OKLAHOMA CITY – Heather struggled with anxiety and depression for nearly a decade and eventually turned to alcohol to numb the debilitating pain.

Francie Moss said her 42-year-old daughter would be dead if it weren’t for state-supported mental health and substance abuse services.

Heather initially hid her alcohol addiction while her parents helped her get mental health treatment. Moss discovered her daughter’s alcoholism about three years ago as Heather’s brain illness spiraled out of control. Her mother asked that The Journal Record not use Heather’s last name to avoid possible prejudice she might encounter when she eventually begins looking for a job.

Heather is two months into a three-month stay at a residential treatment center in the northeastern corner of the state. Moss said she’s grateful her daughter is getting the intensive care she needs. But Heather could have started the recovery process sooner if there were more in-patient treatment centers and she had the same doctors treating her throughout her struggle.

State budget cuts are making those services scarcer and more expensive. Only one-third of the 950,000 Oklahomans who need medical care for brain illnesses or substance abuse receive it. The Oklahoma Department of Mental Health and Substance Abuse Services provides help to about 195,000 people. The state is 46th in the nation for mental health funding per capita.

The mental health and substance abuse service agency’s funding was cut by $9.8 million in January and an additional $13 million in March when the state brought in less revenue than projected.

Commissioner Terri White told legislators in the spring she needed $345.1 million just to maintain the services her department was already providing.

Instead, she got $323.8 million, $16.9 million less than she received the previous year. And that included $1 million lawmakers took from her revolving fund.

All the money in her revolving fund was already encumbered to pay for services to treat people like Heather. She said she doesn’t know how the Legislature can take money from her budget that’s already been encumbered.

“How to handle that is an ongoing concern,” White said. “We’re still trying to figure it out.”

She postponed expanding a wraparound services program, cut prevention programs, and put off expanding mental health courts after the first two revenue failures. If there is another revenue failure, White’s budget will be cut again, which she said could lead to dire consequences. She’ll have to cut provider rates more, which could lead some treatment centers to close entirely.

That could affect drug courts and mental health courts, two things she’s so far been able to protect, and that would push people who are critically ill into the criminal justice system.

“The crisis system can’t take any more people, it’s already full,” White said. “I’m very concerned what this means for the overall mental health and substance abuse system in the next 12 months.”

Red Rock Behavioral Services Chief Operating Officer Steve Norwood said he’s feeling the pinch from the budget cut. His contract was cut by $360,000; he’s not hiring therapists to fill two openings and expects to lose money.

His organization also operates Jordan’s Crossing, an inpatient drug and alcohol rehabilitation center. He isn’t hiring staff for vacant positions, has cut the number of beds available to patients and has put people on a waiting list, because of the cuts.

Provider rate cuts have occurred many times in his 30-year career, Norwood said. But the cost of living rises, which squeezes state-supported mental health treatment centers like his.

Red Rock CEO Verna Foust said decreasing provider rates continue to erode an already-decaying system.

“We already have a system that is on life support,” Foust said. “If we continue down this road, the whole system is going to crumble.”

The 40 crisis beds in the Norman treatment center are full most of the time, Norwood said. In May, all beds were full 21 out of 31 days. Even when crisis beds aren’t at capacity, there may be only one or two openings.

It’s critical to treat people right away when they seek help, he said. People often return to substance abuse while they wait for treatment.

“When they reach out is when you need to grab them,” Norwood said.

Heather’s story

Heather’s depression and anxiety began at age 19, when she entered college, Moss said. Her daughter sought treatment with a therapist and a psychiatrist. She was able to get her illness under control with a combination of medication and talk therapy. Treatment was expensive, but Moss had good private insurance.

Heather’s anxiety and depression returned about a decade later, after she experienced a series of traumas. In 2004, she had a seizure while in labor with her first child. Then she experienced severe postpartum depression.

She sought treatment for postpartum depression, but her husband at the time viewed the depression as a weakness, Moss said. Heather had a second child and her depression worsened. She got a divorce in 2008.

The following year Heather moved in with Moss, who provided support as her daughter dealt with her brain illness. Moss could watch her grandchildren, for example, if Heather had a panic attack and needed to lie down for a few minutes.

