Oklahoma children needing mental health help often left with the state
Editor’s note: This article discusses suicide and suicidal ideation. If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.
Tucked between a highway and railroad tracks just east of Tulsa’s downtown, the county’s only emergency youth shelter acts as a temporary home for some teenagers who have been abandoned by their parents and have nowhere else to go.
The common area is various shades of beige with concrete floors and a few tables, couches and TVs. Some of the youths have drawn on the doors to their rooms in chalk — workout routines, nicknames, flowers. Metal cutouts of stars and “follow your dreams” signs hang above the front desk. The kids can be wary of one another and staff, and some say the Youth Services of Tulsa shelter reminds them of a detention center, shelter staff said.
One girl wanders around, complaining about how there’s nothing to do while another boy watches a scary movie. It’s quiet in the shelter except for the sound of screams from the TV.
Over the last several years, the shelter has seen more youth with high mental health care needs, some who have been abandoned by their caregivers, put into state custody and end up at the shelter, said Craig Henderson, director of counseling services at Youth Services of Tulsa, the nonprofit that contracts with the state to run the shelter. The shelter can sleep up to 20 kids.
Oklahoma youths are struggling with anxiety and depression, suicidal thoughts, aggressive behaviors and a lack of coping skills to get through histories of family problems and other traumas. Some have autism or other developmental disabilities.
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Some parents, reaching a breaking point or worrying for the safety of other children or themselves, may refuse to pick up their kids from emergency rooms, psychiatric hospitals or detention centers, or may want to leave them at one of the state’s youth shelters, advocates and providers told The Frontier.
While the number of kids coming into state custody has declined over the past five years, abandonment cases have remained steady during that time, according to data from the Oklahoma Department of Human Services.
Child welfare monitors said in a 2023 report that a growing percentage of children enter state custody after their caregivers abandoned them and that many had behavioral challenges and developmental disabilities.
Over the last fiscal year, roughly 12% of the more than 3,300 kids who came into state custody were removed because of abandonment, according to data from DHS. The state doesn’t keep track of how many of those cases were due to just mental health challenges.
When kids enter foster care because of abandonment and have mental health care needs or other disabilities, they can be more likely to stay in an emergency youth shelter or to age out of the system without a permanent family, advocates said. Youths who enter adulthood without permanent families have heightened risks of homelessness, substance use and interaction with the criminal justice system.
“We’ll do anything we can to keep the family intact and get the services in place to keep everyone safe,” said Tricia Howell, the state’s child welfare director. “Sometimes it works. And sometimes the family feels like they can’t do it and can’t put enough things in place to feel like all their kids will be safe.”
Seven youth shelters across the state told The Frontier they are familiar with cases where a child is abandoned to state custody because their parents couldn’t meet their behavioral health needs. These shelters are the state’s placement of last resort if no other family-style homes are available or willing to take kids with complex needs.
DHS spent the last decade working to decrease the number of kids who stay in shelters. Now, it’s rare for young kids to stay in a shelter at all, and the number of nights teenagers spend in shelters dropped drastically about 10 years ago. But about 90 to 100 teens were still living in youth shelters each month throughout 2023 and 2024, state reports show.
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The temporary housing facilities usually aren’t the right place for kids with serious mental or behavioral health care challenges, providers said. Staff can’t adjust psychiatric medications, and doors aren’t locked.
“The last thing we want is kids, who have parents, to get thrown in the system,” Henderson said.
A patchwork of services
Despite investments in recent years to expand services, many Oklahoma families still struggle to get connected to the right kinds of mental or behavioral health care, advocates said.
Oklahoma kids can face weeks or months of waitlists before an appointment with a therapist or specialist. Only nine out of Oklahoma’s 77 counties had any child and adolescent psychiatrists in 2022, according to the American Academy of Child and Adolescent Psychiatry. And just about 25 mental health providers in the state had specialized training in providing mental health care for the nearly 21,000 kids in Oklahoma who have been adopted from foster care, DHS told state lawmakers this spring.
Over half of Oklahoma middle and high school students surveyed in the 2023-2024 school year said they experienced moderate or severe psychological distress, according to the Oklahoma Department of Mental Health and Substance Abuse Services.
