FY2020 ODMHSAS Budget Presentation - Prevention, Treatment and Recovery Services Terri White, MSW ODMHSAS Commissioner - Oklahoma Senate
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FY2020 ODMHSAS Budget Presentation
Prevention, Treatment and Recovery Services
Terri White, MSW
ODMHSAS Commissioner
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Diseases of the Brain
(Above): 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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Prevalence
Oklahoma Consistently Has Among The Highest Rates Nationally for
Mental Illness and Substance Abuse
Any Mental Illness Any Substance Use Disorder
21% 10-12%
(Up to 610,000 Oklahoma adults based on SAMHSA estimates) (Up to 300,000 Oklahomans 12+ needing treatment intervention)
Estimates consistently range between 20-22% with Oklahoma experiences very high rates for 18-26
increasing rates of MDE in children (SAMSHA NSDUH populations regarding multiple substances/risk factors
and Region VI Barometer Reports) (SAMSHA NSDUH and Region VI Barometer Reports .
• Between 700,000 and 900,000 adult Oklahomans are in need of services for these diseases
of the brain (approximately 600,000 reporting mental illness and 300,000 reporting alcohol
or illicit drug dependence/abuse).
• Only 1 in 3 of these Oklahomans are accessing the medical services they need to treat these
diseases. SAMHSA Region VI Barometer Reports
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Negative Outcomes That Impact All
• Law Enforcement transports have more than doubled since FY12, an indicator of increased acuity
and need for treatment services in Oklahoma.
Law Enforcement Transports
20,000 17,047 17,860
16,000 15,086
11,727 12,687
12,000 8,122 8,933
8,000
4,000
0
FY12 FY13 FY14 FY15 FY16 FY17 FY18
• Lack of access means that people become more ill to the point that more costly services are required
to address the problem. The impact is often also felt in other areas (and state agency budgets).
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Innovative Approaches (Criminal Justice)
The annual cost of drug court is $5,000 compared to $19,000 for incarceration.
That alone is significant. But, what really tells the story are the outcomes:
• 95.4% drop in unemployment.
• 119.3% jump in monthly income.
• 116.7% increase in participants with private health insurance.
• 81.1% increase in participants who are able to again live with their children.
Lower Incarceration Rates for Graduates
23.4%
7.9%
Drug Court Graduates Released Inmates
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Innovative Approaches (Criminal Justice)
Another measure of success is the success drug courts have in helping individuals
to again be contributing members of society.
If these 4,076 graduates had gone to prison, the state would have expended
$193,610,000 to incarcerate them for an average of 3 years each.
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Perception = Reality
• Attitudes about using substances start early.
• Today’s youth perceive less risk in using illicit or
legal substances. This, in turn, drives future
generations of substance-dependent Oklahomans.
• 63.6% of Oklahoma adolescents ages 12-17
perceive no great risk from having 5 or more
drinks once or twice per week! (SAMHSA Region VI
Barometer)
• Past month use of substances among Oklahoma
12th graders is decreasing, but marijuana use
has not.
• As perception of risk goes down, use goes up.
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Perception = Reality
• Average age of first use of alcohol
among Oklahoma youth is 13. ODMHSAS
• Youth who start drinking before age 15
are six times more likely to develop
alcohol dependence or abuse later in
life than those who begin drinking at or
after age 21. SAMHSA
• More than 85% of those who seek
ODMHSAS treatment services for
alcohol addiction began drinking before
their 18th birthday.
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Lives Cut Short
Three causes of death are driving the decreased
life expectancy:
1. Drug overdose
2. Suicide
3. Liver disease due to alcohol
Upward trends in these areas are large enough to
drive up all-cause midlife mortality.
Who is being impacted?
• Geographically diverse
• Primarily middle-aged
• Rates of death for the three causes are higher
for men than women. But, mortality trends are
identical for men and women with a high school
degree or less.
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PLUSPRO PlusPro 2014 Powerpoint TemplateLives Cut Short
• An April, 2018 study in the Journal of the
American Medical Association named Oklahoma
as one of two states with the highest increase in
the probability of premature death for ages
20-55 (-2 years).
• The average lifespan of Oklahomans with
mental and addictive disorders is far shorter
than that of the general population:
General Population – 75.9 Years of Age
Untreated Mental Illness – 57.5 Years
Untreated Substance Use – 43.2 Years
Untreated Dual Conditions – 40.6 Years
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PLUSPRO PlusPro 2014 Powerpoint TemplateBinge Drinking
Binge drinking accounts for more than half of In Oklahoma:
the deaths resulting from excessive alcohol use. • 12.8% of adults report binge drinking
• 21.8% of high school students binge drink.
Accounts for the most health and economic • Adults outpace the US in binge drinking intensity
costs. at an average of 8.4 drinker per binge occasion.
Accounts for about 90% of the alcohol
consumed by youth.
