By Whitney Bryen, Oklahoma Watch
This story has been updated to reflect a diagnosis made after a participant responded to the survey.
A Guthrie father spent two nights in an emergency room after his son attempted suicide only to be sent home because every state mental health treatment facility that cares for children was full.
After recovering from methamphetamine addiction, an Antlers woman became a peer recovery specialist to help others. She makes too much money to receive free medication and not enough to afford the pills and counseling that are keeping her sober.
A former pastor told employees at an Oklahoma City crisis center that he was suicidal and was turned away because he sleeps with a C-PAP machine, which isn’t allowed in the facility. The pastor shot himself 19 days later in the parking lot of the crisis center.
These life-and-death accounts and other stories of mental health struggles were among the 130 responses shared this year through an Oklahoma Watch survey. Among the most common themes: High costs for treatment, long waits and fear of hospitalization or jail often deterred treatment or efforts to secure treatment for loved ones.
“People like me are not bad or flawed,” Duncan resident Stephanie Marcom said. “We are not bad people trying to get good. We are sick people trying to get well. But it’s hard to get well without appropriate care.”
In every county in the state, the need for care outweighs the number of mental health providers available to help, according to the U.S. Department of Health and Human Services. Overwhelmed and underpaid counselors, many of whom face their own mental health challenges, had weeks or months-long wait lists for appointments, survey participants said.
Low insurance reimbursement rates limit the types of insurance that Oklahoma providers can accept leaving low-income Oklahomans with the fewest options for care, a report released on Dec. 16 by Healthy Minds Policy Initiative found.
Residents in rural communities had few nearby treatment options and couldn’t afford to take off work to travel to appointments, participants said.
Nearly 40% of survey participants said they interacted with police because they or a loved one were in crisis. They were left alone to cope or handcuffed and taken to a hospital or to jail, which was the case with Norman baker Shannon Hanchett who died less than two weeks later in the Cleveland County Detention Center. Hanchett’s death has Oklahomans asking why she was arrested instead of taken to a hospital for treatment.
Those and other barriers to care prompted a U.S. Department of Justice probe into the state’s mental health services.
A February complaint triggered a federal investigation to determine “whether Oklahoma fails to provide community-based mental health services to people in Oklahoma County, leading to unnecessary admissions to psychiatric facilities and police contact.” Investigators will also examine Oklahoma City and its police department’s response to people in crisis.
Brian Wilkerson, legal director for the Oklahoma Disability Law Center which filed the complaint with the American Civil Liberties Union, refused to provide the complaint.
“We’re generally pretty good at providing assistance and support for those that need state assistance and support for general medical needs, but for your mental health needs, which are just as important, those same supports and services don’t exist,” Wilkerson said. “Often, that need can only be met by isolating or incarcerating them, whether it’s in a psychiatric ward, an emergency room, one of our state health hospitals or the jails.”
Wilkerson said the lack of affordable care and high rates of incarceration for people with mental illness violates the U.S. Supreme Court decision that entitles people to receive care for mental health, developmental and intellectual needs in their communities rather than forcing them into institutional care.
Jeff Dismukes, a spokesman for the Oklahoma State Department of Mental Health and Substance Abuse Services said, “I am extremely confident in our capabilities as a system.”
Survey participants were not as confident in the state’s treatment system. Here’s what they told us about their struggle to find care.
What It’s Like To Struggle
“I have never been able to fully live life, only survive.”
— Lawton resident Kerry Kincade-Aneki
Frustrating. Dark. Lonely. That’s how participants described their struggle with mental illness.
Some isolated themselves at home when their symptoms worsened, ignoring calls or messages from concerned friends and family, skipping work or school and sleeping more than usual.
“I hit really, really low points in college where… mental illnesses made it nearly impossible for me to move, to call, to eat, to sleep, to do my schoolwork, anything,” said Kristin Wells, a former Tulsa resident who has recently moved out of state.
