Mental Health and Substance Abuse

These trends should be a wake-up call that there is a serious well-being crisis in this country. In stark terms, they are signals of serious underlying concerns facing too many Americans—about pain, despair, disconnection, and lack of opportunity—and the urgent need to address them

—John Auerbach, Trust for America's Health, 2018

The World Health Organization’s (WHO) constitution states that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Mental health is an essential component of one’s overall health and well-being and can impact and shape the outcome of other illnesses and often influences risky health behaviors such as substance abuse (1). 

Mental disorders are the leading cause of disability in the U.S. Every year, an estimated 18.1 percent (43.6 million people) of American adults age 18 and older suffered from a mental illness (2). These disorders result in high costs to families, employers, and publicly funded health systems. Addressing the impact of substance abuse alone is estimated to cost more than $600 billion each year in the U.S. (3).  

Mental health is composed of multiple sectors including biological, socioeconomic and environmental factors. Creating an environment and community that is understanding of the multiple aspects associated with mental health will increase the effectiveness of reducing prejudice and fear surrounding this subject (1).

Mental Health and Substance Abuse

Definition

This indicator is presented as the number of individuals who received outpatient mental health or substance abuse services funded by Medicaid or Oklahoma Department of Mental Health and Substance Abuse Services per 1,000 population. It is important to note that this indicator does not include any mental health visits that were paid for through private insurance, self-pay, Veteran’s Affairs, tribal healthcare, etc. Following sections include more detailed information for mental health and substance abuse visits separately.

How are we doing?

In 2018, a total of 27,855 Tulsa County clients attended 1,154,606 mental health visits. This was a rate of 43.0 unduplicated visits per 1,000 population and 1,780.8 duplicated visits per 1,000 population. 

In 2018, a total of 11,119 Tulsa County clients attended 129,528 substance abuse visits. This was a rate of 17.1 unduplicated visits per 1,000 population and 199.8 duplicated visits per 1,000 population.

The rate of duplicated mental health visits was significantly higher than all other types. Duplicated rates have been increasing over time, but unduplicated rates have increased only slightly. This likely indicates that the same individuals are receiving more services, but the number of individuals receiving services is either decreasing or increasing more slowly than the population is increasing. It is important to note that numbers of visits does not always indicate higher need or poorer mental health; it may indicate higher access to services. 

 In terms of substance abuse visits regionally, there was again an overall increase for the Downtown region during the time period examined, while the other regions remained somewhat stable.  On both of these measure, the highest rates across the time period were in the Downtown and East Tulsa regions.


Mental Health Visits

Definition

This indicator is presented as the number of individuals who received outpatient mental health services funded by Medicaid or Oklahoma Department of Mental Health and Substance Abuse Services per 1,000 population. Demographic data is presented for unique clients only, while zip code and regional data is presented for all clients. It is important to note that this indicator does not include any mental health visits that were paid for through private insurance, self-pay, Veteran’s Affairs, tribal healthcare, etc.

Why is this indicator important?

Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges. It is essential to personal well-being, family and interpersonal relationships and the ability to contribute to community or society. Mental health disorders are the leading cause of disability in the United States and Canada, accounting for 25 percent of all years of life lost to disability and premature mortality. Mental health and physical health are closely connected. Mental health plays a major role in people’s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people’s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery (2).

How are we doing?

In 2018, there were a total of 27,855 unduplicated individuals who received outpatient mental health services in Tulsa County, which was a rate of 43.0 mental health visits per 1,000 population. When taking multiple visits into account (duplicate clients), there was a rate of 1,780.8 visits per 1,000 population.

Children age 5 – 9 made up almost one-quarter of mental health visits (23.4 percent). In fact, the percentages of people who received mental health services were highest for children ages 5 to 9, and 10 to 14.  With regard to race, about two-thirds of mental health visits were white individuals (63.6 percent). Non-Hispanics accounted for 84.4 percent of visits.

When examined regionally within Tulsa County, the duplicated rate of mental health visits increased noticeably in the Downtown region from 2011-2013 to 2016-2018.  The other regions in Tulsa County remained somewhat stable on this measure during the time period examined. 

The zip codes with the highest number of mental health visits were 74117 (North Tulsa region) and 74103 (Downtown region). It is important to note that these rates include duplicate clients. 


Substance Abuse Visits

Definition

This indicator is presented as the number of individuals who received outpatient substance abuse services funded by Medicaid or Oklahoma Department of Mental Health and Substance Abuse Services per 1,000 population. Outpatient services does not include social support groups such as Alcoholics Anonymous or Narcotics Anonymous, or inpatient rehab services. Demographic data is presented for unique clients only, while zip code and regional data is presented for all clients.

Why is this indicator important?

