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Mental health cuts will leave many children without treatment

Claremore Daily Progress (OK) - 2/6/2016

Feb. 06--OKLAHOMA CITY -- Dustin Palmer knows the stress of living with a chronic illness.

He grew up struggling with primary immune deficiency disease, which limited his body's ability to fight infection. It interfered with his social interactions, his ability to attend school regularly, and he still recalls the anxiety he faced every time he headed to the doctor's office for treatments.

He vowed, if he ever got better, to help improve the lives of other children with chronic illnesses.

Now a licensed clinical social worker, he still lives with the disease, but says it's manageable. Palmer works with a Tulsa medical practice to give therapy to 20 to 25 patients each week coping with chronic illnesses such as cystic fibrosis.

"I've become part of their family and someone they can come talk to every month to help them deal with issues," he said.

Many of those relationships are now in jeopardy as Palmer, like hundreds of other therapists, braces for a proposed cut by the Department of Mental Health and Substance Abuse Services.

The department has said it will no longer provide SoonerCare reimbursement to about 750 private therapists.

The decision isn't set in stone. The state Health Care Authority is slated to take up the matter at its next meeting Thursday.

But Terri White, the state's director of mental health, said cutting the service is "the least terrible of all the terrible choices."

The move comes as state leaders look to White's department to slash $9.8 million from its budget to help balance the state's checkbook.

The department will absorb much of that by cutting administration, postponing a program to expand of mental health courts and limiting funds for suicide prevention services.

Limiting SoonerCare reimbursements to therapists including Palmer will shave off about $1.2 million.

Unfortunately, said White, cuts are trickling down to patients.

"There's been quite a bit of dialogue on this cut," she said. "Cutting anyone out of mental health and substance abuse services is heartbreaking. What we should be doing is increasing funding."

Most of Palmer's patients come from rural towns with no local mental health providers.

Most are from families with low-incomes. About 90 percent qualify for SoonerCare, the state's Medicaid program for children.

And many grieve the loss of normalcy, struggle with anxiety or battle depression stemming from their chronic illnesses, he said.

Since 2010, more than 8,000 children across the state have visited providers like Palmer, known as licensed behavioral health professionals. They treat patients who face less acute mental health needs.

White said children on SoonerCare with the highest needs will still be treated by 400 private, accredited businesses known as agencies. Those provide all levels of care and hold special accreditations showing compliance with guidelines and health and safety standards. Such agencies often employ as many as 100 professionals.

They collectively treat about 80,000 children, most with high levels of need, White said.

Still, she said, it's likely that thousands more from low-income families will lose access to services when their therapists no longer receive reimbursement.

Budget cuts, she said, invariably mean that someone loses.

Children who meet criteria for an agency's help may take someone else's slot. Wait times for service will get longer.

"When you have a system that is this under-funded, you can't cut money out and expect that the services are going to remain the same," she said.

Cutting mental health services, she added, usually incites increases in suicides, school dropouts and the number of children sent to foster care or juvenile detention.

While White's department gets one of the larger appropriations from the state budget, at $330.9 million, Oklahoma's allotment still leaves it ranked 46th in per-capita funding for mental health issues, she said.

Dr. Art Rousseau, a psychiatrist and chairman of the Oklahoma State Medical Association's legislative committee, said he's heard that therapists are "very upset" about the proposed cut.

"There's no question that's going to put quite a burden on the mental health of Oklahoma, in general, especially in the rural areas," he said.

Rousseau said he's sympathetic to therapists who've relied on SoonerCare reimbursements to keep their practices going.

But, he added, "the biggest concern is what will happen to the clients and patients, and where are they going to go?"

A child who isn't seriously ill now may have a mental health issue that evolves into a more serious problem, costing the state that much more.

Without treatment options, Rousseau said, children may end up going to emergency rooms, which are far more expensive than therapists.

"I definitely recognize the state is stuck between a rock and a hard place," he said. "I'm sure Terri White is pulling her hair out trying to balance all this."

Palmer, the therapist, said he understands White's dilemma.

He expects that he'll land on his feet, no matter what happens.

He is more worried about his clients, he said, who are "distraught" by the proposed changes and whether they'll be able to continue to get treatment.

"More than likely they'll just quit services," he said. "I mean, there will be a few that I will refer out to new places, but I think the majority of them will choose to suspend their services."

Janelle Stecklein covers the Oklahoma Statehouse for CNHI's newspapers and websites. Reach her at jstecklein@cnhi.com

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(c)2016 the Claremore Daily Progress (Claremore, Okla.)

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