Others said episodes caused weight loss, hyperactivity and loss of sleep, producing a facade that is difficult to see through.
“I was actively suicidal but no one would’ve known,” said Tulsa resident Maddie Habeck, who suffers from post-traumatic stress disorder and was in an abusive relationship at the time. “I was president of my sorority and actively involved on campus and I was working.”
Edmond resident Christine O’zee said, “I’ve been stable on medication for nine years but when I was having mental health episodes, l looked like someone who was motivated and energized to lose weight, make career changes, and move their life forward. Eventually, I would crash and find myself drowning in debt, jobless, and gain back the weight and then some.”
Half of the Oklahoma Watch survey respondents said they have experienced a mental health crisis.
They experienced homelessness, incarceration and violence as a result of their illness. Most said they felt misunderstood and judged, even by loved ones who try desperately to help.
Oklahoma City resident Matt Chubb said every day is like “swimming upstream. And I feel guilty for needing to help because unlike a cut or a broken bone my injuries cannot be seen.”
In rural northwest Oklahoma, Kathleen Lourde, who has been diagnosed with major depressive disorder, anxiety and PTSD, put it this way: “I’m not different just to piss you off.”
Barriers To Care
“I receive a minimum amount of care that keeps me alive, but in order to really tackle my mental issues I would need a lot more money.”
— Oklahoma City resident Katie Rutledge
All 77 Oklahoma counties face a shortage of mental health providers, according to a November report from the federal Health Resources and Services Administration. High population-to-provider ratios, poverty rates and travel times to the nearest provider provoked the designation.
“Finding qualified mental health providers, especially in rural areas, has become nothing short of a needle in a haystack,” Holdenville therapist Rachel Lindemann said.
Limited public transportation options and high poverty rates made it difficult for rural Oklahomans to access care, participants said. Telemedicine expansion has helped, but insufficient broadband plagues large regions of the state.
“Couple that with the mass exodus of providers leaving the field due to poor reimbursement rates, burnout and unrealistic productivity expectations and we are left with a barren landscape in an already stressed system,” said Lindemann who has practiced in rural Oklahoma for 24 years.
Private health insurance or SoonerCare (Medicaid) covered some mental health treatment for 84% of participants. But the cost remained a significant barrier.
Norman resident Erin Williford pays roughly $850 a month for therapy for herself, her husband and her two kids — even with private insurance.
Misty Strange Trent of Antlers has been sober for five years, partly due to the help of medication she can no longer afford.
“As long as I wasn’t working and making any money my medications were basically free,” Strange Trent said. “But now that I am earning a living, I pay almost full price on Medicaid with a high deductible, so I cannot afford all my medications at this time.”
Despite a slew of diagnoses over the years, Kerry Kincade-Aneki of Lawton said she was forced to forgo therapy and medication for years at a time because she couldn’t afford it. Each lapse resulted in psychotic breakdowns and suicidal ideations, she said.
“We could hire as many clinicians as possible who are well trained. But if we don’t address housing, jobs or food then it doesn’t matter,” Oklahoma City clinician Luke Small said. “Mental health struggles could be mitigated if my families were in more stable housing or had more stable employment.”
Low Pay, Stigma Fuels Clinician Shortage
“Therapists want to provide quality care to their clients but, also, be able to pay their bills.”
— Oklahoma City counselor Jessica Stoops
The clinician shortage was exacerbated by the pandemic, according to participants, half of whom said they have worked in mental healthcare.
Low pay and years of expensive training caused many to leave for better-paying jobs and dissuaded others from entering the field, they said. The increased need for services fueled by the pandemic led to long waits for service and unmanageable workloads intensifying mental health challenges faced by many clinicians.
“As a professional in the helping field, with mental health challenges of my own, I often feel like an imposter walking alongside others in their growth to healing,” said Morgan Evans, a counselor at the Halo Project in Oklahoma City.
Evans said she battles stigma in most aspects of her life: as a black woman, a Christian and a mental health worker.
