4 Serious Questions About Tulsa County Govt.

A hard look at Tulsa County Government

  Why does the Tulsa County Government want to be the solution to problems they don't own?

If cities see a municipal need, shouldn't they go to their own voters? 

  Shouldn't cities keep control of their own projects?

Vision 2025 was almost completely a collection of capital projects for  individual cities. Is the county supposed to become the hired fundraiser for cities who want a civic center?

  Why are the county commissioners so silent about the abuse and failure of the state government?

  When the state closes mental hospitals, why does the jail become the only solution?

  And when the state refuses to take inmates who've violated state law, why should the counties have the cost of caring for them?

Why should the counties build the prison housing for the state?

  Not one public Tulsa county statement about lack of state mental health deficits have been recorded in recent history. Does Tulsa county really care about what it's costing us in jail funding? Or do the commissioners see it as an opportunity to further grow the size of the county bureaucracy?

  Why does the county want to raise money for the cities, instead of letting cities hold their own bond elections?

  Isn't this a case of city failure? Does our city govt. lack the courage to ask the voters for approval? And doesn't the city risk their autonomy by having to submit to more bureaucracy in order to get their own money back?

  When a local shop owner leases a space for his business, the lease specifies the terms. Not many landlords offer to remodel retail space for the local merchant.  This is another case of big businesses like AA buying favor with politicians while "mom & pops" businesses pay all the bills.

  Why do the commissioners want to put the county further in debt until 2029?

  Reports say the 1995 County jail is still not paid off. And now they want to put a 2nd mortgage on the county's tax burdon?
  The commissioners still haven't answered how the excess moneys from vision 2025 will be dispersed. 

  This bond election is not about jail needs as much as it is about big appetites for money which the county commissioners get to play with and buy more influence.

Oklahoma Scores a 'D', in State Mental Health Leadership

  In 2008, NAMI conducted their 2nd national study and grading of the several states' effort to bring relief for mental illness. Oklahoma was among the 6 top states for levels of improvement in state mental health resources. The Oklahoma legislators gave themselves a "pat on the back" for being the heroes of the afflicted.

  But since that study was published, in 2009, a sad legacy of neglect has hit the sooner state, and the capitol building has a cloud of collective shame settling in.

  Every state felt the effects of the 2008 economic crash. Yet the Sooner State leadership used this excuse to cut mental health resources by a higher percent that 35 other states. 

  Even without taking inflation into account, Oklahoma cut mental health resources by 5.9%. When you  factor inflation, the cut becomes more than 12% over the 3 years of 2010-2012. When you factor in the medical inflation rate, the cuts are absolutely devastating. If not for some promising new legislative initiatives, Oklahoma could not justify any claim to a passing grade. 'D' is the best grade that Oklahoma's state government can mercifully be granted, in my best judgment.

 “It’s going to cost us,” said Rep. Gus Blackwell, R-Laverne, who’s heading a House study on how the state should handle the growing inmate population. In 2014, Blackwell estimates;  "the state will need an additional $25 to $30 million in next year’s budget just to address overcrowding at corrections facilities.". And this is just for inmates of state-run correctional facilities. The 77 county jails and municipal detention facilities have borne an even greater financial hit. 

  Is there a connection between the mental health neglect and the ballooning costs of incarceration? Absolutely! The Oklahoma prison population began an astronomical climb in 2011. The mental health funding was cut at the beginning of the previous year. Only Louisiana, Mississippi, and Alabama have a higher rate of state incarceration than Oklahoma. Why do conservative administrations so foolishly spend so much more money on incarceration as a 'cure-all' for people we find inconvenient to care for?

  When will relief come? It will come as soon as preventative and crisis resources are available and utilized. But the prison budgets will still be with us, unless judges or parole boards also tap into treatment alternatives.

sadly, we will have to fund prisons and full mental health resources at higher levels, until the intervention treatment begins to change the prison populations. But Oklahoma currently incarcerates at a higher percent than any other American state.

  Mentally ill people are not criminal. Criminality requires criminal intent. An ill person's delusions and desperation are a greater punishment than jail cells, but the harm caused by delusional acts are still difficult for a society who is looking for someone to punish. A society has a moral right to demand accountability in the stabilization of an ill person whose behavior has harmed others. To this end, Oklahoma's senate has passed an Assisted Outpatient Therapy bill which would mandate accountability of such individuals. The threat of incarceration may serve as an excellent deterrent, for the benefit of all of us.

Swimming Upstream to Solve Problems at the County Jails

By David Van Risseghem

  The Mental Health Association Of Tulsa Has Entered The Debate On The Tulsa Jail Bond Politics.
Executive Director, Michael Brose Addresses His Complex Response To The Jail Bond Vote.

