On this page

Survey of criminal history systems updated

The "Survey of State Criminal History Information Systems, 2001" describes the status of state criminal history records systems at the end of 2001.  This report is an update of Survey of State Criminal History Information Systems 1999, released in October 2000, and is the seventh in the series that began with 1989 data.

The report is available at http://www.ojp.usdoj.gov/bjs/abstract/sschis01.htm.

^ Back to top

Jail design handbook now available

The "Jail Design Review Handbook" helps sheriffs, jailers, county administrators, and other decisionmakers in reviewing and critiquing jail design documents.

The book provides checklists with suggested questions on virtually every space within a jail.

It's available online at http://www.nicic.org/Pubs/2003/018443.pdf

For availability and ordering information, contact the NIC Information Center at 800-877-1461 and ask for NIC accession number 018443.

^ Back to top

Justice report available online

The Sept. 15 issue of "JUSTICE INFORMATION" from the National Criminal Justice Reference Service is available online at
http://www.ncjrs.org/justinfo/sep1503.html.

^ Back to top

State report addresses mental/addictive disorders

You can see the 2003 interim report on "Mental and Addictive Disorders/The State of State's Health" by going to
http://www.health.state.ok.us/board/ir03/index.html.

^ Back to top

Hatch joins sponsorship of act

New sponsors of the "Mentally Ill Offender Treatment and Crime Reduction Act of 2003" will include U.S. Senate Judiciary Committee Chairman Orrin Hatch.

Hatch, R-Utah, and Sen. Richard Durbin, D-Ill., also a Judiciary Committee member, have signed on as co-sponsors of S. 1194. In this powerful demonstration of bipartisan interest and concern, they join introducing Sen. Mike DeWine, R-Ohio, Sen. Patrick Leahy, D-Vt. the ranking member of the Judiciary Committee, and Sens. Charles Grassley, R-Iowa, Maria Cantwell, D-Wash., and Pete Domenici, R-N.M.

The Judiciary Committee held a hearing on S. 1194 on July 30.

The act was introduced June 5 by Sen. DeWine to assist state and local governments grappling with the overrepresentation of people with mental illness in the criminal justice system. U.S. Rep. Ted Strickland, D-Ohio, introduced a companion bill, H.R. 2387 in the House.

Additional information on this legislation can be found in the announcement of its introduction.

^ Back to top

Summary reviews legislative session
The Community Action Project has prepared a summary of the 2003 Oklahoma legislative session.

The summary focuses on major budget decisions and legislation affecting low-income people and is intended for policymakers, advocates and concerned citizens.

Click on the following (in PDF format):
http://www.captc.org/pubpol/Leg/2003_OK_%20Leg_Summary.pdf

For a more comprehensive overview, go to the House of Representative's Web site at http://www.lsb.state.ok.us.
 

^ Back to top

Outline of presidential commission's final report
For the outline of the final report Outline of the Final Report for the "President's New Freedom Commission on Mental Health, " go to http://www.mentalhealthcommission.gov/reports/outline_040303.doc    .

^ Back to top

Act seeks to help those with mental illness
The "Mentally Ill Offender Treatment and Crime Reduction Act of 2003" would authorize new federal funds for people with mental illness.

The funds would provide for jail diversion programs for adults with serious mental illnesses and juveniles with serious emotional disturbances, treatment programs for individuals who are incarcerated, and services to aid people transitioning back into the community.

The Senate bill (S. 1194) was introduced by Sen. Mike DeWine (R-Ohio) and co-sponsored by sens. Patrick Leahy (D-Vermont), Charles Grassley (R-Iowa), Maria Cantwell (D-Washington) and Pete Domenici (R-New Mexico).

The House bill (HR 2387) was introduced by Rep. Ted Strickland (D-Ohio). The collaboration between Sen. DeWine and Rep.

Strickland is the continuation of a partnership that first occurred when the two worked together to pass federal legislation authorizing Mental Health Courts in 2000.

The "Mentally Ill Offender Treatment and Crime Reduction Act of 2003" would authorize $100 million to establish a grant program at the U.S. Department of Justice that can be used by states and communities to:

In recognition that programs authorized by this bill will require extensive cooperation among agencies, providers and stakeholders, S. 1194 and HR 2387 requires successful applicants for grants to demonstrate the involvement of multiple stakeholders, including mental health, criminal or juvenile justice agencies, consumers, family members, and others in all planning and implementation activities.

For more information search for S1194 or HR2387 here: http://thomas.loc.gov/gov/

^ Back to top

Disability council details vision
The National Council on Disability has an important report called "The Well Being of Our Nation: An Inter-Generational Vision of Effective Mental Health Services and Supports."

You can read it by by going to http://www.ncd.gov/newsroom/publications/mentalhealth.html.

^ Back to top

Report summarizes state legislative session
The Community Action Project has prepared a concise summary of the 2003 Legislative session focusing on major budget decisions and legislation affecting low-income populations.