Without help, behaviors can escalate as kids struggle to navigate their environments and relationships while dealing with anxiety, depression, suicidal ideation or, in some cases, psychosis. Kids can hurt themselves or the people around them. They can face problems in school or get into trouble with the juvenile justice system. Most parents are ill-equipped to manage these situations — especially if they have other children or limited resources.
There is a patchwork of services offered across the state, and what gets paid for and when depends on insurance companies, said Brittany Hayes, policy director for Healthy Minds Policy Initiative, an Oklahoma-based nonprofit. The state lacks the kinds of intermediate levels of care that offer more than traditional outpatient therapy and can keep kids out of hospitals or restrictive facilities away from their families and communities.
Many families get trapped in a cycle where lower-level care isn’t enough, more intensive therapies aren’t readily accessible or known about and kids aren’t approved for longer-term residential treatment. In these cases, kids are more likely to turn up in emergency rooms during a crisis — and increasingly, make repeat visits.
Only one or two kids experiencing a mental health crisis came into OU Health’s Oklahoma Children’s Hospital per month in 2007. Now, there is a suicidal pediatric patient every shift, hospital officials told the Oklahoma Commission on Children and Youth in 2022. Some stay for days, weeks or months at the hospital while waiting to be declared stable enough to discharge or for a bed to open up at another facility.
It’s also becoming more common for kids with complex needs to get sent out of state to get care because Oklahoma doesn’t have enough providers willing or able to take on their cases, a Frontier analysis of state data showed. Ongoing staffing shortages mean fewer slots are open. The state spent about $5 million in the 2023 fiscal year to send kids out of state to get treatment they couldn’t receive in Oklahoma.
‘Parents don’t have children to give them away’
Crisis services for youths across Oklahoma are still coming online. A successful rollout of the state’s 988 crisis line has worked to route kids directly to mental health professionals. But as of last summer, Oklahoma only had three urgent recovery centers for youths where caregivers could walk in with a child and receive immediate emergency care. More were being built but weren’t open yet.
When kids need inpatient psychiatric care, they can be admitted to a facility like Parkside Psychiatric Hospital in Tulsa. Parkside is one of the only inpatient psychiatric hospitals with youth beds in northeast Oklahoma.The hospital recently converted some adult beds to serve kids to meet the increased demand for youth mental health services.
Staff at the facility are trained to uncover root causes of behaviors and offer coping skills. But the facility can only keep kids as long as they meet certain medical requirements, like being an active danger to themselves or others. Stays at the hospital average about seven to 10 days, said Eric Sachau, director of administrative services at Parkside.
Ethical questions of when it’s appropriate to keep a person in a locked-down facility have pushed providers to treat individuals in the least-restrictive setting when possible. This can limit time spent at facilities like Parkside or residential treatment centers, even if a person’s challenges aren’t totally resolved.
“You know as a hospital clinician that while you’ve gotten them stabilized, you’re going to send them home probably without enough true skills to mend those gaps,” said Pattie Collins-Jackson, a longtime clinician working in northeast Oklahoma.
Kids are the most vulnerable when they are discharged from a facility after a mental health crisis, said Whitney Downie, chief strategy officer with Family and Children’s Services in Tulsa.
There is a risk of relapsing and self-harm without the right follow-up care while youths stabilize on new medications, try to fit back into old routines and schedule therapy or other services. But, at this point, kids and parents are often worn out. Parents may be struggling with their own issues while trying to help their children.
“It’s a mix that is hard to untangle,” Downie said. But “parents don’t have children to give them away.”
Abandonment charges for parents unlikely
In households with multiple kids, parents have a responsibility to make sure all children are safe from threats of harm. Advocates said some parents fear their other children may be taken away by the state if the household dynamic doesn’t improve.
If problems continue or certain services don’t seem to work, parents can feel hopeless, said Samantha Bowman, assistant clinical director of children’s services at the Oklahoma-based health care provider CREOKS. Without support for things like respite, parents struggle to “breathe and come up with a different plan,” Bowman said.
Some parents wonder if refusing to take a kid home will force the state to step in or for providers to keep a child for longer treatment.But abandoning a child is illegal and can come with jail time or fines.
When possible abandonment cases come to Oklahoma County Assistant District Attorney Jaclyn Rivera’s attention, she wants to know what has been tried so far to get the family help.
