2023 Oklahoma legislative session: Mental health opportunities
In 2022, Oklahoma directed more resources to the treatment of mental illness than ever before.
Legislators made significant investments in the state’s treatment capacity and infrastructure by appropriating nearly $300 million in federal American Rescue Plan Act funding for mental health. In conjunction with the launch of 988 – the new national mental health lifeline – the Oklahoma Department of Mental Health and Substance Abuse Services deployed a new comprehensive crisis response system that includes mobile crisis teams and urgent recovery centers across the state. Also notable, Gov. Stitt signed into law HB 4106, which establishes partnerships between school districts and community mental health providers to respond to students in crisis.
These investments have been unequivocally necessary to improve Oklahoma’s dire mental health outcomes. The state’s suicide rate has increased steadily since 2017 and is now the sixth worst in the nation. A consistent rise in methamphetamine-related overdose deaths since 2014 propelled Oklahoma’s total overdose deaths to a record high in 2021.
Following last year’s historic investments in care facilities, we at Healthy Minds Policy Initiative are now collaborating with legislators on ways to improve access to care and secure the behavioral health workforce our state needs to meet unprecedented levels of demand.
2023 legislative opportunities
Improving Oklahomans’ access to mental health care
Oklahomans struggle to find mental health care in their insurance networks and are further frustrated by inaccurate network directories. SB 442 by Sen. John Michael Montgomery (R-Lawton) establishes standards for directory accuracy and requirements for reporting. More than half of states across the country have implemented similar standards.
When Oklahomans can find a mental health provider in their network, they often face unrealistic wait times. SB 254 by Sen. Jessica Garvin (R-Duncan) requires that insurers arrange mental and behavioral health care in a timely manner if care is unavailable from any in-network provider.
Growing Oklahoma’s behavioral health workforce
Oklahoma faces a growing shortage of behavioral health professionals. According to a report published in August by the state’s Legislative Office of Fiscal Transparency, the number of mental health degrees conferred by Oklahoma public institutions fell from its 10-year high of 2,440 in 2016 to 2,029 in 2021. At the same time, the state’s workforce initiative, Oklahoma Works, estimates a 17% increase in demand for substance abuse, behavioral disorder and mental health counselors by 2030.
SB 444 by Sen. John Michael Montgomery (R-Lawton) activates medical billing codes that reimburse primary care doctors, psychiatrists, and mental health practitioners who collaborate to treat patients, encouraging the use of best practice models of integrated care.
A major opportunity for lawmakers during this year’s legislative session is to fund a state-administrated loan repayment program for behavioral health professionals. Previously authorized in 2019, the program could yield 50 critically needed professionals during the next five years with just $1 million in its first year of funding. HB 2175 by Rep. Cynthia Roe (R-Lindsay) provides an opportunity to grow the mental health workforce by funding this program.
Other key issues in 2023
Licensure and reciprocity
Licensure reciprocity formalizes a process to make it easier for providers licensed in other states to practice in Oklahoma. HB 1345 allows the licensing board for psychologists to enter into agreements with other jurisdictions where requirements are similar. HB 2723 creates the Interstate Licensed Professional Counselors Compact, which allows counselors in participating states to practice in multiple states with just one license.
State Question 781 funding
State Question 780 reduced certain drug and property crimes from felonies to misdemeanors. SQ 781 directed the state to transfer the savings from not incarcerating people for these types of crimes to counties for mental health and substance use disorder services. Years later, however, the Legislature has not appropriated these savings.
SB 247 directs the Office of Management and Enterprise Services to calculate and send these funds to the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) for distribution to counties for evidence-based services. SB 844 shares many similarities, but has the Legislative Office of Fiscal Transparency calculating the cost savings.
Mental health in schools
Children and youth continue to experience increased mental health need. Legislators introduced several measures to help connect students to the help they need in school. HB 2513 instructs the State Department of Education to establish a Handle with Care program. This would allow law enforcement officers to contact a child’s school if the child witnessed a traumatic event, thereby better equipping school personnel to support the needs of the student. HB 2827 directs the Oklahoma State Department of Education to award grants to public school districts to hire school nurses, counselors, and mental health professionals when funds are available. SB 569 requires the Oklahoma Health Care Authority to submit a state plan amendment with the Centers for Medicare & Medicaid Services so that schools are reimbursed for any student receiving services, even if they don’t have an Individualized Education Plan.
Aside from student mental health needs, the next biggest factors to consider for healthy school environments are healthy and supported adults in the schools. HB 1424 authorizes ODMHSAS to create an Education Employee Assistance Program to assist public school employees in seeking help and maintaining their own mental well-being.
Veterans and first responders
SB 379 requires CLEET-certified law enforcement officers to receive two hours of training on maintaining their own mental health and wellness. HB 2686 establishes first responders’ rights when receiving mental health care, such as protecting them from repercussions for seeking care and ensuring confidentiality. HB 1796 allows ODMHSAS to serve as a vendor for employment assistant programs to public employees, which could include Oklahoma’s first responders.
To recognize veterans lost to suicide and bring awareness to the matter, SB 234 declares September 22 as Veteran Suicide Awareness Day. HB 1036 creates the Veteran Suicide Prevention Task Force to make recomms that reduce the number of veteran suicides in Oklahoma.
Fentanyl increasingly contributes to overdose deaths in Oklahoma. Following the passage of SB 511 in 2022, harm reduction providers are allowed to distribute fentanyl testing strips, but people who are not harm reduction providers found with the testing strips can be charged with being in possession of drug paraphernalia. HB 2091 and HB 1987 remove fentanyl testing strips from the list of possible items of paraphernalia.
In nearly 40% of overdose deaths, another person was present at the time of the overdose, but people often don’t seek medical help for fear of encountering law enforcement. HB 2110 encourages more bystanders and people experiencing an overdose to call for emergency medical services by preventing anyone at the scene from being arrested, receiving probation, or having parole revoked for being in possession of drugs or drug paraphernalia. SB 712 requires ODMHSAS to provide hospitals with opioid antagonists, which reverse opioid overdoses, so hospitals can administer two doses to anyone who utilizes the emergency room for an opioid overdose or opioid use disorder.
Drug courts are an alternative for those in need of substance use disorder treatment while going through the criminal justice system. HB 2433 and HB 2828 remove district attorneys as the final determiner of who can participate in drug courts. If a district attorney objects, a judge can set a hearing and rule on the individual’s final eligibility.
When a criminal defendant is deemed incompetent to stand trial, they are often sent to have their competency restored. The wait times to restore competency and restart the criminal justice process have grown over time to the detriment of the accused and the court process. SB 552 defines a reasonable period of time for defendants to receive treatment or the court to determine that they won’t regain competency. If competency is restored, this bill requires a competency hearing be scheduled within 30 business days of the person being deemed competent. HB 1621 contains the same time periods to start treatment, but does not include a specific time frame for a competency hearing beyond adding that the proceedings must be resumed “immediately.”
HB 1960, HB 2179, HB 2276, and HB 2330 all repeal current state laws that require psychiatric and chemical dependency facilities to apply for a certificate of need from the State Department of Health. Certificates of need are meant to manage health care costs by ensuring new facilities aren’t built or expanded unless needed in a given area. However, applying for a certificate of need can be costly and take several years, which has led to fewer options for care and higher prices for consumers.
Additionally, SB 557 requires that mental health and substance use disorder insurance claims are reviewed by someone qualified or credentialed in that treatment or service, ensuring that reviews are conducted by practitioners who understand the service in question.