It is intended for policymakers, advocates and concerned citizens.

You can access the summary (in PDF
format) by clicking on the link below:
http://www.captc.org/pubpol/Leg/2003_OK_%20Leg_Summary.pdf
The House staff has also prepared a more comprehensive session overview available from their website at at www.lsb.state.ok.us.
dblatt@captc.org.org. The website address is http://www.captc.org/public-policy.asp.

^ Back to top

PDF Download
Special report on community-based outpatient services from the state Department of MH and Substance Abuse Services

^ Back to top

PDF Download
President's New Freedom Commission on Mental Health Final Report Outline

^ Back to top

New York report focuses on incarcerated

See "Prisons and Jails: Hospitals of Last Resort The Need for Diversion and Discharge Planning for Incarcerated People with Mental Illness in New York" at http://www.soros.org/crime/MIRep-main.htm.

^ Back to top

Mental Health: Pay Now -- or Later?

By Olga Kharif in Portland, Ore.
(Copyright 2003 McGraw-Hill, Inc.)

Before the bad news arrived earlier this month, Cascadia Behavioral HealthCare in Portland offered community housing and emergency services to about 8,000 Oregonians who suffer from addictions and mental illnesses, such as schizophrenia and post-traumatic stress. Then effective Mar. 1, the state of Oregon, in a desperate attempt to balance its budget, declared some patients ineligible for Cascadia's government-financed care.

As a result, the nonprofit agency cut its budget by 20%, or $8 million a year. Cascadia has since reduced its staff by 350 employees, or 29% -- and now serves 2,500 fewer patients. Those now being turned away are left to fend for themselves, and in some cases they're going without the medication and services that help keep them stable and able to care for themselves.

This story is being repeated with increasing frequency across the nation. Massachusetts, West Virginia, Alabama, Oklahoma, Florida, Mississippi, Iowa, and New Jersey are among the other states that in the past six months have cut or eliminated benefits for mental-health patients and are considering more cuts.

WEAK LOBBY. In one respect, that's understandable. The 50 states are running $17 billion to $45 billion overbudget this year, according to Moody's Investors Service. On average, 20% of state budgets go to fund health-care programs, primarily Medicaid for low-income citizens, says Bruce Gordon, senior vice-president of the nonprofit health-care ratings group at Moody's. About 10% of state health-care spending -- a nationwide total of $20 billion -- goes to treating mental disorders, according to the National Institutes of Health. And since the mentally ill aren't a particularly powerful constituency, cutting funds that are earmarked for them is a politically expedient decision.

Oregon, for example, is in the process of trimming its overall budget by about 10% over the next two years. Over that same period, its budget for mental-health services could drop twice as fast -- by about $200 million, or 20%, says Barry Kast, assistant director for health services at the Oregon Human Services Dept. Benefits such as assisted housing and outpatient therapy are getting hit the most. Oregon eliminated coverage for illnesses such as depression when it first cut prescription benefits for 110,000 working poor on Feb. 1, then reinstated partial subscription benefits for those people on Mar. 14.

As well as hurting patients, the cuts could have an unintended negative effect on the states themselves. Many of the mentally ill could end up in jail, on the streets, or in hospital emergency rooms, says Richard Scheffler, professor of public policy at the University of California at Berkeley. And 24 hours in a hospital can cost as much as six months of outpatient care, according to Cascadia CEO Leslie Ford. She adds that incarcerating someone on a simple charge, say panhandling or stealing a cup of coffee, can cost several thousand dollars -- about as much as what's needed to provide outpatient mental-health care for a year, including counseling and medication.

BIGGER STRAINS. In fact, as the budgets that now support the mentally ill shrink, many of these people will simply end up using other buckets of state funds, says Scheffler. Instead of going to a specialist, they may go to a regular physician, who won't be as well equipped to help. The money needed for their treatment will come out of the budgets of departments of correction and the states' general health-care budgets, says Scheffler. "It's not all savings," he says of the budget cuts. Adding the mentally ill to their load will put a bigger strain on those other budgets, which are being trimmed as well.

U.S. productivity will also suffer if mental illness goes untreated. The World Health Organization estimates that in 2001, the U.S. economy suffered $63 billion in productivity losses, including the time family members took off from work to care for their mentally ill loved ones. The WHO also factors in the inability of disabled people to get an education or to find a job when their illnesses go untreated.

The long-term costs of too little care are more tangible, in part because shortcuts taken now can lead to longer and more intensive treatment later -- and increase the lifetime cost of care for a disabled person. South Carolina, which cut $40 million, or 20%, from its mental-health budget this year, has reduced its capacity for treating such patients by 500 hospital and nursing-home beds over the past two years, says Stephen McCleod-Bryant, medical director at the state's Mental Health Dept.