In 2017, an estimated 19.7 million Americans age 12 and older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.5 million who had an alcohol use disorder and 7.5 million who had an illicit drug disorder (7).  Substance abuse generally refers to alcohol and both prescription and illegal drug abuse. Disorders related to substance abuse cause some of the highest rates of disability and disease burden in the U.S. This can result in high costs to families, employers, and publicly funded health care systems. Additionally, chronic diseases such as diabetes and heart disease can be caused by drug and alcohol use. Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year (3).

How are we doing?

From 2018, there were a total of 11,119 unduplicated individuals who received outpatient substance abuse services in Tulsa County, which is a rate of 17.1 substance abuse visits per 1,000 population. When taking multiple visits into account (duplicate clients), there was a rate of 199.8 visits per 1,000 population.  The rate of substance abuse visits in Tulsa County has been increasing since 2013, with the biggest increase coming from 2017 to 2018.

Adults ages 35 – 44 made up the largest percentage of substance abuse visits (23.5 percent). With regard to race, two-thirds of mental health visits were white individuals (67.3 percent). Non-Hispanics accounted for 93.5 percent of visits.

The Tulsa County regions with the highest rates of substance abuse are the Downtown and North Tulsa regions.  This has been a pattern since 2011-2013.  The zip codes with the highest number of substance abuse visits was 74117 in the North Tulsa region and 74103 in the Downtown region. It is important to note that these rates include duplicate clients. 


Depressive Disorder

Definition

This indicator is presented as the percentage of Tulsa County adults who reported that they had ever been diagnosed with a depressive disorder, based on 2018 BRFSS data.

How are we doing?

In 2018, 25.8 Tulsa County adults reported that they had been diagnosed with a depressive disorder. This was higher than both Oklahoma (23.3 percent) and the US (19.6 percent).  The percentages of Tulsa County adults who have reported being diagnosed with a depressive disorder have shown much variation in Tulsa County since 2011. 

Overall in Tulsa County and Oklahoma in 2018, females had higher percentages of those who'd ever been diagnosed with a depressive disorder than males.  Adults age 35 - 44 had the highest prevalence of depressive disorder in Tulsa County (38.1 percent), while the highest percentage of those diagnosed with a depressive disorder in Oklahoma were in the 55 to 64 age group (28.3 percent).  Generally, percentages across age groups were higher in Tulsa County than in Oklahoma.  There were only sufficient response data for reporting for two racial groups in Tulsa County for 2018, and of those, American Indian/Alaskan Natives (non-Hispanic had the highest percentage.  

Depressive disorder diagnosis decreased as income increased in Tulsa County, until 'over $75,000,' where it increased.  Adults with less than a high school education had the highest percentages of those who'd ever been diagnosed with a depressive disorder.  The pattern of the percentages of those diagnosed with depressive disorders by education was the same for Tulsa County and Oklahoma overall.  

Prescription Opioid Mortality

Definition

This indicator is presented as the number of deaths from prescription opioids per 100,000 population, for the single year 2018, and over the years 2016 – 2018. This does not include illicit opioids, such as heroin. The rates were age-adjusted to account for differences in age distribution among locations and races/ethnicities.  However, rates at the zip code and regional level have not been age adjusted, due to the extremely low number of deaths in many of the zip codes.

Why is this indicator important?

Opioids - mainly synthetic opioids (other than methadone) - were the main driver of drug overdose deaths in the US in 2018.  In 2018, opioids were involved in almost 47,000 overdose deaths (69.5 percent of all drug overdose deaths, with two out of three (67 percent) opioid-involved overdose deaths involving synthetic opioids. (8,9).   The prescription drug issue has become a public health crisis with increases in overdose deaths, neonatal abstinence syndrome and increases in infectious diseases related to the sharing of needles for injection drug use. The CDC also estimates that the economic burden of prescription drug misuse is $78.5 billion per year in the U.S., including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement (4).

How are we doing?

In 2018, there were a total of 35 deaths from prescription opioids in Tulsa County, which was a rate of 5.4 deaths per 100,000 population. This was slightly less, but very similar to the rate in Oklahoma (6.1 deaths per 100,000 population). In general, Tulsa County and Oklahoma have had very similar rates of prescription opioid mortality since 2011. Additionally, the rate in both locations has been decreasing since 2013. 

When examining prescription opioid mortality by race and ethnicity for the time period 2016 to 2018, the highest mortality rates are in the American Indian/Alaskan Native populations and the white populations for both Tulsa County and Oklahoma overall.  

When examining the crude mortality rates by region over time, it is clear that the highest mortality rates due to prescription opioid overdoses has been the Downtown region, although the mortality rate in this region has been decreasing overall since 2011-2013.

The zip code with the highest prescription opioid mortality rate for 2016-2018 was 74115 in the North Tulsa region. 