When she told members of her former, non-denominational church that she was struggling with her mental health, they told her to pray for healing. And when that didn’t work, Evans said she wondered what she had done wrong.
“All of these factors withheld me from receiving the services I needed earlier,” Evans said.
Elizabeth Fletcher, a clinical social worker in Oklahoma City, said she can’t afford to pay full price for her own therapy.
“I have been fortunate to work with therapists who have allowed me to pay a fraction of their rate so that I could afford to see them,” Fletcher said. “I see many therapists in my practice and none of them can afford to pay my full rate.”
Oklahoma’s provider reimbursement rates are below the national average and the lowest among surrounding states, according to a 2019 national study.
Participants said insurance companies only reimburse clinicians for time spent with clients and don’t account for other vital tasks or training.
To receive her certification, Oklahoma City counselor Jessica Stoops needed a master’s degree that strapped her with thousands in student debt and 3,000 hours of supervised counseling, which took two years and required her to cut back on hours at her previous job to complete. Now that she has her own practice, about 1/3 of her work is unpaid.
“Insurance reimburses for time spent in session and that often misses the other work that therapists do, including doing research, notes, consultation, and training to best help those they work with,” Stoops said.
Stoops and Fletcher are founding members of Therapists for Equitable Pay, which seeks to boost compensation for Oklahoma clinicians by negotiating with insurance companies on their behalf.
‘I Sought Care But It Didn’t Help‘
“It’s a frustrating, heartbreaking, hopeless feeling when you feel you are screaming for help and everyone just shrugs and suggests a shower or a walk.”
— Olivia Cotter, a Broken Arrow mother of three
Despite challenges, most participants said they obtained treatment for themselves or their loved ones. But it often fell short of their expectations and, in some cases, magnified their symptoms.
Charla Collins’ daughter went missing early this year after a state hospital released her four days after she was involuntarily committed, Collins said. Two weeks later, Collins found her daughter at the Oklahoma County jail.
During another of her daughter’s psychotic episodes, Collins took her to an Oklahoma City hospital for help. Collins said her daughter was armed and dangerous, but there were no beds available so she was told to come back tomorrow.
“That was scary,” Collins said.
Former pastor and hospital chaplain Tim Miller told employees at the Oklahoma City Crisis Intervention Center that he was suicidal. The workers began admitting Miller who was filling out paperwork and had already removed his belt and shoelaces complying with safety protocols when Miller said he needed to get a medical device that treats his sleep apnea from his car.
“This is where everything went wrong,” said Rachel Graham, an Oklahoma City counselor who, months earlier, had advised Miller where to find care.
Crisis center staff turned Miller away saying the medical device wasn’t allowed in the facility.
Miller went home.
Nineteen days later, he returned to the crisis center where he shot himself in his car in the parking lot.
“This story is proof that we are failing massively…” Graham said. “His death was preventable.”
Kathleen Lourde, the rural resident who struggles with PTSD, said she began telehealth therapy through a state-funded center after the Jan. 6 attack on the U.S. Capitol caused her symptoms to flare up. Before any counseling could begin, Lourde was required to complete three hourlong appointments to fill out paperwork and answer batteries of questions.
After a couple of months of counseling, the paperwork and questionnaires returned, which interrupted her progress and triggered anxiety as she flashed back to interrogations from a former abuser.
“It felt like I was drowning in quicksand and I was screaming for help and people were standing all around me watching me struggle but first before they could help, I had to answer three days’ worth of questions,” Lourde said. “Surely, whatever needs to be done for their own processes can be done in a more caring way.”
Ana Chavez Maendele, an Oklahoma City resident and mental health worker, said the shortage of clinicians has led to lax standards at publicly-funded treatment centers.
“After working for two of the largest community mental health centers in Oklahoma City, I must say that blatant covert disrespect and bias against people with mental health issues by those serving them needs to be addressed,” said Chavez Maendele, who paused her treatment after hearing insensitive and cruel remarks from superiors. “I saw clinicians that caused more harm than good, and that is just wrong.”