More than 40% of binge drinking costs are
paid by state government
Binge drinking is related to increased:
• Car crashes • Unintended pregnancy and STDs
• Sexual assault • Fetal Alcohol Spectrum Disorder
• Violence • Neurological damage
• Firearm injury
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PLUSPRO PlusPro 2014 Powerpoint TemplatePrevalence: Suicide in Oklahoma
• Suicide is the most common manner of violent death in Oklahoma.
Three times as many people die by suicide than by homicides each
year in our state. OSDH
• A U.S. Dept. of Veteran’s Affairs report found that Oklahoma had the
highest suicide rate in the country among young veterans ages 18-
34 in 2014 (the most recent year available).
• For ages 10-34, suicide is the second leading cause of death in
Oklahoma. OSDH
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PLUSPRO PlusPro 2014 Powerpoint TemplateInnovative Approaches (Suicide)
The department works continuously to address the state’s high suicide rate.
• Patient Screening for Suicide and Substance Abuse in Primary Care/Hospital Settings
(Evidence-Based Treatment Models, CAMS, Survivor of Suicide Attempt Support Groups
and others)
• Follow up within 24 hours of discharge from the emergency department or hospital
• Over 3,000 OK Educators in 43 counties trained in suicide prevention the 2017/18
School Year
• Community-Based Suicide Prevention Programs
• QPR, Mental Health First Aid, Talk Saves Lives in communities statewide.
• Tribal partnerships
Oklahoma in the past year has improved from 7th to 16th nationally (suicide rate).
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PLUSPRO PlusPro 2014 Powerpoint TemplateInnovative Approaches (Opioids)
• Comprehensive efforts are
working. Oklahoma’s
unintentional overdose death rate
involving a prescription opioid
decreased by 28% from 2007 to
2016. OSDH
• Also, Oklahoma saw the 2nd
largest decrease nationally in
opioid prescribing from 2013-
2015 – down 18% – and was
one of only 12 states to see a
decrease in the rate of drug
overdose deaths from 2013-
2014. CDC
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PLUSPRO PlusPro 2014 Powerpoint TemplateInnovative Approaches (Services Management)
Continued 14% Average Annual Growth Compared to ODMHSAS
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PLUSPRO PlusPro 2014 Powerpoint TemplateFY2020 ODMHSAS Budget Request
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PLUSPRO PlusPro 2014 Powerpoint TemplateFY2020 ODMHSAS Budget Request (Additional)
Smart on Crime Initiative ($91,610,000)
The purpose of this funding is to implement the ODMHSAS Smart on Crime initiative that includes proven programs to effectively divert non-
violent individuals with mental illness and/or addiction from the criminal justice system. Interventions with these individuals must be
available at various points in the criminal justice system, from pre-booking to re-entry, with the intent to intervene and divert at the earliest
possible opportunity. There has been targeted investment in portions of this plan to address specific at-risk populations. Still, we as a state
have struggled to invest in treatment services at a level sufficient to meet public need. This has resulted in increased negative
consequences, and cost, for Oklahoma, particularly in the criminal justice system. These costs can be avoided with better access to
treatment delivered before Oklahomans become engaged with the criminal justice system, and through services designed to reduce repeat
incidents and future problems for those who have already entered the criminal justice system. In FY17, there were 9,627 DOC receptions of
which approximately 7,000 were for non-violent offenses (almost 75% of prison receptions that year). DOC data estimates that 82% (or
over 5,700) of all non-violent DOC receptions are individuals with a mental health or substance abuse treatment need. The projected growth
of our prison population over the next 10 years (growth of 25%) will cost the state nearly $2 billion. Continued investment in mental health
and substance abuse services will benefit Oklahoma families and the state as a whole. A “Smart on Crime” approach in particular will create
an opportunity for the state to avoid millions of dollars in future expenses related to the criminal justice system…eventually paying for itself
and even providing a hefty positive return on the overall investment. Continued inability to address the treatment needs of all Oklahomans
will result in continued (and expanded) negative outcomes impacting the state’s overall health, economic development and public safety.
The ODMHSAS Smart on Crime Initiative has been endorsed by the Oklahoma District Attorney’s Council, the Oklahoma Sheriff’s
Association, the Oklahoma Association of Chiefs of Police, the Academy for State Goals and the Oklahoma Turning Point Council.
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PLUSPRO PlusPro 2014 Powerpoint TemplateFY2020 ODMHSAS Budget Request
Marijuana Treatment & Prevention Costs Resulting from SQ788 ($3,513,989)
Approximately 198,000 Oklahomans (ages 12+) report marijuana use in the last month, with 358,000 reporting marijuana use in the last year.
