Oklahoma has a huge number of people who need treatment and less money to fund it

Maddy Boehrer had her first break with reality when she was 9.

She spent nearly three months in a psychiatric hospital. The cost to her parents: $54,000.

"We did all the right things. We both worked. We paid our health insurance premiums every month. And still, we couldn't afford her care," said her mother, Susan Boehrer, who is the director of the Oklahoma Federation of Families for Youth and Children's Mental Health.

Once Maddy left the hospital, her medication cost $1,200 a month, Boehrer said.

After much difficulty, the family obtained a Medicaid card for Maddy to help with prescription finances. Still, Maddy -- suffering from numerous mental illnesses, including schizo-affective and bipolar disorders -- had six more inpatient stays during the next 2 1/2 years.

"Our bills had become astronomical," Boehrer said.

Eventually, the Boehrers cut their own path through the system.

After reaching many dead-ends and hearing "no" too many times, the family happened upon the Children's Recovery Center in Norman, a state-operated residential center.

"We found that there was a place to go if you don't have Medicaid and you can't pay," Boehrer said. "We were able to get some help without going into greater amounts of debt."

Although Maddy, now 18, will always need help, she is doing well and is a productive citizen, her mother said.

Cut to the bone

The Oklahoma Department of Mental Health and Substance Abuse

Services has cut $16 million from its budget since July, and state legislators have ordered another 5 percent cut for the rest of this fiscal year. The first round of cuts closed 28 mental-health beds at Griffin Memorial Hospital in Norman.

Now, about 120 additional state-funded beds hang in the balance, including 40 for children with severe mental disorders. An additional 18 beds at a men's treatment center in Tahlequah are among those targeted, and about 100 state employees are expected to lose their jobs.

"These decisions we're being forced to make are the things that keep us from sleeping at night," State Mental Health Commissioner Terri White said. "More importantly, Oklahoma families are suffering."

Boehrer is now advocating for other families in need during this budget crisis, testifying at a recent Senate subcommittee hearing on behalf of children's mental health services.

"I'm not naive. I understand there is a budget shortfall," she said. "I'm just asking that we save at least eight of these beds for children."

Oklahoma ranks second in the U.S. for its number of adults in serious psychological distress, more than 380,000. About 250,000 Oklahoma adults and 31,640 youth need substance abuse treatment.

"I don't believe there is a family in Oklahoma that hasn't in some way been affected by substance abuse or mental illness," White said. "The consequences of these cuts are devastating."

Outpatient capacity gap

As residential capacity for people suffering from mental health or substance abuse falls, demand for outpatient treatment is accelerating rapidly, mental health advocates say.

"The need is just extraordinary," said Gail Lapidus, the executive director and CEO of Family and Children's Services in Tulsa, the largest provider of outpatient services to the uninsured in the state.

The agency, which serves only Tulsa County, has seen a 37 percent increase in just adults seeking help since last year, most likely a symptom of the poor economy, she said.

In rural Oklahoma, the need for outpatient mental health and substance abuse treatment is just as strong.

"We've got diminishing resources along with that significant increase in need," said Robert Lee, the executive director of Mental Health Services of Southern Oklahoma. The Ardmore agency serves nine rural counties.

Lee said the agency had seen a five-fold increase in patients over the last three years.

As residential beds to treat mental illness or substance abuse become more difficult to find, demand for outpatient care will rise further, mental health advocates say.

"When you make these kind of cuts, more people die, end up in jail or end up in the hospital," Lapidus said.

The National Alliance for Mental Illness named Oklahoma the most improved state this year for mental health care systems. It was poised to become a national leader in comprehensive, recovery-oriented mental health care.

Now, White says, the state agency is just trying to maintain services.