FEWER CHOICES. That's significant in light of a 2002 study by researchers at the University of North Carolina at Chapel Hill, which showed that extended hospital visits at the proper time help reduce the amount of medical attention severely mentally ill patients need long-term. The study found that only 12% of patients who stayed in a hospital for at least six months had to return within a year, vs. 31% of those who were treated for less than four months.

More worrisome may be the restrictions that many states are considering on which drugs they'll provide under mental-health programs. Drugmakers may offer six primary treatments to treat a disease today. But in the future, some states may decide to pay for only two of them. The problem is that each drug has its own set of side effects, such as insomnia, weight gain, and restlessness. Taking the wrong drug could make some patients worse, says Michael Fitzpatrick, director of the Policy Research Institute at the National Alliance for the Mentally Ill in Arlington, Va.

Of course, it makes sense to ensure that mental-health spending is done as efficiently as possible -- such as requiring the disabled to use outplacement services in place of hospitalization when appropriate. And in cases where drugs overlap directly, states could save money by eliminating one, says Richard Frank, professor of health economics at Harvard Medical School.

NO UMBRELLA. However, it seems possible that in the current round of budget-cutting states could go beyond that -- and even risk excluding more effective drugs that have been developed over the past decade. Thanks to new medications, treatment for schizophrenia has advanced faster than for heart disease, according to health-insurance industry studies. Patients can even lead normal lives -- if they have access to the right medications and care, says Fitzpatrick.

The state budget cuts are putting such treatments in jeopardy at the worst possible time. For instance, 17% of the inmates in Oregon's state prisons suffer from serious mental illnesses -- twice the percentage 10 years ago, says Kast, who blames the rise on the proliferation of street drugs, plus a local housing crisis. "It's like we're giving away our umbrella in the middle of a rain storm," says Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, an advocacy group in Washington, D.C. And next year could bring more budget cuts, as state deficits are projected to reach $85 billion in 2004, according to Moody's.

The current crisis has plenty of suggested solutions, but little in the way of consensus. The National Governors Assn. argues that the federal government should increase its share of Medicaid funding so that states have to shoulder less than the 50% to 60% they do now. The problem, of course, is that even before Washington mounted the war against Iraq, federal resources were stretched thin.

"IN SHAMBLES." Some states, such as South Carolina, hope to increase revenues by enacting laws that raise taxes on tobacco. But higher levies are hard to pass, especially in this economy. Recently, in fact, Oregon voters rejected a proposal for a temporary income tax that would've supported health-care programs and schools.

Another problem is that the needs of the mentally ill carry little weight with legislators. Such people rarely vote, notes Bernstein, and many face discrimination. "The cards are very much stacked against them," he adds. "Even when times weren't tough and states were rolling in money, [getting services] was a battle."

An interim report released last summer by the President's New Freedom Commission on Mental Health found that the nation's mental-health system "is in shambles." Which implies that budget cuts now will lead to only further disintegration -- and a need for greater spending in the future than might otherwise have been required to put the system on a sound footing.

^ Back to top


NICE guidelines address social aspect of schizophrenia

Online subscriptions for the British Medical Journal are free at www.bmj.com. The following is a copy of one of their articles. The link for the guidelines is http://bmj.com/cgi/content/full/326/7391/679/b.

The National Institute for Clinical Excellence (NICE) this week launched its first set of guidelines on the treatment and management of schizophrenia in primary and secondary care, in an attempt to improve healthcare outcomes among patients in England and Wales.

People with schizophrenia often encounter stigmatisation and discrimination, says the report. "This may occur not only in wider society... but also with the NHS," where, say the authors, people with schizophrenia often receive substandard care.

According to the report schizophrenia costs the NHS more than any other mental illness, consuming more than 5 percent of the NHS budget. However, say the authors, provision of effective psychiatric treatment varies across the country. "The introduction of this guideline means that no matter where they live in England and Wales people with schizophrenia can expect the same high standards of care," says Dr Tim Kendall, from the Royal College of Psychiatrists' Research Unit, London. The guidelines, a result of over two years' work by the National Collaborating Centre for Mental Health

One of seven collaborating centres funded by NICE to develop evidence based guidelines on treatment gives recommendations on the best psychological and drug treatments. It also recommends how best to organise mental health services for adult patients with schizophrenia and outlines the role of general practice in managing these patients.

"Although the focus is on treatment, these guidelines place much stress on a holistic and social approach... Treatment failure is often a result of a breakdown in social circumstances," said Dr Mike Shooter of the Royal College of Psychiatrists at a press conference this week.

Professor Erwin Nazareth, of the Royal Free and University College LondonMedical School, said that the guidelines highlighted some particular areas for GPs. He said that GPs had an important role in the prevention of cardiovascular problems and in health promotion and drug monitoring among patients with schizophrenia, 10 percent to 12 percent of whom are cared for exclusively by GPs.