Suicide Mortality

Definition

The mortality rate from suicide is presented as the number of deaths from suicide per 100,000 population, for the single year 2018 and over the years 2016 to 2018. The rates were age-adjusted to account for differences in age distribution among locations, regions, zip codes and races/ethnicities.

Why is this indicator important?

Suicide was the ninth leading cause of death in Tulsa County 2016 to 2018.  Although the causes of suicide are complex and determined by multiple factors, the goal of suicide prevention is to reduce risk factors and increase factors that promote resilience (protective factors). Risk factors include family history of suicide or child maltreatment, previous suicide attempts, history of mental disorders and substance abuse and barriers to mental health treatment. Protective factors include effective clinic care for mental, physical, and substance abuse disorders, family and community support and easy access to a variety of clinical interventions and support for help seeking. Prevention aims to address all levels of influence (individual, relationship, community and societal) (5).

How are we doing?

In 2018, Tulsa County had a suicide death rate of 20.1 deaths per 100,000 population, which was very similar to that of Oklahoma (19.9) but higher than the United States (14.2). The suicide mortality rates for Tulsa County and Oklahoma overall have fluctuated over time, while the rate for the US has been steadily increasing since 2011.  Additionally, the rates in Oklahoma and Tulsa County have consistently been higher than the rate in the U.S. since 2011. None of these regions met the Healthy People 2020 goal of 10.2 deaths from suicide per 100,000 population. 

From 2016–2018, there were 370 suicide deaths in Tulsa County, which was an age-adjusted death rate of 19.4 deaths per 100,000 individuals. The suicide death rate was highest among American Indian/Alaskan Natives (22.5 per 100,000) followed closely by whites (21.6 per 100,000). This pattern was true in Oklahoma overall, as well.  The suicide mortality rate was higher in non-Hispanics compared to Hispanics both in Tulsa County (22.2 compared to 11.4) and in Oklahoma (22.4 compared to 9.9).

In the time period 2016 to 2018, the suicide rate was highest in three regions within Tulsa County:  the Sand Springs/West Tulsa region (24.0 deaths per 100,000), the Midtown region (24.8 deaths per 100,000) and the Downtown region (25.0 deaths per 100,000). 

The zip code with the highest overall suicide death rate was 74119.  This zip code is in the Downtown region.

Individuals Experiencing Homelessness

Definition

Each January, the agencies of the Tulsa City-County Continuum of Care and Homeless Services Network, in cooperation with the cities of Tulsa and Broken Arrow, conduct a one-night survey of homelessness (point-in-time survey). This count records the number of homeless individuals and collects demographic information about homeless persons sleeping in emergency shelters, transitional housing or other sites, as well as the number of non-sheltered people. This indicator presents results from the 2018 point-in-time survey. A full report on homesslessness in Tulsa County is accessible here

Why is this indicator important?

Homelessness is a growing public health problem. It exists when people lack safe, stable, and appropriate places to live, which includes sheltered and unsheltered people, as well as people living in overcrowded living situations or motels because of inadequate economic resources. It is associated with behavioral, social and environmental risks that lead to poor health outcomes such as hypertension, asthma, diabetes, sexually transmitted infections, HIV/AIDS and tuberculosis. People experiencing homelessness also have higher rates of hospitalization for physical illnesses, mental illnesses and substance abuse than other populations, as homelessness often presents barriers to healthcare access (6).

How are we doing?

On January 25, 2018, there were 1,083 persons experiencing homelessness in Tulsa County, 124 of which were children under 18.  A total of 933 of these individuals were surveyed.  Over 150 of these individuals were experiencing chronic homelessness. 

The majority of homeless adults were male (65.4 percent). The majority were also white (52.0 percent). Six percent reported that they were Hispanic. The primary age group reported was 51 – 65 (29.5 percent). Eleven percent reported that they were veterans. 

When asked about length of homelessness, about one-fourth reported 1 - 6 months (23.1 percent) and an additional one-fourth reported 1 - 3 years (23.7 percent). 

Respondents were asked about types of health concerns. The top responses were mental health diagnosis (50.8 percent), physical disability (35.3 percent), substance abuse (24.3 percent), and victims of domestic violence (16.2 percent). Additionally, less than half of respondents had been to the emergency department in the previous year. About one-fifth of respondents had been to the ED once in the previous year, and an additional one-fifth had been 2-10 times. 

Explore the Data



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Data sources

• Oklahoma Department of Mental Health and Substance Abuse Services. 2011 – 2018.

• Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. Retrieved from: http://www.cdc.gov/brfss/brfssprevalence/.

• Vital Statistics. Center for Health Information. Oklahoma State Department of Health.

• Tulsa City- County Continuum of Care Point-in-Time Survey. 2018.