Behavioral Health In Oklahoma

Terri L. White, MSW Commissioner

Oklahoma Department of Mental Health and Substance Abuse Services

Both mental illness and addiction are real medical conditions, just like diabetes, cardiovascular disease and heart disease.

In terms of addiction, although initial substance use might be voluntary, drugs of abuse have been shown to alter gene expression and brain circuitry, which in turn affect human behavior. Once addiction develops, these brain changes interfere with an individual’s ability to make voluntary decisions, leading to compulsive substance abuse, seeking and use. (Natl. Institute on Drug Abuse)

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The brain scan on the left reflects normal activity; the scan on the right shows a person affected with schizophrenia.

Source: PBS.org

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In March, SAMHSA released a national report showing Oklahoma ranks second nationally in prevalence rates of both “serious” mental illness and “any” mental illness among adults over age 18. This represents more than 630,000 adults, and doesn’t include children and those with substance abuse issues.

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In Oklahoma, mental disorders are the third leading cause of chronic disease – behind only pulmonary conditions and hypertension – and more prevalent than heart disease, diabetes, cancer and stroke.

More than 245,000 Oklahomans above the age of 12 abuse or are dependent on alcohol or illicit drugs; and underage drinkers consume just over 20% of all alcohol sold in Oklahoma.

10% of youth have a mental illness; and another 10% have substance abuse issues.

Deaths due to suicide are increasing, jumping from 567 in 2009 to 618 in 2010. Oklahoma ranks 13th nationally in terms of suicide rate.

Between 1-3% of all Oklahomans are problem or compulsive gamblers and in need of intervention.

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In 2010, Oklahoma had the 4th-highest unintentional poisoning death rate in the

nation (17.9 deaths per 100,000 population).

Oklahoma has the 9th-highest rate of deaths involving prescription painkillers in the

nation. (CDC, 2011)

Of the nearly 3,200 unintentional poisoning deaths in Oklahoma,

from 2007-2011, 81% involved at least one prescription drug.

Adults (both men and women) age 35-54 had the highest death

rate of any age group – nearly twice that of any other age group.

From 1999 to 2010, the overdose death rate for women in

Oklahoma jumped 535% compared to 382% for men.

The most common prescription drugs involved in overdose deaths

were hydrocodone, oxycodone, and alprazolam.

In Oklahoma, more overdose deaths involved hydrocodone or

oxycodone than all illegal drugs and alcohol combined.

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As with adults, mental health is a key component in a child’s healthy

development. Kids need to be healthy in order to learn, grow and

lead productive lives. As parents, advocates and policy makers, we

must be the ones to invest in our children to ensure the future

prosperity of our state.

Our children are our future, and safeguarding their physical and

mental health should be at the forefront of state agency objectives.

Even back in 1999, Former Surgeon General Dr. David Satcher said

children’s mental health care must become a

standard part of general health care, as

mental health and healthy social/emotional

development are integral and inseparable

parts of overall health and affect virtually

every outcome of a person’s life.

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Mental, emotional, and behavioral (MEB) disorders are a major health threat and are as commonplace today among young people as a fractured limb – not inevitable, but not at all unusual.

One in five young people have one or more MEB disorders at any given time.

Half of all mental illnesses occur by age 14 and three-fourths by age 24.

The median age of onset for anxiety disorders and/or impulse-control disorders is age 11.

Clear windows of opportunity are available to prevent MEB disorders and related problems before they occur. Risk factors are well established, preventive interventions are available, and the first symptoms typically precede a disorder by two to four years.

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Nearly 40% of Oklahoma high school students in grades 9-12 are current drinkers.

74% of 12th graders have used alcohol.

19% of Oklahoma youth report that they had their first drink of alcohol, other than a few sips, before age 13.

Children who drink before age 15 are five times more likely to have problems with alcohol as adults than those who wait until age 21.

Of those Oklahomans who sought ODMHSAS treatment services for alcohol addiction in FY13, nearly 85% said they began drinking before their 18th birthday.

Prescription drug abuse is a rising problem among youth, as it is with Oklahomans of all ages.

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Risk factors such as victimization, bullying, academic failure, association with deviant peers, violence and substance use occur primarily in neighborhood and school settings.

Much of youth exposure to violence occurs either at school or on the way to school, research indicates.

Exposure to violence is associated with children’s development of various mental health problems, particularly post-traumatic stress disorder, anxiety, depression, antisocial behavior, and substance use.

A reciprocal relationship exists between academic achievement and mental health outcomes, in which mental health problems adversely affect academic achievement and poor academic achievement is related to the development of multiple problem behaviors.

Students’ relationships with their peers and teachers and the social climate in the classroom have a powerful effect on their development of MEB problems.

Programs promoting classroom and school procedures that encourage pro-social behavior, positive classroom management strategies, academic achievement, or increased positive bonding to school have important implications for children’s healthy development.

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In 2010, 618 Oklahomans died by suicide, up from 567 in 2009.

Oklahoma ranks 13th nationally in terms of suicide rate

Suicide continues to be the most common manner of violent death in Oklahoma.