At the press conference to launch the guidelines many speakers called for their swift implementation, for resources to be made available to carry the process through, and for continuous audit. Dr Kendall stressed that there was "a will to implement this and make it happen." Local healthcare groups will now be expected to produce a plan and identify resources for implementation in the near future, he said. The report recommends that a multidisci-plinary group involving commissioners of health care, primary care and specialist mental health professionals, service users, and carers should work to translate the implementation plan into local protocols, according to the local context.

Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care can be ordered at http://www.rcpsych.ac.uk/ publications or by phoning the Royal College of Psychiatrists, tel 020 7235 2351. A training session on the guideline is available at http://www.rcpsych.ac.uk/cru/sts/index.htm.

^ Back to top

Oklahoma's budget crises threaten mental health care

By David Nickell
Public Policy Specialist
Mental Health Association in Tulsa

The effects of Oklahoma's budget crises have begun to threaten health care in ways that could seriously affect consumers of mental health services.
Recently, state finance officials announced further revenue shortfalls necessitating additional across-the-board allocations to state agencies. The Medicaid agency must reduce its budget by $5 million in state dollars in two months (because the cuts cannot be put into place until May 1, leaving only two months in the fiscal year).

While state leaders may find these funds, it will only be a temporary solution. The OHCA will need $50 million in new funds next year to maintain programs. Without new revenue (taxes) this increase will almost certainly not be available at a time that the legislature has over $700 million less than last year to appropriate. The Department of Mental Health would also face severe cutbacks next year without new revenue.

Our Public Policy Committee, along with the coalitions to which we belong (The Children's Coalition, The Oklahoma Policy Consortium for People with Disabilities, and Partners for Healthcare Investment), have called on the Legislature to pass new revenue sources to forestall disastrous effects on healthcare (either additional tobacco excise tax or a temporary sales tax increase).

WHAT YOU CAN DO:

Please CALL your Senator and Representative and the Governor's office now with the following message:

"Please support funding to prevent the proposed cutbacks in Medicaid. Also please support additional revenue for the state for next year that will preserve health and mental health programs"

TO FIND YOUR LEGISLATORS USE THIS LINK:

http://www.lsb.state.ok.us/

and click on "Find Your Legislators"

PHONE NUMBERS:
1-800-522-8502 or 1-800-522-8506 (House of Representatives)
1-405-524-0126 (Senate)
1-405-521-2342 (Governor's office)


Changes in Medicaid Policies for the Current Fiscal Year

(FY 03)

On March 13, 2003, the Oklahoma Health Care Authority Board considered a series of additional cuts to the Medicaid program affecting both eligibility and benefits. The Governor's office has asked the OHCA Board to delay taking action on these recommendations for one week and to meet in emergency session in one week to make a final decision. (This would leave the OHCA with the minimal amount of time necessary to notify Medicaid beneficiaries by 4/1/03, giving enrollees 30 days' notice about the changes in their eligibility and benefit status.)

Proposed Cuts in Eligibility & Services:
 

Proposed Effective Date Clients Affected (Annual Basis)
Reduce eligibility for children ages 1-5 from 185% of FPL to 133% of FPL 5/01/03 (see next number for total children & youth affected)
Reduce eligibility for children ages 6-18 from 185% of FPL to 100% of FPL 5/01/03 78,840 children & youth
Reduce coverage of pregnant women and infants from 185% of FPL to 133% of FPL 5/01/03 15,015
women & infants
Reduce eligibility for nursing home recipients from 300% FPL to 200% FPL 5/01/03 1,100
Eliminate all prescription drug benefits for the month of June (excludes children, pregnant women, institutionalized and waiver clients) 5/01/03 80,000
Reduce all provider rates by 2% (inpatient, outpatient, everyone across the board) 5/01/03 All providers
Reduce administrative costs by $500,000   OHCA offices

We are currently exploring the impact on these changes on the general Medicaid population and the Medicaid population with serious mental illnesses in Tulsa County.

^ Back to top

Treatment wins, five-year study reports

WASHINGTON -- Drug-addicted, non-violent felony offenders with five prior drug arrests and an average of four years behind bars achieved significantly lower recidivism rates and higher employment rates through a drug treatment program than comparable offenders who were sent to prison, according to findings published in the White Paper, Crossing the Bridge: An Evaluation of the Drug Treatment Alternative-to-Prison (DTAP) Program, released today by The National Center on Addiction and Substance Abuse (CASA) at Columbia University. These results were achieved at about half the cost of incarceration, the CASA evaluation found. The five-year evaluation was funded by the National Institute on Drug Abuse.

"This DTAP program demonstrates that we don't have to throw away the key for repeat drug addicted offenders, even those who sell drugs to support their habit. Prosecutors can help repeat felony offenders become responsible citizens if they combine treatment and vocational training with the certainty of punishment for noncompliance," says Joseph A. Califano, Jr., CASA president and former U.S. Secretary of Health, Education and Welfare. "In this time of burgeoning prison populations and shrinking federal and state budgets, every prosecutor in the nation can follow the lead of Brooklyn District Attorney Charles J. Hynes and try this program. DTAP offers prosecutors the same kind of effective alternative to incarceration that drug courts offer judges."