Rivera has directed Oklahoma County’s juvenile division since 2006. She knows mental health resources are difficult to access, so how hard a family tried to meet a child’s needs plays a role in where their case goes, Rivera said.
Prosecutors can file criminal charges for abandonment that carry fines and jail or prison time if a parent refuses to take their child home or find another appropriate living situation, but district attorney’s offices in Oklahoma’s three largest counties said those decisions are made on a case-by-case basis. It’s uncommon for parents to face criminal abandonment charges in court. But if a parent fails to come to court or participate in a treatment plan, prosecutors in Tulsa and Oklahoma counties said they will look at filing a case or move to terminate parental rights.
Tulsa County Assistant District Attorney Kim Jantz follows kids’ cases as they bounce from shelters to group homes to treatment facilities. The constant moving and loss of family can make kids angry and depressed, causing them to act out, she said.
Like parents, the state also struggles to care for kids with high needs. There is a shortage of foster homes willing to take kids with complex issues, and any waitlists or denials for placements or services that parents face are also issues for state workers.
When a shelter can’t keep a youth or other residents safe, a child has to go somewhere else. Some kids move from shelter to shelter, something youth services organizations call “shelter hopping,” said James Carter, director of Northern Oklahoma Youth Services, which runs a shelter in Ponca City. Moving around frequently makes it difficult to build meaningful relationships and consistently get already-stretched resources.
“It’s a real problem right now,” Carter said. “But I’m not sure that anyone has a good solution.”
Jantz worked with one child with behavioral issues since summer 2023 who received inpatient emergency care nine times. She estimates the youth has bounced between roughly 18 or more placements since being put in state custody.
“They just keep cycling. They never really get to the point where they can self-regulate to where they can go to a traditional placement,” Jantz said. “And I don’t blame a lot of these kids. They feel abandoned.”
Many of the kids with more significant challenges stay in foster care until they age out of the system at age 18.
Challenging solutions
For the past several years, state lawmakers and agency officials have been investing in more interventions for children with high needs.
This year, Oklahoma lawmakers gave $18.5 million for crisis mental health services for kids. Oklahoma Children’s Hospital is in the process of building a new children’s behavioral health center. The Oklahoma Health Care Authority started working with foster care staffers in 2022 to find resources for kids with complex cases. The Office of Juvenile Affairs is pushing to expand an intensive, full-family therapy program for at-risk kids. And DHS created a program to place kids with high needs with well-trained foster parents.
In Tulsa, Family and Children’s Services runs one program, Bridges, meant to catch youth as they discharge from inpatient care and provide services directly to that family with a small group of staffers and clinicians.
The program has served hundreds of kids so far with family therapy, behavioral health aides going to school with kids, coordinators helping get specialized education plans in place and respite care for parents.
Initially the program was funded with a federal grant. That grant ran out, and the agency has just absorbed those costs, said Whitney Downie, who also coordinates Bridges. But Family and Children’s Services is a large agency and has been able to make it work. It’s the only program of its kind in the state, Downie said.
“Dealing with someone’s mental illness is really complicated,” Downie said. “It takes a team.”
Programs like Bridges are meant to keep kids in families, where they have better outcomes, according to the federal Department of Health and Human Services fiscal year 2024 budget brief.
Still, finding providers to fill the gaps between outpatient therapies and crisis or inpatient care is challenging. When the state offered additional dollars in 2022 to providers to take kids who had a mental or behavioral health need, along with something like a developmental disability, aggressive behaviors or physical health condition, only a few accepted.
Shelters are called on when there are no other options.
In El Reno, the walls in the Canadian County Youth and Family Services Shelter are dotted with posters on empathy, encouragement and consequences. The large common room is quiet while three boys sit at a table absorbed by tablets before lunch.
The days are slow, but by the evening, the shelter will get calls from case workers across the state looking for emergency beds for kids that have nowhere else to go.
Staff are trained on how to work with kids with trauma or developmental disabilities, said shelter Director Latuisha Davis. The shelter is airy, full of games, activities and calming rooms.
But it’s not a fix-all for kids left at the facility, Davis sighed, who “struggle with a lot.”
The Frontier is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center and newsrooms in select states across the country.
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