Evidence Based Practices and Proven Programs in Mental Health

Mental health and substance abuse services have traditionally been the most under-funded of government programs. Yet, our state leaders demonstrated during recent years that they now recognize the benefits of increasing access to treatment. While Oklahoma has not progressed to the point at which we need to be, many accomplishments deserve attention. Examples of programs and services that will hasten progress include:

Mental Health Courts

Mental health court is a highly structured, court-based program providing a treatment alternative for non-violent offenders diagnosed with a mental illness. Court structure and processes are designed to identify and address the unique needs of a non-violent person who has come in contact with the criminal justice system because of his or her mental illness. A review of data from the state’s first Mental Health Court program indicates notable improvements in the lives of participants. Several factors were measured and compared against pre-court measurements, resulting in significant findings regarding program graduates. Some key points are as follows:

	Percent Reduction
Hospital Days	98%
Arrests	77%
Jail	97%
Unemployment	80%

Programs for Assertive Community Treatment (PACT)

The Program of Assertive Community Treatment (PACT) is an effective, evidence-based service delivery model providing intensive, outreach-oriented mental health services to people with schizophrenia, bi-polar disease and other serious and persistent mental illnesses. Using a 24 hours-a-day, seven days-a-week team approach, PACT delivers comprehensive community treatment, rehabilitation and support services to consumers in their homes, at work and in community settings.

Building community supports such as PACT and other non-traditional programs of care allows an individual, who otherwise may be subjected to multiple hospital visits, or jail, the ability to address the demands of their illness while remaining in the community. The program is intended to assist clients with basic needs, increase compliance with medication regimens, address any co-occurring substance abuse, help clients train for and find employment, and improve their ability to live with independence and dignity. PACT was implemented in Tulsa and Oklahoma City in May of 2001 with $2 million provided by the state legislature. The program now has an annual appropriation of $5.3 million, much of which is used to draw down additional Medicaid funds, and has expanded to include 14 PACT teams serving 19 counties statewide.

Oklahoma is considered a national leader in this area. The following measures show a pre/post hospital and jail comparison for consumers:

	Pre-PACT	Post-PACT	Percent Reduction
Hospital Days	5,233	1,942	63%
Jail Days	1,050	314	70%

Systems of Care (SOC)

In the fall of 2002, Oklahoma received a six-year, $9.4 million “Systems of Care” grant to establish children’s behavioral health service “hubs” throughout Oklahoma. The program has since expanded to serve children in 30 counties throughout the state.

There is a tremendous need to expand children’s services throughout the state and programs such as Systems of Care, which cut through red tape and focus attention on the needs of the children and their families to provide the appropriate level of services. It is targeted to impact children, ages 6-18 years, with serious emotional and behavioral problems at home, school and in the community; and, it has been proven as a model system.

Evaluation demonstrates significant achievements in a child’s behavior when measuring outcomes following six-month client participation. Examples include:

	Percent Reduction
Out of Home Placements	31%
School Detentions	64%
Self Harm Attempts	65%
Arrests	54%

Community Mental Health Centers (CMHC)

One of the major challenges currently facing the department is that of equitable funding for community mental health centers. Despite this struggle, the CMHCs continue to provide core services such as medications, counseling, and case management that help many people with mental illness live a life in the community. In addition to core services, most CMHCs are able to offer best practice, evidence-based services, albeit on a limited basis.

Medicaid for Mental Health Providers

In recent years the Medicaid program has become a significant revenue source for mental health providers. Much of this increase has come about because CMHCs are assuming more responsibility for persons needing treatment as opposed to state hospitals. Many CMHC services are Medicaid reimbursable, while state psychiatric hospitals are considered institutions and are, therefore, ineligible for Medicaid.

Medications

The advent of more effective psychotropic medications for people suffering from schizophrenia, severe depression, and bipolar disorder has enabled many more clients to lead normal, healthy lives in their communities. These “new generation” medications have improved quality of life for many people and have the potential to decrease hospitalization costs for states. It is important to provide appropriate medications on a consistent basis for all clients. Otherwise, persons with mental illness are stabilized in hospitals with medications, discharged, then either cannot or do not continue to take prescribed medications. Their condition deteriorates until law enforcement or loved-ones intervene, then they are re-admitted to a hospital.

Forensic Services

DMHSAS is responsible for providing several forensic services: evaluating all people charged with a crime that are believed to suffer from mental illness, treating defendants with mental illness who are waiting for trial, but are not competent to proceed because of their mental illness, and hospital based treatment for persons adjudicated as Not Guilty by Reason of Insanity (NGRI). The forensic population, served at the Oklahoma Forensic Center in Vinita, is on the increase. In July 2000, there were 132 forensic patients at OFC. Census now averages approximately 160. Occasionally, there is a waiting list of individuals being held in local jails awaiting the availability of a bed at OFC. In addition many of the buildings are over 70 years old with numerous maintenance needs. In the 2004 Legislative Session, DMHSAS received approval for up to $18.9 million in capital bond funds to build a new, 200-bed forensic unit. Ground breaking on the new construction occurred in July 2006.