The DTAP program provides 15 to 24 months of residential drug treatment, vocational training, and social and mental health services to drug-addicted, nonviolent repeat offenders who face mandatory punishment under New York State's second felony offender law. Participants are abusers of heroin, crack and powder cocaine among other substances. They plead guilty to a felony, thereby ensuring a mandatory prison sentence if they abscond from the program. Sentencing is deferred upon program participation; if participants complete the program, their guilty plea is withdrawn and the charges dismissed.

The five-year CASA evaluation found that participants who completed the program and graduated were 33 percent less likely to be rearrested, 45 percent less likely to be reconvicted, and 87 percent less likely to return to prison, than the comparable prison group.

DTAP graduates were three and one-half times more likely to be employed after graduation than before their arrest. Before their arrest, 26 percent were working either part-time or full-time. Following successful completion of the program, 92 percent had found employment.

DTAP participants remain in treatment six times longer than individuals in other long-term residential treatment (a median of 17.8 months compared to three months). Retention rates are important because the longer an individual stays in treatment, the greater their chance of maintaining sobriety. "This program in which failure is a one-way ticket to prison shows the effectiveness of coerced treatment," says Califano.

These results are achieved at about half the cost of incarceration. The average cost for each DTAP participant of residential drug treatment, vocational training and support services was $32,975 compared to an average cost of $64,338 for the time spent in prison for DTAP participants who dropped out.1

DTAP was developed in 1990 by Brooklyn District Attorney Charles J. Hynes in response to the number of drug-addicted offenders in Kings County. The 1998 CASA report Behind Bars: Substance Abuse and America's Prison Population revealed that 80 percent of the men and women behind bars in the U.S. were seriously involved with drugs and alcohol. That year, states spent nearly $30 billion on the adult corrections system, $24.1 billion of which was spent on substance- involved offenders making substance abuse the number one contributor to crime in America.

"With the advent of this innovative and effective program, Charles J. Hynes sets an example for prosecutors nationwide," says Califano. "Fifteen prosecutors in New York State have already replicated DTAP. I encourage every prosecutor in the country to try it to reduce crime, the cost of incarceration and budget deficits."

To download or order a copy of Crossing the Bridge: An Evaluation of the Drug Treatment Alternative-to-Prison (DTAP) click the following link:

http://www.casacolumbia.org/publications1456/publications_show.htm?doc_id=155067

The National Center on Addiction and Substance Abuse at Columbia University is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA's missions are to: inform Americans of the economic and social costs of substance abuse and its impact on their lives; assess what works in prevention, treatment and law enforcement; encourage every individual and institution to take responsibility to combat substance abuse and addiction; provide those on the front lines with the tools they need to succeed; and remove the stigma of substance abuse and replace shame and despair with hope. With a staff of more than 70 professionals, CASA has demonstration projects in 60 sites in 32 cities and 21 states focused on children, families and schools, and has been testing the effectiveness of drug and alcohol treatment, monitoring 15,000 individuals and more than 200 programs and five drug courts in 26 states.

*The National Center on Addiction and Substance Abuse at Columbia University is neither affiliated with, nor sponsored by, the National Court Appointed Special Advocate Association (also known as "CASA") or any of its member organizations, or any other organization with the name of "CASA".

1. These estimates are based on 1996 dollars (at the time of analysis, the most recent year for which sufficient data were available) adjusted for inflation based on the consumer price index published by the U.S. Bureau of Labor Statistics.

The National Center for Addiction & Substance Abuse at Columbia University

^ Back to top

Medicaid vital for many Oklahomans' survival

By David Nickell
Public Policy Specialist
Mental Health Association in Tulsa

Because of the state budget crises, this session of the Oklahoma Legislature will be the most critical in recent years. The Tulsa Area Alliance on Disabilities and the Mental Health Association in Tulsa will host two opportunities for Board Members, consumers, employees and families to learn about the issues and how to impact the legislature. This training will review the legislative process and, most importantly, the training will address current issues Oklahomans with mental illness and other disabilities are facing, alongside solutions and legislation to advocate for.

* One of the coalitions that the Mental Health Association has joined is the Partnership for Healthcare Investment (PHI). PHI has prepared the following excellent script to accompany a video explaining the importance of the Medicaid program to Oklahomans. While it is fairly lengthly, reading it may help you understand the importance of this program.

First we'd like to thank you. Thank you for taking the time to watch this short presentation. And thank you on behalf of the 450,000 Medicaid patients who depend on you. That's a little more than the population of Tulsa, the second most populist city in our state. That's a lot of people. It's because of your efforts that they are able to receive healthcare.

Imagine not being able to afford a doctor. Imagine your child desperately ill, and no place to find help. For these people Medicaid is the only option, it is not a luxury, it's survival.

