Advocacy mode

An interview with Mental Health Association Oklahoma’s Mike Brose

Last Wednesday, the Oklahoma House of Representatives voted on HB 1054X, a measure designed to fill a $215 million hole in the state’s budget. The bill proposed to increase taxes on tobacco, gasoline, and diesel, to expand taxes on alcohol, and to increase the gross production tax on new oil wells. The proposed budget failed.

This bill would have plugged funding gaps for organizations like Mental Health Association Oklahoma (MHAOK), an organization that operates more than 1,000 housing units across Tulsa. The day of the vote, I sat down with MHAOK’s CEO, Mike Brose, about what the failure of HB 1054X would mean to the organization.

Zack Reeves: Tell us about the mission of MHAO.

Michael Brose: Everything we do comes back to mental health advocacy and mental health education. Our mental health touches so many things, and all of us at one time or another struggle with our mental health; it affects everybody. Sometimes we’re able to heal on our own, but many times we also need professional assistance, just like physical problems.

Reeves: Where does the lack of a working budget leave MHAO’s operations day-to-day?

Brose: We are still in full-blown advocacy mode. We always have a presence at the state capitol during the session, meeting legislators and educating them about mental health. We send legislative alerts using social media, communicating across Oklahoma with board and advisory council members, friends, and other advocates, asking them to call, write, email. That’s not just for Mental Health Association; that’s for mental health services across the state.

Additionally, we think teachers need their increase too. Our teachers, every day, are involved with the mental health of our children, and we think they need to be compensated well for the important work that they do.

Now, that leads to: What happens if this hole doesn’t get filled? The Department of Mental Health and Substance Abuse Services—which helps fund us and mental services across the state—their funding has either been cut or hasn’t increased with inflation, so we were in the hole before this even started. It really limits what we can accomplish.

If that $215,000,000 hole is filled, that just takes us back to breaking even, underfunded. It didn’t help that Oklahoma didn’t take the Medicaid expansion, because we left a lot of federal dollars on the table by not taking it. [The dollars we’re talking about could’ve been leveraged for this, but the leadership of the state of Oklahoma decided not to do that because it would go away, but those other states that accepted it are still getting those federal dollars.]

If the hole’s not filled, the Department of Mental Health has to pass those cuts along. How they would do it is unknown to us today. They might say, “Okay, everybody who contracts with us, we’re going to cut this percentage across the board to make up that amount of money.” They could also cherrypick: keep this, lose this, bang for the buck.

Reeves: So you’re not sure yet how much you stand to lose from this.

Brose: We at MHAO could potentially have to padlock our drop-in centers. We operate one in Oklahoma City and one here. This is where people who are homeless or people who have mental illness can just drop in and get connected to services.

These are peer-run drop-in centers; everyone who works there lives in recovery with some kind of a serious mental illness, histories of substance abuse, histories of incarceration, or all of the above. So, people would lose their jobs, those programs would close. Right now, if we went over to the drop-in center, there are all kinds of people over there receiving those services.

Also, for some of our housing programs and case management services that provide support and assistance, helping people to get housing, losing these funds would cut our ability to bring people off the streets and from shelters into safe, affordable, decent housing. We would not have that funding available. That would end that.

We have a program we contract the state with called Creating Connections. That’s for people who live in recovery, doing peer-to-peer work with other people who have serious mental illness and histories of substance abuse. We would have to potentially cut that program too.

We’ve had all these programs for a long time.

Even when the Department of Mental Health has had other cuts in previous years, they’ve never cut those programs. We think they’ve never cut those programs because they believe in them. Now, they wouldn’t have any choice.

It could potentially be putting a padlock on the door and laying all those employees off and telling the people who are served by those programs, I’m sorry, we can’t serve you in this way anymore. It doesn’t mean we’re going to abandon them, but we’re not going to be able to serve them in this cost-effective—and effective—way; we’ll have to serve them as best we can in some other form or fashion.

I’m hoping it doesn’t come to that.

The other thing is, up until now, the solutions that they’ve looked at were not only not filling the $215,000,000 hole; they were one-time ‘a little bit of putty here, a little bit of putty there’ solutions, and we’re going to be right back in the same spot next year. One of the things we’re advocating for is our legislators finding an ongoing funding solution, so we can maintain these services.

