EDITORIAL: Medicaid expansion not a quick fix for mental health services

July 29--RECENT news stories that underscore Oklahoma's poor mental health statistics have turned up the volume on calls for the state to expand Medicaid. Additional funding would certainly help, but it's a stretch to suggest that Medicaid expansion is a panacea.

Oklahoma has gotten where it is today as a result of legislators treating mental health with a shrug, year after year. In this respect Oklahoma is no different than most states, which also are scrambling for solutions.

An estimated 10 million Americans suffer from serious mental illness. Oklahoma has nearly 33,000 adults diagnosed with untreated severe bipolar disorder, according to the Treatment Advocacy Center. Oklahoma has the country's second-highest rate of adults with mental illness -- 700,000 to 900,000 adults reported having a mental health issue last year.

About 70 percent of indigent adults, and 40 percent of children, who need mental health treatment don't get it. Terri White, who heads the state's mental health agency, says those percentages would be reduced with additional funding. She's made inroads in recent years in getting lawmakers to understand that Oklahoma's approach to funding her agency must change.

The Kaiser Family Foundation says Oklahoma ranks seventh-lowest in mental health funding per capita. That translates into a lack of resources that puts the severely mentally ill at the front of the line but also hinders efforts to provide early help to those who need it. Mental health issues contribute to Oklahoma's high suicide rate, its abused and neglected children, and its crowded jails and prisons.

About 122,000 Oklahomans with mental health issues would have qualified for Medicaid had it been expanded here, according to the American Mental Health Counselors Association. The state's decision not to take the expansion bait has made Gov. Mary Fallin a regular target of critics.

However, those critics ignore legitimate concerns about the program. Even with the state paying "only" 10 percent of expansion costs, that comes to $850 million over 10 years, according to one estimate, money that would be diverted from schools, roads and public safety. There's also good reason to suspect the federal government will start shifting more costs to the states, given national deficit spending and debt levels.

Fallin has increased funding to the state's mental health agency in recent years. Among other things, this has aided suicide prevention efforts and provided additional urgent care and crisis centers. USA Today, in its continuing series about the mental health crisis in America, noted that police agencies in Oklahoma traveled nearly 1 million miles last year transporting mentally ill offenders to locations where beds were available. These transports increased by 45 percent from 2009 to 2011, taxing manpower and funding.

Medicaid expansion is no quick fix for mental health services. For starters, states have some leeway in what services they cover. More importantly, expansion would strain the mental health care delivery system beyond its capacity to respond. A February report by McClatchy News Service noted that as millions of Americans gain health coverage through Medicaid expansion, "experts say their higher rates of mental health and substance abuse disorders will be difficult to treat due to a lack of counselors and behavioral therapists who accept Medicaid patients."

In short, Medicaid rates paid to providers are insufficient. Higher rates would help, but that would only increase the state's outlay for Medicaid. It's a myth to think Medicaid expansion will overcome deficiencies in mental health care services.

More needs to be done, and can be. State budget writers can start by paying close attention -- really listening -- when Terri White lays out her agency's needs and her many ideas for improving mental health outcomes in Oklahoma.

Without question, making gains in this area will provide long-term dividends to help make Oklahoma a better place to live, work and raise a family.

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