We are the Partners for Health Investment (PHI). Our members, health care providers and professionals, want to improve the quality of healthcare for everyone in Oklahoma. The Partners for Health Investment (PHI) is a resource and policy information group of over 30 of the most respected healthcare associations, corporations, and advocates in Oklahoma.

Our mission is helping Medicaid uninsured and underinsured patients across the state. It's our mission, and its something more, passion. But passion and commitment without common sense just don't work. That's why we want to make sure that good people like you understand that Medicaid is a program that works.

It's not a hand out. It's not welfare. It's not a program created twenty years ago and exploited by people who don't want a job. Medicaid is health insurance, it's that simple. It's administered with a set of rules, and guidelines, it's cost effective, and it delivers the most service to the greatest number of people at the most reasonable cost.

And it has proven to be a sound solution to the healthcare crisis in every state in the nation.

Medicaid works, but sometimes it's misunderstood. The truth about this program that may surprise you. Here are some facts:

First, almost 20% of our people are uninsured. That's about three quarters of million people.

But Medicaid doesn't cover all of them. Medicaid was designed to cover people living at or below the poverty level. (That's a family of four earning at or less than 17, 500 a year.) In > Oklahoma additional children recieive medical coverage through programs like the CHIPS program.

Who are these poverty level people? Well, that's simple. They fall into the following categories. These people represent a real cross section of Oklahomans. And they can't afford health insurance. They have the same and sometimes worse health problems that you and I have.

Any change that affects our Medicaid program is arguably the single most directly immediately decision the state government makes. It's a very serious responsibility.

Of course the question is and should be about money. Medicaid is a state program. It's not like Medicare, which is a retirement health benefit, funded by the Federal government.

But unlike other state programs, Medicaid is a pretty good deal. Why? Because for every dollar Oklahoma puts into the Medicaid program, the Federal government contributes three dollars. Those are our federal tax dollars coming back into the state, for every dollar that we invest. At the same time, the state runs the program by enlarge, without federal control.

So the more we can budget for Medicaid, the more people we can save. And the bulk of the cost is paid for by the federal government. This is a great deal for Oklahoma from a budget standpoint, because the truth is Oklahoma is one of the top ten states with the highest poverty rates.

Twenty percent of our children live in poverty so the money we get back from the Federal government to help them, has an unusually large impact.

You may be aware that Oklahoma is ranked 46th in the nation for public health care support., in 1990 we were ranked 31st. Many places in the world have a higher life expectancy than Oklahoma.

Clearly the amount of money we get from Medicaid has a huge impact not the people from our state.

A person who qualifies for Medicaid, must see a Medicaid provider. Medicaid providers are doctors, nurses, hospitals and pharmacists, they are all health care professionals. And they are paid by the state's Medicaid program for their services. But there's a problem here.

Less than one third of Oklahoma Phyciains accept Medicaid patients on a regular basis and are actively participating in the Medicaid program. Why? Well, it's simple. Some healthcare professionals actually lose money when they provide healthcare to Medicaid patients. And that's because our Medicaid insurance does not pay our healthcare professionals enough money to cover even their cost for these services. In fact, Medicaid provides substantially less than Medicare.

For example: facts facts facts ...

These people depend on Medicaid for their prescription drug medication. Some Medicaid providers lose money on Medicaid. In order to cover the cost of Medicaid service, they must increase the cost of service for privately insured patients.

This is what we call the Hidden Health Care Tax. In much the same way that insured drivers must pay the extra for the risk of uninsured drivers, anyone in our state who can afford health insurance must pay extra for the costs of Medicaid patients, and for the cost of the uninsured.

This is in addition to the taxes that they already pay.

Because without the ability to pass along the cost of providing Medicaid coverage, hospitals must pay drug companies, doctors, nurses, ambulance companies simply could not afford to provide Medicaid coverage at all.

Now this is not as bad as it may sound. There are solutions to these problems, and they not be as expensive as you may think.

First, we need to continue to provide Medicaid funding in our budget. Over 450,000 people depend on it.

And the Federal government gives us three dollars for every dollar we invest. If nothing else, the program must continue at the best funding level we can provide. Nothing else our government does effects so many people in such a critical way. >

Secondly, we need to pause and examine that Hidden Health Care tax. This is an issue that the > Care Coalition is actively engaged in. We're interested in how much real money we can save by increasing Medicaid coverage, and thereby lowering the overall cost of health care to the privately insured people.

Now there's a possibility, and it must be proven, that we can actually save tax-payers money, by increasing Medicaid funding and receiving the extra Federal money as a result. Helping health care professionals with things like Medicaid by eliminating the Hidden Health Care tax. The potential savings in this approach may be far greater than the extra money we spend on Medicaid. If this is the case, it can be a classic example of government working smarter, saving money, and doing its best for the most people.

Again, thank you for the time that you have shared with us. We hope we have helped you to understand the facts about Medicaid. If you have any further questions, please contact PHI.