Suicide rates among youth 10-24 years of age remained stable. Yet, for this age group in Oklahoma, it remains the 2nd leading cause of death.

Suicide rates in rural counties were generally higher than rates in urban counties. The rate increased 10% in rural counties and 7% in urban counties from 2004-2009.

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How Can We Help Our Youth?

Strengthening families by targeting problems such as substance use or aggressive behavior; teaching effective parenting skills; improving communication; and helping families deal with disruptions (such as divorce) or adversities (such as parental mental illness or poverty).

Strengthening individuals by building resilience and skills and improving cognitive processes and behaviors.

Preventing specific disorders, such as anxiety or depression, by screening individuals at risk and offering cognitive training or other preventive interventions.

Promoting mental health in schools by offering support to children encountering serious stresses; modifying the school environment to promote pro-social behavior; developing students' skills at decision making, self-awareness, and conducting relationships; and targeting violence, aggressive behavior, and substance use.

Promoting mental health through health care and community programs by promoting and supporting pro-social behavior, teaching coping skills, and targeting modifiable life-style factors that can affect behavior and emotional health, such as sleep, diet, activity and physical fitness.

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Systems of Care – Impacts children, ages 6-18 years, with serious emotional and behavioral problems at home, at school and in the community; it has been proven as a model system with successful outcomes.

What started as a program with only a handful of sites now encompasses 58 of Oklahoma’s 77 counties.

Suicide Prevention – ODMHSAS has trained nearly 8,000 suicide prevention gatekeepers using Garrett Lee Smith Memorial Act (federal) funds.

Columbia Teen Screen – In-school depression and suicide screening provided by mental health professionals.

Mental Health First Aid – Trains school personnel to recognize signs of mental illness and substance use within the student population so they can intervene early to prevent a crisis or act to de-escalate a crisis once one develops.

AlcoholEdu – An evidence-based alcohol prevention program available to all Oklahoma high schools at no cost through a partnership between the ODMHSAS and the Oklahoma Department of Education.

2M2L – Enforcing underage drinking laws.

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ODMHSAS/OKDHSPartnerships

Working TogetherNo longer can any one agency be all things to all people and no longer can only one group meet the multiple needs of Oklahoma's diverse population.

The axiom that two heads are better than one really is true when it comes to strengthening service systems in a holistic way. By thinking, planning and working together, state-level initiatives involving multidimensional partnerships can sustain system level change.

Left untreated, mental illness and addiction can lead to heartbreaking and often tragic consequences. Costs to society include school disruptions, delinquency and drop-outs; children becoming increasingly engaged in foster care (untreated substance abuse by a parent is a primary commonality of child neglect cases); and/or involvement in the criminal justice system.

To address these issues, which often affect the entire family, ODMHSAS and OKDHS have partnered to offer programs that help people:

Reunite with their families Increase employment prospects and monthly income Stay out of jail/reduce involvement with the criminal justice system Reduce homelessness Break the cycle of addiction

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Oklahoma Partnership Initiative Phase 2Program Example

The OPI-2 uses a multifaceted approach to address the presence of alcohol and other drug abuse within the context of the OKDHS child welfare system; and strives to improve collaborative efforts across substance abuse, child welfare and treatment systems.

Objectives are to increase the well-being of substance-affected children and families; expedite permanency for children from substance-affected families; ensure safety of children from substance-affected families; and increase the state’s capacity to deliver collaborative and integrated services.

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Oklahoma Partnership Initiative Phase 2Program Example

Strengthening Families – a curriculum within OPI – is geared toward families with children ages 6-11. Studies find it to be the most effective intervention for substance-abusing parents as it has positive outcomes for both children and parents.

Parental training includes discussion on appropriate expectations for children at different ages; promoting desired behaviors in children through increased attention, positive reinforcements and behavioral goal statements; stress and anger management; communication training; alcohol and drug education; and problem solving.

Children's skills training uses games, coloring, role-plays, puppet shows and other age-appropriate methods to teach conversation skills; peer pressure resistance skills; compliance with parental rules; understanding and handling emotions; sharing feelings and dealing with criticism; and alcohol and drug education.

SFP also includes family skills training.

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Infant and Early Childhood Mental HealthProgram Example

In the initial stages of building a trauma-informed infrastructure to support the mental health needs of infants and young children throughout the state by strengthening relationships with their families and caregivers.

ODMHSAS is working with OKDHS to identify best practices related to trauma and developmental screening of infants and toddlers to link them with appropriate infant mental health supports and services.

Objectives are to establish sustainable infrastructure to support an early childhood system of care which is developmentally sensitive, relationship focused and trauma informed.

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OK County Family Drug CourtProgram Example

ODMHSAS received a three-year grant from the Office of Juvenile Justice and Delinquency Prevention in the spring of 2011 to begin implementation of a Family Drug Court in Oklahoma County. Goals of the court were to improve permanency outcomes for participant families involved in child welfare as a result of substance use, intervene in adult, child and family risk factors through the provision of evidence-based services, and improve substance abuse treatment outcomes for participant families.