   Like Michael,   many of us who serve in leadership for mental health advocacy are sorting out conflicting concerns about mental health treatment, and the format in which it is being delivered; or not delivered.
   I am the President-elect of NAMI Tulsa. The National Alliance on Mental Illness is the largest advocacy organization for mental health issues. Our organization has not endorsed either side of the upcoming bond election, in Tulsa County. I happen to personally oppose the current jail bond and several others in NAMI are also concerned that the jail has encountered "mission creep" into  public mental health through criminalizing people who are experiencing a nervous breakdown.

Mr. Broce's comments (printed in blue) are very insightful and I want his concerns to be further amplified.  I'm going to post Michael's recent letter and give my own comments:

   Unfortunately, sometimes you have to swim upstream

   Over the past few weeks, I've been repeatedly asked about my thoughts regarding the April 1 tax extension vote to expand Tulsa’s David L. Moss Criminal Justice Center, and to improve its facilities and treatment for inmates impacted by severe mental illness.

   Mental healthcare is critical care. It needs to be available wherever and whenever it plagues humanity. To neglect it is to endanger the sufferer and every person within that person's sphere of interaction. Most people with mental illness are NOT violent. But life-threatening concerns are always present. As the current trend progresses, one day, someone you love will likely face the criminal charge of being mentally ill.

   Like many issues in search of a simple answer, this question is complex. I do support Sheriff Stanley Glanz’s proposal for several reasons. First, Sheriff Glanz, and deputies who operate the jail, have no control over who is placed in the jail. They have to accept and care for whomever law enforcement charges and brings to the jail. Inmates can only be released if the sheriff receives an order from the court to do so. Second, the sheriff clearly recognizes inmates with severe and untreated mental illness committed crimes they would not have committed if they were receiving the treatment they desperately need in their respective communities.

   This is a very valid point.  The county sheriff houses inmates whom the sheriff has prosecutorial role. He and his deputies are charged with the duty to keep the inmates safe and keep the county safe. He is not responsible for the failures of the state in providing the preferred mental health facilities which many of these sufferers should should be treated at.

   Sheriff Glanz has personally witnessed bad things happening to people who are severely ill, and have been placed in his jail, almost always due to the absence of enough treatment beds in the community. Because of our failure, and the State of Oklahoma’s failure, to fund treatment beds adequately for Northeast Oklahoma, people who are severely mentally ill continue to be placed in his jail. He wants to properly care for them in an area where they are free from being preyed upon in the general population of inmates. The sheriff also wants to have the resources to properly train specialized officers who understand mental illness, and their special needs.

   Sheriff Glanz is personally named as a defendant in wrongful deaths. He does not get to choose the medical staff which treats the inmates. That is the county commissioners' role. He does ultimately answer for the failure of his wardens and staff, when they fail. If their failure results in harm or death, then he cannot pass the blame on lack of resources. If he feels he cannot do his duties correctly, his duty is to resign his role.

   Is the sheriff’s proposal the long-term answer? No.

   Sadly, this is the reality of our refusal to properly fund treatment beds to serve the size and population of Northeast Oklahoma. We need to help the jail properly care for these inmates who live with severe, untreated mental illness at no fault of their own now. At the same time, we must organize all of our combined efforts to insist lawmakers begin investing in people who, if they receive the treatment they need in their own communities, become taxpaying, contributing members of the community. Sixty percent of Mental Health Association in Tulsa employees are doing just that — living in recovery with severe mental illness, because they secured adequate treatment in the community. Many of our employees have histories, and sad stories, of incarceration in jail and in prison. With adequate treatment, they live in recovery, pay taxes, have families, and they are gainfully employed. They are the fortunate ones. Right now, the jail is full of people facing charges because their severe mental illness went untreated and, subsequently, have committed non-violent and often petty crimes. On any given day, 33 percent of inmates in the jail will present with a severe mental illness, according to the Tulsa World’s own Julie DelCour. Simply put, these inmates were unable to secure adequate treatment in their community, and now they are behind bars.

   This is the "heart" of the Oklahoma issue. None of the problems will truly be resolved by a jail bond. In fact, it may take longer to bond and build a jail than for the state to appropriate funds to open treatment centers in existing facilities. Correcting the state funding problem this month, could result in a shrinking jail population in every county of our state, this year! The legislature is now in session. we don't need to wait until the next bond election to fix the problem.

   The Mental Health Association in Tulsa supports the sheriff’s desperate appeal to support the tax extension vote. At the same time, we call on the sheriff, the Tulsa County commissioners, Mayor Dewey Bartlett, the Tulsa City Council members, and the whole of the community, to join forces, regardless of party affiliation, and insist together that Oklahoma lawmakers, and Governor Mary Fallin, invest in Northeast Oklahoma with the community-based treatment and beds we so desperately need. This isn’t about raising taxes. This is about investing in our people. Sadly, sometimes you have to swim upstream.  

   Some folks don't care about treating mental illness, until their loved one becomes stricken within it's hideous grasp. I, and many other mental health advocates urge every Oklahoman to look beyond the jail bond elections and help fix the statewide failure at the state capitol.  There are some who are using my arguments only to defeat a county tax increase. I am aware of that.

