Monday, March 6, 2017

Terri White's Insane Mismanagement

Terry White's Oklahoma

According the legislative budgets of the last 20 years, excess serious mental illness evidently is now completely cured here in Oklahoma.

Our state constitution mandates the operation of a public mental health component, if for no other reason than for the sake of public safety. But since the psychotic population has not formed an effective lobby group and don't generally make campaign contributions, they are helpless get heard or  to put on the type of demonstrations at the capitol that the unionized public school teachers do. Even if they did show up, it's not likely that they would be allowed to stay in the capitol building if they did gain entry lest they wander onto the House and Senate floor and make it nigh on impossible to know who to remove.

The greatest annual act of theft perpetrated upon our county sheriffs and local police department doesn't come from petty thieves, drug pushers, or pick pockets.  It comes from the 149 members of the legislature who have conspired to rob the counties and municipalities of billions through passively defunding the constitutional role of getting the psychotic folks into a safe environment, restored to a stable state, and transitioned back to the civilian population. In most cases when they do get help, these patients spend about a week in a psych hospital, then move to outpatient follow-up.

This past month the folks up in Tulsa got a first look at a state-of-the-art new public mental health facility. But it's a county jail psych unit which remains desperately needed until the state returns to following their constitutional mandate. The jail's psych unit did not come from federal or state funding.

You see, the mentally ill in Tulsa somehow never got the memo that they had already exceeded the state budget's cap of how many are allowed to get seriously psychotic. So the Tulsa County taxpayers are forking out $15 million to build a solution for living in a state which abdicated it's constitutional duty. The cost of the building is just a small portion of the real theft being sustained at the hands of the legislature. The newly-expanded Tulsa jail houses a psych wing which is larger (capacity) than the state's largest public mental health facility (Griffin Memorial, at Central State Hospital, in Norman).

Our local cops get called out several times daily, to the scene of a  mental meltdown. Any decent cop knows he can't just let a perceived danger play itself out and cause a bigger community tragedy. But there's rarely an open bed at a state mental hospital as we only have a three hundred beds in the whole state. So under some creative pretense from the cop at the scene, the suffering psychotic individual is now an inmate of a correctional facility, at city and county expense. Men are inordinately being abused this way, far more than women.

While serious mental illness afflicts both sexes evenly, psychotic men are being arrested about 6 times as often as women. Tulsa's sheriff recently said that 33% of the men incarcerated at the jail are diagnosed and currently treated for a serious mental illness. But only 5% of the women at the jail are diagnosed & in treatment. Is this because people are more afraid of psychotic men? Perhaps…. but unless they truly committed a crime, they are unjustly arrested just so a cop can quickly resolve a community complaint. This is shameful.

What could have cost the state a few thousand in the state mental health hospital now costs every city police department and county sheriff  department several thousand dollars more. Then you add district court costs, District Attorney costs, and perhaps DHS is taking in a mentally ill parent's child in foster care; leaving our full costs far higher than the expense if we had an efficient clinical response from funding the constitutionally mandated state agency tasked with addressing the horrible scourge of serious mental illness.

Recovery from serious mental illness is tough enough without a police record piled on top of the oppressive new mental reality. A sick person could have taken a leave-of-absence from work to go to a psychiatric hospital, but couldn't take a medical leave to go to jail. And even though Oklahoma's largest mental health treatment facilities are all correctional facilities these are the worst facilities in terms of recovery success, cost-effectiveness, and even accuracy in diagnosis. When a patient finally gets out of jail, he likely discovers he's lost his job weeks ago, along with his family, his home, and his ability to pay for the medications which he had previously been getting from the sheriff. We've stacked the deck against him and he will not likely ever be the productive citizen he once was.

So the legislature, didn't really succeed in cutting any REAL costs. They actually more than doubled the cost, but made our sheriffs pay the bill out of the county criminal incarceration funds.

