of about $7,967. That drastically increased last year to about 2,292 hours on transports at a cost of about $95,301.
So far this fiscal year, the department has expended more than 1,617 hours at a cost of $66,751 getting people in crisis to a hospital bed.
"It seems to me like we have more and more mentally ill people, and the calls have exploded," Ralston said. "We don't have enough beds. The majority of the week, all state beds are full, so we have people sitting in hospital beds waiting to get treatment. They aren't getting the treatment they need while they wait."
For people accused of committing a felony, they sit in jails.
Since January 2011, 890 Tulsa residents have been transported a total of 180,806 miles by officers to find a treatment bed out of town. The average is about 22 patients a month to cities as far as Lawton or Clinton.
To maintain a full force in Tulsa, officers making the trips must work overtime in between shifts. Two officers per patient are required for transports for safety reasons.
Officers not only initially transport the patient but also must return a few days later to get the person to court, then back again.
"Keep in mind, these are not people convicted of a crime. They are sick," Ralston said. "But we are putting them in police cars in handcuffs in order to get them to help."
Prisons or treatment?
About 58 percent of women in prison and 30 percent of male inmates have a serious mental illness requiring psychiatric medication, according to the Oklahoma Department of Corrections.
The percentage of inmates with a diagnosed mental illness has climbed in the past five years, from 20 percent to 36 percent. The number on psychotropic drugs has increased by 50 percent since 2007.
The state ranks No. 1 in female incarceration and No. 4 among male prisoners.
"We let it go and don't do anything about it," Brose said. "We've limped along and now incarcerate people and let the justice system address our social problems. We are paying for it and paying dearly."
Almost every day, someone calls Tulsa's Mental Health Association desperate to find help for a family member or friend.
"They have no money, no insurance, and it's very, very difficult," Brose said. "I tell them I'll work with them as best I can. But for that kind of treatment, timing is everything."
Brose calls the system a "shocking failure" and blames elected officials for putting money in prisons instead of treatment. He said their concerns about elections have led to a short-term view instead of long-term vision.
"We've moved from large psychiatric institutions to incarceration institutions," Brose said. "Instead of replacing those hospitals with long-term care, we replaced with jails. It's an old story. I started my practice 32 years ago, and it pains me we are still working on the same issues we were then."
Treatment teams
The most cited evidence-based program for intervention and prevention among the most seriously mentally ill people is the Program of Assertive Community Treatment, known as PACT teams.
Oklahoma has about 12 teams across the state, including three in Tulsa.
The teams offer 24-hour services seven days a week to reach patients at homes, work or other community settings to help with medical adherence, basic needs, family relationships and employment skills.
The savings from reducing incarcerations and hospitalizations outweigh the cost of operating a PACT team, said Dr. Nicole Washington, a psychiatrist with OU Physicians and director of the University of Oklahoma School of Community Medicine's Impact team (a PACT team).
OU Impact has a capacity for 75 patients and conducts 800 to 1,000 monthly visits. The savings is about $15,000 per patient.
A patient averages about three visits per week, with some adding visits for health appointments or help with groceries or budgets.
A concern is a growing group of people who don't qualify for PACT services but aren't successful in other programs.
"These consumers tend to fail in traditional outpatient treatment and could benefit from a higher, more appropriate level of service such as day treatment programs," Washington said.
Washington said Oklahoma has a shortage of psychiatrists and psychiatric specialists, including those for children, adolescents and geriatric patients.
"Increasing the number of psychiatric specialists would help address the state's mental health needs," Washington said.
'Not a healthy state'
This state of mental health did not appear overnight. It was the result of a chipping away of prevention services, cutting down crisis interventions and a lack of replacing long-term, supportive housing when large institutions closed.
"We are not a healthy state overall," said White, the director of the state's mental health and substance abuse department.
"We have one of the lowest outcomes in overall health in the country. Mental illness and addiction are diseases like any other."
For years, the state has had a blueprint for getting more investment in treatment and away from crime, child welfare and other corrective social systems. The state mental health and substance abuse agency includes in its budget line-item programs as a wish list to a stronger continuum of care.
"It is set out as a menu people can pick and choose which items to fund first," White said. "Picking anything off the menu has an immediate savings."
For example, the Smart on Crime initiative outlines programs such as mental health and drug courts, jail diversion and prison re-entry.
The total cost is $96 million, but, realistically, parts are to be implemented over time, White said.