   If we don't fix this problem right, we will see endless ballooning county bond issues and ever higher expenses in criminal justice funding, at a very wasteful misappropriation of effective treatment and a much worse record of successful recovery.

By Mental Health Association In Tulsa On March 27, 2014
By Michael W. Brose, MSW
Executive Director
Mental Health Association in Tulsa

Michael Broce and MHAT's full messages are available at: http://goo.gl/48nYvD 

Preventative Mental Health Successes Are Ignored By Lawmakers

   The Oklahoma Mental Health Department has released the following statistical evidence for money saved and lives restored through pro-active solutions to mental health crisis. Each of these programs is currently under-funded and under-utilized.

   Only 15 of Oklahoma's 77 counties have a mental health court. Most of the treatment programs are full and not able to receive new clients. Yet many of those turned away are forced into county jails and prisons, because of the imapct their untreated illness poses to the community.

Proven Mental Health Programs Making a Difference in Oklahoma

  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 Tulsaand 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 54 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, birth through age 21, 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	30%
School Detentions	53%
Self Harm Attempts	39%
Arrests	48%

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. 

The Best Help For Mental Illness Is Not A Jail

County Budgets Pay the Price For State Govt. Failure

Jails are trying to become mental hospitals

  Perhaps the most glaring example of legislative failure, in Oklahoma, is illustrated by the terrible abuse of the county jail. Tulsa's jail is taking on a role that is was never designed for - nor should it be!  County jails are supposed to serve to protect society from criminals. But they are now the #1 & #2 mental health treatment centers in Oklahoma.

  Because the state has failed terribly, to replace the now-closed Eastern State Mental Hospital, in Vinita, OK.; law enforcement cannot exercise the prudent discretion to bring a mentally unstable individual to a psychiatric facility for a court-ordered assessment and follow-up treatment.  Because these individuals are perceived a danger to themselves and/or others, the officers have created a make-shift class of criminals out of them.

Perhaps if the County Commissioners spent as much effort
in lobbying the legislature as the teachers and tea party are,
we'd not need to burden the county taxpayers with more
wasteful funding of mental health jails.

  Over 15 years ago, the Oklahoma legislative leaders determined that the 2600-bed mental hospital in Vinita needed to be replaced with a network of community mental health centers. This required a multi-year plan and discipline to avoid "raiding" these funds for other pet projects like Indian Museums and Passenger Rail service. Some in the senate warned us that Oklahoma would fall into this terrible situation by not building the new network ahead of Vinita's final closure.

  To the discredit of all the state's leadership, only one new community mental health facility was added, and it was done "on the cheap" by acquiring the outdated and unsafe Doctors Hospital of Tulsa. The facility was faulty in design and short-sighted in oversight, but it was thrown together quickly.  Even if the legislature authorizes five more community mental health in the next 3 years, Oklahoma will still operate at well below the capacity which the Vinita facility had.

As bad as Vinita had become, it was more
humane than the county jails of Oklahoma

Perhaps the biggest medical expenditure at county jails have to do with the dozens or perhaps hundreds of mentally ill inmates. Tulsa County is constantly seeking to squeeze this ballooning expense. This has led to even more expenses, due to lawsuits because mentally ill people are dying from the terrible failures of inept medical staff and poorly-trained wardens. Some are characterizing Tulsa's medical contractor, Correctional Treatment Companies, of what amounts to assisted suicide of the mentally ill. KJRH TV posted  an article about this problem.

The Tulsa jail medical service is so bad,  it looks like they are assisting suicide for the mentally ill

  But Tulsa County's commissioners are silent about the state failures which have led to massive new expenses to the counties. Instead, they are eagerly pushing to expand county government and even more massive jail compounds with expanded roles in public mental health.

  The costs are much greater than just higher taxes. The more we incarcerate folks with mental breakdowns, the  expense to provide foster care for children blows up as a result. Folks who could have responded well to medication and resumed their roles at home and work within a couple weeks, usually face a much longer sentence as an inmate. A person who could have taken a medical leave-of-absence and kept their job; probably lost it because he's now an inmate with a police record.

This Tulsa County citizen died of starvation & dehydration over 3 days, while Tulsa County jail staff watched and did nothing!

  Perhaps the best thing voters can do for their community is to force the county commissioners to lobby the state legislature and governor for a real solution and a fresh commitment to the Vinita transition they promised us many years ago.

  If even half of the mentally ill inmates would have had an option of court-ordered mental healthcare, there would be no new jail bond elections, far less lawsuits from gross mistreatment of ill people, more families intact, less unemployment, far lower county criminal justice expenses (jail, court costs, & prosecutor), and our society would reflect a more humane compassion for those victimized by the cruel scourge of a mental illness. Our "crime rate" statistics would diminish and our state will be far more attractive to new industry. Then maybe we can talk about funding more Indian museums and passenger rail service.