“When you’re dealing with depression and anxiety, you are frantic anyway; it’s such a drain on your energy,” Moss said. “Then if you have small children and suffer from depression, just quadruple how those stresses affect you.”

Heather lived with her parents for two years. She was doing well and working part-time. She moved to a different city in 2011, so her children could live closer to their father. She didn’t have a support system and her depression and anxiety spiraled out of control again, her mother said. The next year she learned she was pregnant again, in her late 30s, and a high risk for complications.

She gave birth to her third child in May 2013 and the next month she was hospitalized with suicidal thoughts. That’s when Moss discovered Heather used alcohol to cope with her brain illness.

Treatment challenges

During the next three years, Heather bounced in and out of hospitals, treatment centers, halfway houses and homelessness as she struggled with her illness. She stopped working, so she didn’t have health insurance to cover her treatment. She now relies on state-provided services.

In a single month, Moss drove more than 1,000 miles within the state, picking up Heather from a facility when she left and taking her back as soon as there was an opening.

Before recent budget cuts began, Heather was transferred to a crisis center in Tulsa, because there were no available beds in Oklahoma City. Three days later she was discharged. The treatment center recommended she go to a homeless shelter, because she didn’t have any family or friends in Tulsa.

Moss said she started walking to the shelter, but became so overwhelmed in an unfamiliar city, she laid down on the sidewalk in the midst of a panic attack. Heather called 911, and an ambulance took her to an emergency room, where she was evaluated and transferred back to the same crisis center. She stayed for five days, and Moss was able to schedule a meeting and get involved in her daughter’s care.

Unless under a court order, patients typically can leave a rehabilitation center when they’re ready. Mental health court or drug court systems can require patients to stay in treatment for at least 90 days. But because Heather has never been arrested or in trouble with the Department of Human Services for child welfare issues, there is no requirement for her to complete a treatment program.

Moss said Heather spent several three-week stints in a treatment center and left, only to relapse.

National Alliance for Mental Illness’ Oklahoma Executive Director Traci Cook said Heather is like many they refer to as frequent flyers: people who get treatment, feel better and leave before a program is completed, then relapse, starting the cycle over again. But there are so few resources available, it’s exceedingly difficult to get treatment if you rely on the state to pay for your care.

White said it’s like turning away a cancer patient and asking the person to come back when they are critically ill.

Cook said Heather is among the 350,000 state residents who can get treatment for their brain illnesses and substance abuse. But there are about 600,000 more who can’t get treated at all because there isn’t enough money to provide services.

Recovery

Moss, believing that Heather could recover, continued to insist that her daughter complete a three-month, in-patient treatment program.

Moss sought support from the National Alliance for Mental Illness’ Oklahoma chapter. There, she learned how to provide support for her daughter, but create boundaries to avoid enabling Heather’s addictive habits. Moss no longer felt isolated, she said. She was able to work through the guilt she felt about her daughter’s mental illness and substance abuse problem.

“I felt like I was drowning. They threw me a lifeline,” Moss said. “They are such a critical piece for me, where I am, and (where I’m) being able to get to (emotionally).”

Cook said the organization’s family support groups are crucial, because when a child has a breakdown, a parent wants to fix it. The guilt about the child’s situation can be overwhelming. Research shows peer support helps families struggling with mental health crises, she said.

But individual family members must be able to cope with the situation before they can be an advocate for their child, Cook said.

“It’s like an oxygen mask on an airplane; you have to put yours on first,” she said. “Because you won’t do well and you won’t be helpful to the person who is struggling.”

Moss said she hopes Heather can complete the last month of the treatment program. Then she’ll need to go to a sober living center and eventually get a job.

Moss said it takes more than just addressing chemical addiction for people with brain illnesses. It’s critical to address the root cause that created the trauma. Rather than asking people why they’re addicted to substances, society should instead ask what happened to the person, Moss said.

Brain illnesses coupled with addiction shouldn’t be a moral issue. But turning to substances to self-medicate mental health issues isn’t a choice, Moss.

“It is not a choice, because we will do what it takes to ease our pain,” she said.

This story is part of an ongoing series about how the state’s budget cuts affect Oklahomans.