It’s so painful to look at. It’s interesting: they’re holding the Department of Corrections without those types of cuts. And that’s how the state of Oklahoma is structured: downstream. Most expensive form of care, if you call incarceration care. It also happens to be the one with the proven worst outcomes.

The other things that we’re talking about are way upstream: community-based services across the state, primarily provided by community mental health centers and programs like those we operate. You’re talking about those programs potentially going away.

And what happens if those people can’t get services? It’s going to put an added burden on the emergency rooms, first responders, police, fire, ambulance; you put everybody at risk. And then you fall back to reinforcing and expanding the largest mental health institutions in the state of Oklahoma, our jails and our prisons.

So, we’re saying, “In Oklahoma, we don’t really provide very many community-based services. We rely on a solution of high-cost hospitalization, and for those in a mental health crisis, we’re going to use our incarceration system as the treatment of choice.” We’re saying that now in a lot of ways.

And when people are discharged, say, from the Tulsa Center for Behavioral Health—which doesn’t have enough beds now—there’s a high possibility that, with these proposed cuts, there’s going to be no one in the community to help or treat them.

Reeves: And then they just go back into the system.

Brose: And then they just go back. Right now, we’re working on a program in a partnership with Family & Children’s Services: the fire department and police department having a mental health professional assigned to a three-person first responder team. The police and fire department are great supporters of that. We’d like to see it spread to Oklahoma City. With these cuts, that goes away. I don’t think we’d have the mental health professionals to staff it. We’d obviously continue to work with training for law enforcement and firefighters and dispatchers, but that’s not the same. Are we going backwards or are we going forwards?

I am 62 years old. I’ve been in clinical social work practice in the state of Oklahoma for 37 years. My clinical social work license number is 237—I think it’s up in the tens of thousands now; that tells you how long I’ve been around. When I came out of graduate school, the community mental health center system was on the drawing board; it came online not too long after I started. We’re getting ready to turn the clock back almost 40 or 50 years in terms of community-based treatment and services in the state of Oklahoma. Everything that I and the people who came before me worked and advocated for is on the line right now.

Reeves: How does this fit into the narrative of mental health in Oklahoma? Is this unprecedented?

Brose: In my career, it’s unprecedented. Things have often been not as fast as we’d like, not funded to the extent that we’d like, but everything has been headed in the right direction: more state-of-the-art, evidence-based practice in the community. We didn’t used to talk about the importance of housing as a form of treatment, but now that’s considered standard practice.

One of the things that I think gets lost on our elected officials is that we tend to live in an us-and-them world: People say, “I don’t know who those people are; I just know who I am, who my family is.” These budget cuts, this hole, $215,000,000: every single family in this state will be touched in some way.

The Department of Human Services and the Department of Mental Health have all kinds of interactions with so many people in this state that everybody will be affected. It might be minor or it could be major. It could be manageable or it could be devastating. If not us, our children and our grandchildren.

I’ve got calls right now that are on hold: people waiting to hear back from me, trying to figure out what to do with their child. Their services are available today; they might not be tomorrow, with these cuts. I’ve got two people on hold right now who are suicidal, and we’re trying to get them to services that they need, so they can continue to improve and get better and not have to think about taking their own lives. 

I think a lot of people in the state think that this doesn’t touch them, and they’re wrong. They’re going to find out in all kinds of ways.

I’m not one for hyperbole; that’s not really my style. This will have a massive impact. These cuts will have dire, dire consequences on the state. We’re not talking about a race to the bottom; we’re talking about a race about six feet past the bottom. It’s really a sad moment.

Reeves: How can the average Oklahoma help the state of mental health in Oklahoma?

Brose: Advocacy. Twitter. I think the silver lining of all this, regardless of how it turns out, is that those legislators will think twice in the future, and I think they now know that there are a lot more people out here who need and use these services who do have a voice than they ever would have imagined. They always say, ‘if we get 10 calls on a bill, that’s a shock to us.’ Listen. I heard yesterday that the Speaker of the House’s voicemail box was filled. They’re hearing it.

At the rally in the capitol, it was very powerful to see all those people together. There was joy in realizing that we have a voice. I have a voice. You have a voice. And we’re letting our elected officials know it. Sometimes our voices don’t get heard, but they’re getting heard right now.