For people in Tulsa going through a mental health crisis or suffering from a substance use disorder, the path to treatment might start by being towed across the state in the back of a police car.

The situation is common, often happening more than once per day.

Under state law, law enforcement is the appointed body to transport people going through a mental health or substance use crisis to and from mental health facilities when it is deemed they are a danger to themselves or others.

The number of out-of-town transports by the Tulsa Police Department has continued to increase since at least 2013, when police made 240 transports, according to TPD data. By 2016, that number had more than doubled as the department transported 632 people.

Mental health advocates, law enforcement and health providers point to a lack of access to outpatient care and private beds. Last year, the city’s police department changed its policy to better handle the situation.

“We go to all over the state, and these people who live in Tulsa, they’re Tulsa citizens in their time of crisis,” said Capt. Shellie Seibert, TPD mental health coordinator.

“They’re getting toted across the state in an unknown area so they don’t have the familiarity or the family support.”

Change in TPD policy

Law enforcement transporting people across the state isn’t taxing only on people going through crises, it strains the police department, Seibert said.

“We talk about transports, there’s two issues for us,” she said. “The cost to us — overtime, the vehicle maintenance. In one year, we had 100,000 miles on new vehicles. The only thing we get reimbursed for by the state is milage.

“And when you look at the consumer part, you think of quality of care.”

A resident in crisis transported across the state in the back of a police car is less than ideal, Seibert said.

To better handle the issue, TPD changed its policy on how out-of-town transports are handled last year.

[perfectpullquote align=”full” cite=”” link=”” color=”” class=”” size=””]“In how we responded to hospitals, we were going to hospitals 50 to 60 times a month. We changed the policy and now we’re in single digits a month. We reduced those responses to those hospitals by hundreds.” – Capt. Shellie Seibert, TPD mental health coordinator. [/perfectpullquote]

Instead of bringing in officers for overtime to transport residents going to a regional facility, the transports are scheduled for times when on-duty officers are available. And rather than taking only one resident, officers transport multiple people at a time.

The practice is expected to save TPD $100,000 in this year, Seibert said.

“In how we responded to hospitals, we were going to hospitals 50 to 60 times a month,” she said. “We changed the policy and now we’re in single digits a month. We reduced those responses to those hospitals by hundreds.”

When officers transport residents to a facility a long distance from Tulsa, TPD still must bring in officers on overtime. But more than half of transports are to somewhere regional, such as facilities in Muskogee, Seibert said.

Dr. Jason Beaman, chair of the Department of Psychiatry and Behavioral Science at Oklahoma State University Center for Health Sciences, said he thinks TPD’s new policy is working well.

“I think it’s better for the patients,” Beaman said. “I think it’s much better for the police department, and also it’s better for the hospitals because we’re not always arguing with each other and with the police and all that.”

Increase in out-of-town transports

So why are out-of-town transports going up? It’s complicated.

At first glance, the problem might appear to come from a lack of inpatient or crisis beds in Tulsa. Mental health advocates, law enforcement and health providers say that’s only part of the problem.

But they all point to the same issues: A lack of access to routine, outpatient care and a loss of private beds in Tulsa.

“One of the things people talk about is we (Tulsa) have a lack of inpatient beds, but we need to provide more outpatient care,” Seibert said.

Mike Brose, Mental Health Association Oklahoma CEO, said he believes Tulsa has had success in diverting nonviolent offenders from jail.

“It lowers the pressure on the jail but increases pressure on the treatment system,” he said. “We knew that this was gonna happen, but now we’re at least getting people to treatment. Now, let’s address that. We need more beds.”

The rise in out-of-town transports isn’t unique to Tulsa. Statewide, law enforcement transports increased by 86 percent from fiscal year 2012 and FY2016.

Decrease in access to care

As the Oklahoma Department of Mental Health and Substance Abuse has made cuts to its programs due to budget shortfalls, outpatient treatment options have decreased, said Carrie Slatton-Hodges, deputy commissioner of treatment and recovery of the agency.

“And so as we see our outpatient treatment decrease due to funding cuts, we see a higher number of calls throughout the state of people in crisis,” Slatton-Hodges said.

People who can’t access outpatient services as easily — or as early — are more likely to end up in a crisis situation, she said.

Outpatient care tends to be less expensive than inpatient care, and adding more inpatient beds would mean taking away funds from outpatient and preventative services, Beaman said.

[perfectpullquote align=”full” cite=”” link=”” color=”” class=”” size=””] “We’re talking about a very, very sick population who needs to take a pill every day, and if they don’t take a pill they get arrested. -Dr. Jason Beaman, chair of the Department of Psychiatry and Behavioral Science at Oklahoma State University Center for Health Sciences [/perfectpullquote]

“People love to beat this drum of no inpatient beds and sure, we all want more inpatient beds,” Beaman said. “I want them because I don’t like housing patients within the hospital or whatnot, but it’s really a chicken or the egg thing.”

“We’re talking about a very, very sick population who needs to take a pill every day, and if they don’t take a pill they get arrested. … And if we’re going to cut those services then we’re going to need more beds.”

The number of state beds in Oklahoma increased from 2010 to 2016, from 401 to 431. Many of those increases were in facilities in the Tulsa area.

In Tulsa, Hillcrest Medical Center is the only private hospital that accepts people in need of an inpatient psychiatric bed without a payer source. Laureate Psychiatric Clinic & Hospital generally only takes people without a source if they come in through its emergency room.

If a resident has a payer source — insurance or self-payments — their options for inpatient care grow significantly. But for residents without those resources, services in Tulsa can be slim.

When beds in state facilities that accept patients without a payer source fill up, the person in crisis is often transported out of town.

“Normally why that happens is there will be a person and there may be a bed in Tulsa at a private facility, but if the person doesn’t have insurance then they’re not going to accept a transfer of a person that doesn’t have a payer source,” Slatton-Hodges said.

“So they may have to go further to find a bed for someone that has no payer source.”

The budget shortfall and decrease of access to outpatient care isn’t the only to blame for the increase in out-of-town transports, Slatton-Hodges said. Patients with private insurance filling state facilities may be making the problem worse.

“I think also Tulsa over the years has lost private beds, as well,” she said. “So when you lose private beds and people don’t want to transport them, we might fill up (a state psychiatric hospital) with private insurance, medicaid, medicare patients.”

Correction: The original version of this story misspelled the name of Tulsa Police Department Capt. Shellie Seibert. It has been corrected.

Tulsa agencies aim to reduce mental-health related 911 calls, connect people to better resources