Mental health of Oklahoma children and youth
Already increasing before 2020, the number of children and youth struggling with poor mental health in Oklahoma has surged during the pandemic. Stressors unique to COVID-19 – including deaths in the family, virtual schooling, financial hardship, and social isolation – have weighed heavily on children and intensified the youth mental health crises. This increased need has exposed gaps in Oklahoma’s continuum of mental health care services, leading to higher emergency room utilization for children with suicidal thoughts and other mental health conditions.
Based on the results of a statewide survey of middle and high school students conducted during the 2019-20 school year:
experienced high or moderate psychological distress
made at least one suicide attempt
This multi-part research series will provide an overview of Oklahoma’s mental health services for children, youth, and their families, as well as identify opportunities to expand, strengthen, and sustain the state’s continuum of mental health care services.
Healthy Minds Policy Initiative has studied Oklahoma’s mental health services for children and youth attending schools, living either with their families or in foster care, and/or are involved in the juvenile justice system. We have seen many exemplary services and strengths in the state service system. There are strong efforts to define a vision for meeting the mental health needs of children and youth.
There are also gaps in services and challenges to accessing the services that best meet the needs of individual children, their families, and caregivers, as well as in population health strategies to prevent, detect, and address mental health conditions.
Moving forward, the state needs a full and robust continuum of mental health services for its children and youth.
- Promotion, prevention, and early intervention
- Outpatient and integrated care
- Intensive home- and community-based services, comprehensive crisis care
- Inpatient care and residential treatment
Promotion, prevention, & early intervention
In this report, we examine the current state of Oklahoma’s array of promotion, prevention, and early intervention services. We also discuss the supports and interventions needed to reduce risk, build protective factors, increase supports, and provide treatment to prevent or lessen the impact of mental illness on Oklahoma’s children.
- A strong foundation, but better integration is needed. Oklahoma has a strong foundation of preventative and early intervention mental health services, but these supports don’t always integrate with the systems used most by children and families, such as education and general health care.
- Pediatric primary care must be part of the solution. Oklahoma’s shortage of psychiatrists is especially severe for children and adolescents, as only six of Oklahoma’s 77 counties have child and adolescent psychiatrists. But when pediatric primary care providers have access to mental health training, coaching, and consultation, they can identify and treat mild to moderate mental health challenges, decreasing demand on child and adolescent psychiatrists. The state has several specific opportunities to expand integrated care practices in pediatric primary care settings.
- A pressing opportunity for psychiatric teleconsultation. The forthcoming Oklahoma’s Pediatric Mental Health Care Access Program’s sustainability relies on engaging existing providers, securing a committed funding stream, and gaining legislative support.
- A need for schools to act on data. HB 1103 in 2021 expanded the use of the Oklahoma Prevention and Needs Assessment (OPNA) in Oklahoma schools. Data from the OPNA conducted during the 2019–20 school year can be used to identify students’ mental health and wellness needs and to select interventions to address those needs.
Outpatient and integrated care
In this report, we examine the current state of Oklahoma’s array of outpatient and specialty mental health services. We discuss the treatment services available across the state’s network of Community Mental Health Clinics, as well as new opportunities available with the adoption of the Certified Behavioral Health Clinic model.
- Oklahoma’s children rely heavily on traditional therapy but often don’t receive other forms of outpatient and intensive services that can be necessary for long-term stability.
- Access to appropriate services is hampered by workforce shortages, insurance barriers, and limited availability of intensive services.
- Both the public and private systems need coordination and collaboration to meet the needs of all children and youth in Oklahoma.
Intensive home- and community-based services, comprehensive crisis care
In this report, we examine the current state of Oklahoma’s crisis services for children and youth and discuss the services they need, when and where they need them. A robust array of crisis services anchored in a strong behavioral health continuum can save lives, decrease the use of more restrictive care such as emergency rooms, inpatient beds, and the justice system, and improve the mental health and well-being of Oklahoma’s children and youth.
- COVID-19 has revealed gaps in the mental health treatment system for youth. This is evident in an increasing number of children with suicidal thoughts and other psychiatric conditions who present at hospital emergency rooms.
- Oklahoma’s plan for crisis care is strong, but not fully realized. The state’s vision for children’s crisis services aligns with national standards, but implementing that vision is fragmented across the state and complicated by funding limitations.
- After-crisis care is often missing. Oklahoma lacks a complete array of home- and community-based supports for children who need intensive and ongoing care following a crisis.
- 2022 is a year of opportunity. New state and federal funding and ongoing work to implement the new 988 crisis number by July 2022 provide an unprecedented opportunity to build out Oklahoma’s ability to respond to youth mental health crises.
Residential treatment and inpatient care
In this report, we examine the current state of Oklahoma’s inpatient and residential services for children and youth with complex and acute needs and offer considerations and opportunities for quality and capacity improvements. Having timely access to psychiatric inpatient care or residential interventions is critical to meeting the needs of children and youth who cannot be safely supported in the community.
- The state’s limited beds are disproportionally concentrated in Oklahoma City. The Oklahoma City metro has 60% of the state’s 915 children’s mental health beds but only 36% of the state’s children. The Tulsa area has 12% of the beds but 26% of children, and non-metro areas have 27% of the beds for 37% of children.
- Oklahoma overutilizes inpatient and residential beds, lacking appropriate alternatives. Because the state has relatively few non-inpatient intensive services for children with complex needs, there are few options to divert these children from inpatient care or provide appropriate step-down care after an admission. This contributes to overwhelming demand on inpatient facilities, hospitals, and child protective services.
- New beds like those proposed for state ARPA funds would provide immediate relief, but won’t meet the need on their own. Inpatient services are expensive and can be avoided in most cases. Filling gaps in other treatment areas is the first step toward ensuring inpatient resources are “right sized” for the children who truly need them.
- Current inpatient services are often not community-linked, youth-guided, or family-focused. Oklahoma children in inpatient or residential care can receive little discharge planning, connections to aftercare services beyond a referral, or family involvement.
This report explores the mental health needs of children and youth in three key child-serving systems: child welfare, juvenile justice, and primary care. Enhanced coordination between child welfare, juvenile justice, primary care, and mental health would strengthen the continuum of behavioral health services and supports available to Oklahoma’s children and youth and their families. Ultimately, improved cooperation between these systems will strengthen the broader ecosystem in which children and youth may receive care.
- Lasting outcomes require removing siloes. Effectively connecting treatment with the broader array of community services available to children decreases school dropouts, juvenile arrests, and inappropriate inpatient hospitalizations — promising cost savings of up to 57%, according to recent research.
- Children and families use multiple systems during a mental health struggle. The mental health treatment system must coordinate with child welfare, juvenile justice, and pediatric behavioral health systems.
- Oklahoma has a good record and a better opportunity. Oklahoma is recognized for its work building cross-system collaboration. The state could see additional benefits by further developing a cross-system strategy to address the behavioral health needs of infants, children, youth, and families.