On a final note, please understand that we appreciate the pressures that you face. It's a fact of life that you must make decisions on how the government's money is spent, everyday. You have an enormous responsibility. And we know you want to do the right thing, for the most people, and we know you will.

There are certain basic things that a government must address, and healthcare is one of them. Beyond the statistics, the talk about government programs, the abstractions and budgets, there are 450,000 people who count on you for something more than just the best possible government we can provide. They count on you for the most basic things we can provide.

Someone has said that when you have your health you have everything. If that is true, than fundamentally everything that 450,000 people of Oklahoma have is in your hands. A vote for Medicaid funding is much more than a vote. It's a vote for the very best of good government. You could say also that it is also a vote for quality of life, and it is, and so much more. Your vote for Medicaid for many is a vote for survival.

A vote for 450,000 people in our state and beyond you, they have no where else to turn. Your vote is their voice.

^ Back to top

Fact Sheet

Oklahoma Department of Corrections
Mental Health Services
(January 2003)

The following are frequently asked questions concerning mental health issues within the Oklahoma Department of Corrections.

How many inmates have a mental illness?

Answer: Approximately 6,000 (26 %) out of 23,000 inmates have a history of, or are currently exhibiting some form of mental illness. Of the 2,000 female inmates, 1,050 (50.3%) and of the 21,000 male inmates, 5,024 (24.4%) fall in that category. These numbers/percentages have dramatically increased since 1998. Currently, approximately 4,000 inmates take some sort of psychotropic medication as prescribed, and about 20% of inmates with mental illness refuse to take the medication that is prescribed.


What are the costs for mental health services for DOC inmates?

Answer: In FY 2002, approximately $7,316,000 was spent on Professional salaries and medications for inmates in the state-owned facilities and an estimated $2,500,000 was given through contracts for private prison inmates. The reader is reminded that the state-owned facilities house the more severely mentally ill inmates. In a comparison of costs in six other states, ODOC costs per inmate per year was lowest.


What crimes are mentally ill inmates incarcerated for?

Answer: Overall, 57.29% of inmates with some form of mental illness were incarcerated for non-violent offenses. Of the mentally ill females, 68.3% were incarcerated for non-violent crimes, and of the males, 54.7% were incarcerated for non-violent crimes. A more detailed analysis of the data gathered to answer this question will be published by February 1, 2003.

^ Back to top

People with mental illness shouldn't be in jail, Oklahoma County panel says

The issue of mentally ill prisoners being placed in jail became a prominent part of the discussion during a recent forum on "Oklahoma County Jail: A Taxing Situation."

The forum, sponsored by the Citizens League of Central Oklahoma, focused on issues affecting the county jail, which houses more than 2,300 inmates, including 400 prisoners with mental illness. It the largest prison in Oklahoma, according to a statement from the league.

At one point during the forum on Thursday, Dec. 5, Moderator Billie Rodely asked the panel that included Oklahoma City Mayor Kirk Humphreys and recently elected Oklahoma County Commissioner Jim Roth about the problem of housing mentally ill prisoners. All five members of the panel agreed that something must be done to resolve the situation.

Here is an excerpt of a story by Steve Lackmeyer that ran Dec. 6, 2002, in The Oklahoman:
 
The only concern that drew unanimous agreement among the panel was the need to end the jail's status as the state's largest mental health operation.

"This is a no-brainer," Roth said. "I've watched over the last two decades as the federal government cut off funding and put our mentally ill on the streets. They're not getting the care they would if they were in a healthy environment."

Humphreys agreed, saying a communitywide discussion should include finding better solutions to helping the mentally ill.

"Many people end up in jail because of their mental illness. They shouldn't be there, and we really need to address that."

Also during the forum, Roth publicly praised Oklahoma County District Judge Nancy Coats for launching the state's first mental health court in November 2002. Coats donated $20,000 in campaign contributions to start the court.x

^ Back to top

MH commission issues searing indictment of nation

From: Mental Health Weekly (November 4, 2002)

Taking the first major step in its mission to evaluate and then provide recommendations for systemwide improvements in this nation's mental health system, the President' s New Freedom Commission on Mental Health holds nothing back in decrying the current system as fragmented and in disarray in its interim report released last week.

The interim report, the result of months of public hearings with stakeholders from across the spectrum, is the first step for the commission. The report focuses on problems in the current system across five areas, and highlights community-based programs that have been successful in each of the five areas and that serve as rays of hope in an otherwise dismal outlook on the current system.

President Bush also has charged the commission with making recommendations for improving the system. If the interim report offers any guide, the recommendations, due next April, could be quite provocative. Among the more intriguing conclusions in the interim report are the importance of finding employment for people with serious mental illness and breaking the cycle of dependence that the current system promotes, citing parallels to the former welfare system.