This doesn't mean that the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) isn't also complicit in robbing from counties. Director Terri White has deliberately chosen to take away the vast majority of the state's public mental health beds out of commission, so her department can fund other mental health  issues that she believes is a priority. Reviewing Terri White's recent funding requests, she spends many millions on projects not directly tied to serious mental illness. And her past 5 years of budget requests did not mention a single dollar for expanding public mental health beds. The State Auditor shows no record of ODMHSAS ever undergoing a performance audit... EVER! It's high time that the legislature call for some serious outside review or audit, as part of a real reform of public mental health policy.

Terri White's ODMHSAS operates only about 300 public beds which are accessible to the entire states various law enforcement agencies and district court judges. A judge or cop cannot order a dangerous psychotic person into a privately operated hospital. But Terry White has shut down several state mental health facilities and rented the buildings to corporations who operate for profit psychiatric businesses in structures which our state taxpayers paid for. Those corporate psych units do not have to accept any patient from any court order, or from any cop who is executing an emergency psych evaluation. Our several hundreds of law enforcement agencies and our hundreds of district court judges must all use the one waiting list for the same paltry 300 or so public mental health beds. And Terri White's ODMHSAS ("Oh-Dem'-sas") show's no priority in changing that in her recent budget requests.

The odds are that your city police department is soon going to have exploding budget costs because of the state's mental health capitulation. Your county sheriff is probably already admitting to serious failures in his jail's response to the need. Several of our counties are now passing massive bond votes to address both operational budget crises and new jail construction plans. Oklahoma County Jail is the most deadly jail in the nation. And most of those deaths are tied to mental illness not being detected and/or handled properly.

But the remedy is simple...

Reforming the ODMHSAS agency and mandating a priority of the budget going to public mental health bed capacity so a psychotic sufferer can be taken safely off the street WITHOUT the compulsory criminal record which many of them are unjustly being slapped with.

Shifting the costs away from cities and counties, and back to the state role, where it is far less burdensome on the taxpayer, because there's a far lower cost of treating ill patients separately from the willfully criminal people. This is, in truth; a more conservative fiscal position, because it follows best-practices for seeking consolidated savings.

Follow the state constitution in acknowledging where the public mandate is stated. Our jails were never intended to usurp the public mental health role and individuals are being stripped of constitutional liberties by criminalizing their illness. Yes, they need to be safe, and their neighbors need similar safety and peace, but our constitution recognizes this and prescribed a specific state infrastructure just for this reality.

Accept the reality that we didn't get in this sad shape overnight and it will take years to get out. About half of the inmates in our state correctional system are diagnosed with a serious mental illness. It is no stretch to speculate that we could have avoided our high prison population by supporting a civil commitment infrastructure BEFORE another Mark Costello Tragedy occurs. Just as it took years for "the chickens to come home to roost", we will be spending more on both prisons and civil commitment for a few years, before we see huge savings at both county jails and state prisons. After that, we will reap the rewards of lower prison populations, low county jail burdens, and more people returning to productive lives.

Public mental health response has always been a part of constitutional government for civilized nations. Civilized nations deal with it because there is a far higher cost of not dealing with it. But the only superpower who avoided the cost altogether, was Adolph Hitler's Third Reich. (Except that little bit of gas for the ovens and gas chambers did cost a little).

Mental illness is not a criminal offense any more than diabetes is; but the state is committing a major crime by making sheriffs pay the bill for what the state government is constitutionally bound to provide. The legislature needs to take a lesson from congress and mandate a clear outcome from ODMHSAS to provide a public mental health capacity of at least 1500 beds (50 beds for every 100k of state population). We currently have less than a third of the minimal national threshold capacity and until we return to about 1500 beds, we will continue to waste far too much money at county and municipal expense.

Too often, fiscal conservatives have gauged success by how low the state income tax is. But until you monitor the whole burden of city, county, and state tax collections, you're likely getting the wrong results.

Recommended Reading: Jaque Cosgrove provides a historic review of state mental health public policy for the Oklahoman. Epidemic Ignored"