National estimates are that approximately 9% of all marijuana users become dependent. The risk of dependence is increased by frequency of
use along with the individual’s age when they first begin using. Between 25-50% of daily marijuana users become dependent. People who
begin using marijuana before age 18 are four to seven times more likely than adults to develop a marijuana use disorder. In Oklahoma,
approximately 32% of Oklahoma high school students report having used marijuana. Marijuana is second only to methamphetamine as the
primary drug of choice, other than alcohol, among Oklahomans receiving addiction treatment from ODMHSAS. Current resources do not
meet the critical need for prevention programming and do not meet the demand of people requiring treatment for cannabis use disorder.
Resources will be directed to high need populations for the implementation of best practice community and school-based prevention
services and to provide cannabis use disorder treatment services.
Alcohol Dependence Treatment and Prevention Resulting from SQ 792 & SB 383 ($37,817,372) Excessive alcohol use is responsible for
nearly 1,400 deaths a year in Oklahoma and cost citizens and government $3 billion (CDC 2010) to address the consequences of additional
healthcare costs, increased crime and the negative impact on businesses. Alcohol is the number one drug used by young people in
Oklahoma, and the number one reason people enter substance use disorder treatment in the state. Oklahoma also outpaces the nation in
adult bring drinking intensity - the most deadly and costly pattern of drinking. Excessive drinking is preventable and alcohol use disorder is
treatable through evidence-based community and clinical services. Current resources do not meet the critical need for prevention
programming and community interventions and do not meet the demand of people requiring treatment for alcohol use disorder. Resources
will be directed to high need populations for the implementation of best practice community-, school-, university-, and healthcare-based
prevention and treatment services.
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PLUSPRO PlusPro 2014 Powerpoint TemplateFY2020 ODMHSAS Budget Request
AOT-Full Implementation of the Labor Commissioner Mark Costello Act ($12,600,179)
Assisted Outpatient Treatment (AOT) is court-ordered treatment, including medication, for people with severe mental illness who meet strict
legal criteria and who have difficulty remaining compliant with treatment. AOT supports their adherence to treatment plans, helps to reduce
hospitalizations and other negative consequences at the community level, and furthers recovery. The key is matching the right person
(appropriateness for AOT) to the correct treatment/funding source. Without resources and appropriate identification of who can benefit
from AOT, the potential influx of persons to the AOT program could break an already fragile system and leave thousands of more
Oklahomans without care; therefore, the statute still limits who is eligible for this critical program. This is a program that has demonstrated
success across the country. This funding change would provide funding to fully implement the Labor Commissioner Mark Costello Act.
Saving Lives and Families through Suicide Prevention ($450,000)
Oklahoma families continue to experience suicide rates that are greater than the national average with our state consistently having one of
the ten worst rates. Suicide and suicide attempts impact Oklahomans throughout the lifespan, from school age youth through our older
adults. Suicide is preventable and attempts can be minimized through community awareness and identification strategies. Oklahoma made
an important first investment in suicide prevention in FY14. Prevention efforts have included a number of evidence-based, community
prevention initiatives including training in risk recognition and intervention, school-based partnerships along with awareness and outreach.
This request is for funding to build upon previous successes and ensure continued positive progress by growing the availability of these
services throughout the state. ODMHSAS seeks funding to implement best practice suicide prevention strategies, focusing on service
members, veterans and their families along with other recognized high risk populations such as American Indians and transition age youth
(16-24).
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PLUSPRO PlusPro 2014 Powerpoint TemplateFY2020 ODMHSAS Budget Request
Prescription Drug Abuse Prevention ($500,000)
From 2007-2016, more than 6,800 Oklahomans died from unintentional overdose. Prescription drugs are the most common substance
involved in overdose deaths. Investment of funds for the prevention and treatment of opioid addiction and overdose has helped temper the
opioid crisis in several areas. Continued effort and a sustained state investment of resources are required to prevent new incidences of
addiction and put an end to the epidemic. Resources will be directed to high need communities for the implementation of community- and
school-based prevention services; targeted overdose prevention communication and outreach; and continuing medical education.
Parity-Based Staff Compensation Equalization
Pursuant to HB1024XX, ODMHSAS received funding to provide specified salary adjustments to ODMHSAS staff in FY19. The department is
grateful for this much needed investment. Still, even with this increase, the gap in salaries for ODMHSAS employees compared to other
agencies remains. Other agencies received similar employee pay adjustments. While ODMHSAS salaries did rise, so did the salaries of
employees at other agencies and at the same rate of increase. These salary discrepancies create difficulty in recruiting and retaining
desperately needed behavioral health care staff. Essentially, ODMHSAS often must compete against other state agencies paying more for
the same job. ODMHSAS employees are serving some of Oklahoma’s most vulnerable citizens, and in many cases individuals who have been
deemed dangerous to self or others. They have delivered incredible outcomes and consistently go above and beyond to serve all
Oklahomans. They deserve to be paid at the same rate as their peers performing the same job at other state agencies.
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PLUSPRO PlusPro 2014 Powerpoint TemplateFY2020 ODMHSAS Budget Presentation (Conclusion)
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@ODMHSAS
@ODMHSASINFO
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