The Interim Report to the President is the most significant report on mental health since the release of Mental Health: A Report of the Surgeon General toward the end of 1999 (see MHW, Dec. 20, 1999). While the Surgeon General's s report offered an extensive overview of the biological nature of mental disorders and the current state of treatment and research, and has been critical to reducing stigma and bringing increased mainstream medical acceptance to mental illness, that report did not offer broad policy recommendations.

While the Surgeon General's report acted as a rallying call for treatment, the interim report takes a critical look at where improvements are needed and sets the foundation for broad policy recommendations.

The critical tone is set in the report's cover letter to President Bush.

Commission chairman Michael Hogan, Ph.D., writes, "Our review for this interim report leads us to the united belief that America's mental
health service delivery system is in shambles."

Hogan goes on to write in the cover letter that the system is incapable of efficiently delivering and financing effective treatments. He points to the fragmentation of the existing system among agencies, programs and levels of government.

"There are so many programs operating under such different rules that it is often impossible for families and consumers to find the carethat they urgently need," wrote Hogan in the cover letter.

The report points out that the system is in disarray not from a lack of commitment or skill among those who deliver care, but from underlying structural, financing and organizational problems. The report states that many of the problems are due to the "layering" of multiple,
well-intentioned programs without overall direction, coordination or
consistency.

Citing various studies, the report estimates the prevalence of mental health among U.S. adults at 5 percent to 7 percent, with 5 percent to 9 percent of children having a serious emotional disturbance.

Referring to a World Health Organization (WHO) survey in 2001, the report states that by far, mental illness is the leading cause of disability. The report states that one out of two people who need mental health treatment do not receive it.
The five barriers

The report identifies five barriers that needlessly impede access to mental health services. They are: fragmentation and gaps in care for children;
fragmentation and gaps in care for adults; high unemployment and disability for people with serious mental illness; older adults not receiving care; and mental health and suicide prevention not being a national priority.

The report describes a mental health system with varying missions, settings and financing. It states that the $80 billion that is financed annually for mental health services could come from one of many sources --
Medicare, Medicaid, a state agency, a local agency, a foundation or private insurance, each with a different set of rules.

The reasons for the fragmentation of the system date to the 1950s, when patients were moved from institutions to community-based care, the report states. The unintended consequence of this reform movement, the report states, was to scatter responsibility across levels of government and
multiple agencies. New programs created to fill gaps added to the complexity and fragmentation.

Compounding the problem, the report states, is that most federal resourcesare within larger programs, such as Medicaid and Medicare, housing programs and vocational rehabilitation services that are not tailored to the requirements of good mental health care.

The report states that while many mental health providers are dedicated and make valuable contributions despite the system's disorganization, no one isultimately responsible while consumers and families struggle to find care.

The result is that there are hundreds of thousands of individuals with
serious mental illness in settings that are not designed to meet their needs, the report states. "Something is terribly wrong, terribly amiss with the mental health system,' the report states.

According to the report, the system is even more fragmented for children, with even more uncoordinated funding streams and differing eligibility requirements. It is again the unintended consequence of good
intentions: There are more programs in existence for children. The problems are disproportionately worse for children from ethnic and racial minority groups, the report states.

Among adults, the report states that about 25 percent of homeless persons have a serious mental illness and, for the most part, do not receive any treatment. Adults ages 65 and older are reluctant to seek care.

The commission reported that they don't go to a mental health professional, mostly for stigma reasons. They feel more comfortable going to their primary care doctor, the report states, and are more likely to describe physical symptoms rather than feelings of depression.

The report states that primary care physicians may see an older person's suffering as a part of aging rather than an underlying mental illness.

The report states that the nation's failure to prioritize mental health is a national tragedy, pointing to the 30,000 lives that are lost annually to suicide.

Citing an Institute of Medicine report, the report says that about 90 percent of individuals who commit suicide have a mental disorder.

High unemployment

The report found a 90 percent unemployment rate among adults with serious mental illness is at the worst level of employment among any group of people with disabilities. The report states that many of these people want to work and could work with a modest amount of assistance.

Instead, according to the report, the nation's "largest program" for people with mental illness is disability payments. The report compares the situation to that of the old welfare system "unintentionally trapping millions into long-term dependency."

The report concludes that the nation's mental health system
is not oriented to the most important goal of the people it serves -- "the hope of recovery."

Many more people could recover from mental illness if they had access to programs tailored to their needs, the report states. State-of-the art
treatments are not being transferred to the communities, according to the
report, while outdated and ineffective treatments are being actively supported.

The report concludes that barriers to care can be overcome, as illustrated by the programs highlighted in the text. Programs need to be integrated across fragmented governments and agencies, and capacity increased.

This "Mental Health E-News" posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights.

To join our list, e-mail us your request and, where appropriate, the name of your organization to NYAPRS@aol.com.

^ Back to top

PDF Download
A Useful Management Tool for Understanding Correctional Mental Health Services
 

 

^ Back to top