An enhancement grant, in its first year, is now under way. This extension will allow the ODMHSAS/DHS staff to strengthen the service delivery of two evidence-based parenting education programs – Strengthening Families and Celebrating Families – both of which are designed to increase individual and family functioning, increase the likelihood of timely reunification with birth families, and decrease maltreatment recurrence. The grant also will allow for enhanced treatment services and increased capacity of community stakeholders through a multi-year education initiative.

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Children Affected by MethamphetamineProgram Example

The CAM grant, awarded in 2010, provided four years of expanded and improved children’s services to the Tulsa County Family Drug Court to treat the trauma of children living in an environment of drug addiction. This is the final year of the grant. Through collaboration among ODMHSAS, DHS and the Tulsa County court system, families receive holistic support to heal family systems with the goal of reunifying families.

Program results indicate court participants have reunited with their children 82% faster than the matched comparison group, with an estimated cost savings of $1.6 million. With 18 months to two years in treatment, the family drug court group is reunifying at greater than twice the rate of the comparison children.

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Weaving Access for AllProgram Example

WAFA exists to ensure that Systems of Care and wraparound services are available for all children and youth with serious emotional disturbance, and are widely utilized in every county in the state. Programs within this grant include the:

Tulsa and Oklahoma County Juvenile Justice Diversion Initiative:

This initiative is attempting to establish a standardized screening process for youth entering into the Tulsa and Oklahoma County’s Juvenile Detention Centers with behavioral health challenges.

Region 4 Pinnacle Project:

OKDHS Region 4 was identified as a region with high need for intensive services. This project will provide crisis diversion services to children and youth with behavioral health and/or co-occurring need who have significant risk factors that could disrupt their placement.

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Additional Program Examples

The Youth in Custody Certificate Program serves as a venue that offers leaders the opportunity to develop capacity, effectuate change, and sustain and build on system improvements over time. Specifically, this program shines a brighter light on the serious, high-risk juvenile offender population, and help leaders begin or accelerate systemic change to improve outcomes for youth in custody. While the need for a continuum of services and placements throughout the juvenile justice system provides the context for this work, the program focuses on youth in post-adjudication custody. (Tulsa County Juvenile Court)

The Information Sharing Certificate Program is designed to enable leaders to overcome information-sharing challenges, while respecting laws and other provisions that protect the privacy and other rights of youth and their families. Create a cross system data sharing agreement among the three child serving agencies (DHS/OJA/ODMHSAS)

In Depth Technical Assistance – Designed to strengthen collaboration and linkages across service systems and family courts

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Additional Program Examples

OK Trauma Assessment and Service Center Collaborative – Pursue an innovative and aggressive trauma-informed/focused evidence-based/evidence-informed systems approach to addressing mental and behavioral health needs of all children in care. Reconfigure current approaches that are responsive to screening and functional assessment data while descaling practices and services that are not effective; and/or do not meet the assessed needs. Evaluate implemented system changes on safety, permanency, well-being and adoption outcomes for children overall.

Adolescent Recovery Collaborative – Enhance and expand substance abuse services for adolescents 13-17 years. Early stages of development.

Strategic Prevention Framework State Incentive Grant – Use the SPF model to implement evidence-based strategies to address non-medical use of prescription drugs, and underage alcohol consumption. Multiple state agency involvement, including DHS, Health, Regents for Higher Education, Public Safety, Juvenile Affairs and Education.

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Treatment Works

The good news is this: TREATMENT WORKS!

Mental illness and addiction can be diagnosed and effectively treated. In some instances they are preventable.

The sooner a mental or addictive disorder is diagnosed and treated, the better the outcome is for all involved, just as is the case with diabetes, cancer or heart disease when diagnosed early.

Success rates for heart disease treatments range from 41-52%. The treatment success rate for schizophrenia is 60%.

More than 80% of people with depression can be treated successfully with medications, psychotherapy or both.

Substance abuse treatment has similar positive outcomes if people can access appropriate treatment and follow-up care.

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Treatment Works

In FY13, ODMHSAS provided services to approximately 80,000 individuals. Nearly 64,000 received mental health services and 19,000 received substance abuse treatment services, with some overlap.

ODMHSAS programs have been proven to help people:

Reunite with their families

Increase employment prospects and monthly income

Stay out of jail/reduce involvement with the criminal justice system

Reduce homelessness

Break the cycle of addiction

Achieve numerous other successful outcomes, such as obtaining higher educations, increasing productivity on the job, stopping tobacco use, etc.

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Conclusion

To be successful, any discussion about keeping our families together and addressing the wellness of our state as a whole must address the issue of mental health. As nearly half of all lifetime mental illnesses start by age 14, the importance of prevention and early intervention cannot be overstated.

The sooner a mental or addictive disorder is diagnosed and treated, the better the outcome is for all involved, just as is the case with diabetes, cancer or heart disease when diagnosed early.

By working in partnership, we can better meet the needs of Oklahoma children and their families who may be impacted by untreated mental illness and substance abuse.

The good news is that there is help and there is hope.

Website: www.odmhsas.org

Facebook: www.facebook.com/ODMHSAS

Twitter: @ODMHSASINFO

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