Tulsa County has nationally recognized drug, mental health and veterans courts, but other counties do not have all those options.
"People are going to prison in other counties because a mental health court is not available," White said.
Another item is Screening, Brief Intervention and Referral to Treatment Private/Public Partnership, or SBIRT, at a cost of $4 million.
The program recently has been found to be the most cost-effective prevention program for addiction.
It screens at emergency rooms and doctors' offices to determine if intervention is needed. This catches people who are using substances but not yet addicted.
"The longer we wait to treat addiction, the more complex and damage is done," White said. "This program found that one brief intervention with a medical professional tips a majority of people back. It prevents addiction.
"It's huge in terms of cost savings. It's preventing disease."
The current worry is the lack of funding from the Legislature.
While most agencies saw a 5 percent cut in the governor's proposed budget, the mental health and substance abuse agency will receive the same amount.
It received about $155 million last year but needs an additional $21 million to pay its bills. Without it, 7,000 indigent residents will see their mental health services disappear.
"These cuts will really hurt Oklahoma families and people will go without services," White said. "In the end, it is going to be devastating to Oklahoma families and will cost Oklahoma taxpayers more."
Oklahoma mental health
No. 2 in U.S. for prevalence of mental illness
Third leading cause of chronic disease in the state
21 percent of residents say they had a mental health need during the past year
70 percent of adults needing services are not receiving it
40 percent of youth needing services are not receiving it
Oklahoma substance abuse
No. 1 in the U.S. for prescription drug addiction
12 percent of residents say they needed addiction treatment within the past year
77 percent of adults needing treatment are not receiving it
80 percent of youth needing treatment are not receiving it
Where prescription drugs come from
55 percent from a family member or friend
17.3 percent from a doctor
11.4 percent bought from a friend or relative
4.8 percent taken from a friend or relative without asking
4.4 percent bought from a stranger or drug dealer
7.1 percent, other
In total
Between 700,000 and 950,000 residents need services for mental health or substance abuse
About 182,000 residents were served by the state mental health and substance abuse agency
82 percent of nonviolent offenders in prison have a mental health or substance abuse treatment need
In the Office of Juvenile Affairs, 33 percent of youth in custody and 26 percent on probation need treatment.
Nearly 80 percent of youth in the highest level of residential service have a substance abuse problem.
Oklahomans die too soon
| Age | Condition |
| 71.7 | General population |
| 57.5 | Mental illness |
| 43.2 | Substance abuse |
| 40.6 | Co-occurring (mental illness and substance abuse) |
Source: Oklahoma Department of Mental Health and Substance Abuse, Oklahoma Policy Institute
Voices
'We are trying to overcome decades of stigma and underfunding. We can't do it in a couple of years.'
— Terri White, director of the Oklahoma Department of Mental Health and Substance Abuse'
We need some long-term placements for people. Some people cannot function on their own, and it's not fair to ask them to live on their own. They are in crisis and in danger and no place to really put them.'
— Tulsa Police Officer Susannah Ralston, mental health liaison
'As an advocate, I'm pointing the finger right at elected officials and leaders and their lack of vision and expediency to look at the increase of people in this situation.'
— Mike Brose, executive director of the Tulsa Mental Health Association
'There is a whole subset of people who are not quite ill enough for PACT standards but require more support than traditional outpatient services.'
— Dr. Nicole Washington, psychiatrist at OU Physicians and director of OU Impact, a team that provides round-the-clock services for people at a serious level of illness
How Oklahoma has saved money in the past three years:
The governor's $2 million for substance abuse treatment for about 200 women resulted in a savings of $6.4 million that would have gone to prisons.
The Systems of Care, at a $1.6 million request this year, has resulted in 200 children avoiding out-of-home placement for an annual savings of $4.7 million.
About the series
This week, the Tulsa World is presenting a series that addresses key issues affecting our area and state. The project has a central question: If we spent money on these issues in the short term, could it save us money in the long term?
The "Spend to Save" series was among priorities identified by newspaper editors and the World's Community Advisory Board, a group of 24 people who are part of a cross section of the community.
HERE ARE THE TOPICS FOR THIS WEEK'S SERIES:
Tuesday: Teen pregnancy
Wednesday: Medicaid: Use of "medical homes"
Thursday: Alternative energy
Friday: Prison reforms
Saturday: Obesity and smoking
Today: Mental health
Ginnie Graham 918-581-8376
