Oklahoma has some of the highest rates of mental illness and substance use disorders in the country. But nonprofits, state agencies, lawmakers and dedicated Oklahomans have been working to change the stats.
Hundreds of millions of dollars in funding for those efforts has come directly from the federal government – including grants from the Substance Abuse and Mental Health Services Administration (SAMHSA), the primary federal agency charged with advancing the nation's behavioral health.
Last month, the U.S. Department of Health and Human Services announced that SAMHSA will be consolidated with several other health-related agencies into a new "Administration for a Healthy America." The consolidation, along with recent and looming cuts to SAMHSA's workforce and funding, has prompted significant uncertainty about the agency's future services and grants.
According to Executive Director of Healthy Minds Policy Initiative Zack Stoycoff, Oklahoma has a lot to lose. The nonprofit, nonpartisan policy group put together a report on the state's mental health grants to better illustrate what's at stake.
The report found Oklahoma has received nearly $750 million in federal funds from SAMHSA over the last five years. The money has primarily benefitted children, rural communities and tribal nations.
Currently, Oklahoma has almost $450 million in active grants, more than $186 million of which have yet to be distributed. Those funds would be at risk if agency leaders decide not to honor previously awarded amounts.
Stoycoff said the money translates into direct services. It has funded EMS trainings in rural districts, supported young children in need of mental health resources and helped address high suicide rates in tribal communities.
He said if federal support runs dry, more financial responsibility will fall on the state.
"There is a network of services that has been established with the federal and state funding that has been available," Stoycoff said. "As one changes, it just puts responsibility on the state to ensure that the services that Oklahomans need, remain."
Trump administration officials have floated returning SAMHSA to funding levels before the onset of the pandemic. According to Healthy Minds, the reduction could mean a roughly 39% decrease in money to Oklahoma, yet public health data indicate Oklahomans experience worse mental health outcomes now than in 2019.
Stoycoff said financial losses are not the only fallout that could be triggered by top-down changes.
"Behavioral healthcare is notoriously difficult to perform," he said. "Yes, it takes clinicians who are trained, but it also takes somebody who really understands how to fit the pieces together of so many different systems that have to come together."
In addition to yearly and need-based grants, SAMHSA collects nationwide data and gives guidance and support to state service providers.
"Many of our policy decisions at a state level and a local level are based on data that is available nowhere else," Stoycoff said.
He said SAMHSA has historically been the only source of well-vetted, trusted information practitioners can access for free.
For example, data from the National Survey on Drug Use and Health has informed evidence-based practices for years.
SAMHSA has also been instrumental in building infrastructure across the country for the 988 Suicide and Crisis Lifeline. Without it, Stoycoff said, Oklahoma wouldn't have been able to launch 988 and the first crisis response system in the state.
"None of that really would have been possible had the parameters of an ideal crisis system not been established by the federal mental health agency," he said.
While it's still unclear what SAMHSA will look like and how it might operate in the future, Stoycoff said it's important for state leaders to consider potential impacts.
"We have to be really diligent about how we approach these funding conversations," he said. "We can't have reactionary decisions. We can't have abrupt cuts without plans. We have to be very thoughtful about this."
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