Law Enforcement Response
“Jail isn’t appropriate for many people with serious mental health issues but often it’s the only option to ensure their safety and the safety of others.”
— Duncan mental health worker Stephanie Marcom
When she saw her friend’s suicide note on Facebook, an Edmond teenager called 911 for help.
When her husband stormed out of the house following an argument and threatened to kill himself, a Norman woman called 911 for help.
When a Kiowa woman’s bipolar disorder led to hallucinations and delusions, someone — she didn’t know who — called 911 for help.
Survey participants said sometimes police involvement is the only way to get help for their loved ones who are unwilling or unable to secure treatment.
Stephanie Marcom, a mental health worker in Duncan, interacts with police frequently in her job. She said, most are trying to help but their options are limited.
“I have witnessed, first-hand, law enforcement do all they can to help someone get into services. I have witnessed the frustration when state facilities or providers turn them away,” Marcom said. “When we don’t have appropriate services available, these struggling people end up back on the streets.”
In 2021, Oklahoma City police responded to a record number of mental health calls – more than 21,000, according to department reports.
These interactions lead to treatment for some and violence, or even death, for others.
Oklahomans were reminded of the sometimes deadly consequences for people in crisis earlier this month when Hanchett, owner of the Norman’s Cookie Cottage, died in jail.
Hanchett, 38, was tackled to the ground when she tried to get away from Norman police and arrested on Nov. 26 after calling 911 for a welfare check on her children, whom she told officers were in danger. Hanchett exhibited “behavior that was consistent with some type of mental health disorder,” officer Dustin Crawford wrote in a court document.
There is no mention of taking Hanchett to the hospital or other mental health treatment center in police records or court documents.
Hanchett was charged with obstructing an officer, a misdemeanor, and was being held at the Cleveland County Detention Center on a $1,000 bond, according to court records.
On Dec. 8, Hanchett was found not breathing in a cell, according to a statement from the Cleveland County Sheriff’s office.
Departments across the state are arming officers with Ipads that connect to counselors. Some are bringing social workers or therapists to the scene with police. Others send officers who volunteer to specialized mental health training called Crisis Intervention Training.
Nearly 40% of survey participants said law enforcement responded to their or a loved one’s mental health crisis. Their experiences varied greatly, but those who were met by officers with crisis training reported better outcomes.
Oklahoma City mother Kathy Walker asked for crisis-trained officers when she called 911 after her daughter locked herself in the bathroom where her mental health medication is stored. Her daughter had been screaming incoherently and Walker was afraid she would try to overdose on pills. An officer was able to calm her down and convince her to lie down and try to go to sleep. The next morning, Walker called for help again when her daughter began screaming at her husband and blocked the doorway so he couldn’t leave their bedroom. Again, officers calmed her down and this time they convinced her to go to the hospital for an evaluation. The officers waited with the family until a clinician was available to see her.
“I was thankful that I knew to ask for CIT (officers) and that the officers had been well-trained in de-escalation,” Walker said.
Before Small graduated with his degree in social work, he called the police to check on a friend who was suicidal.
“I watched my friend being placed in a cop car with a bag over his head,” Small said. “What a difficult experience that was that I hope he doesn’t have to go through again. However, it was the impetus for him to seek help afterward and to make changes in his life.”
In July, Oklahoma launched 988, an emergency hotline for people experiencing a mental health crisis. Counselors answer the calls and, according to Dismukes at the department of mental health, 90% are resolved over the phone. Teams of counselors and paramedics or police respond to the rest depending on the nature and severity of the crisis. If a weapon is involved or the person is threatening to harm others, police are called.
This article first appeared on Oklahoma Watch and is republished here under a Creative Commons license.
Oklahoma Watch, at oklahomawatch.org, is a nonprofit, nonpartisan news organization that covers public-policy issues facing the state. Republished here with Creative Commons License
Photo credit: Whitney Bryen/ Oklahoma Watch