Addressing the Mental Health and Addiction Crisis in Rural Oklahoma

Rural Oklahoma faces a mental health and addiction crisis. In Oklahoma, 1 out of every 5 adults experiences a mental illness while 1 out of every 10 adults has an active substance abuse disorder, two of the highest rates in the country. Instead of community resources providing support for individuals in need of care,  too many counties rely on jails to facilitate treatment.

This approach has several notable drawbacks. First, the criminal legal system is ill equipped to deal with mental health problems effectively, and even if it was better prepared, using the criminal legal system as a delivery method for treatment comes with the added stigma and the economic barriers of a criminal record. The cycling of individuals needing medical care in and out of local jails is not conducive to effective treatment and ultimately is harming entire communities. In order to prioritize the health, safety, and economic viability of our rural communities, we need to seriously examine the role of the criminal legal system in this public health crisis.

Mental Health & Substance Abuse Affect Everyone

Substance abuse is as big a public health issue in rural areas as it is in urban ones. Studies consistently show that substance abuse disorders occur at a similar rate in urban and rural areas. The same holds true for mental health issues. Oklahoma in particular has extremely high rates - ranking third and second respectively in the nation for mental illness and substance use disorder prevalence. It turns out, the main difference between urban centers and other rural communities across our State is the availability of resources to help deal with these issues. For example, Oklahoma has 28 rural counties that are categorized as having high need but low capacity for opioid treatment. This indicates that there is a significant gap between addiction treatment needs and ability to provide that treatment at the county level, which makes it hard for rural families to get the help they need and increases the risk for fatal overdoses.  The gap between need and availability exists for both addiction treatment and general mental health services in many rural communities across Oklahoma.

The Criminal Justice System Steps In

Due to the lack of community resources dedicated to the purpose, local law enforcement and the court system often end up being the first responders to mental health and substance abuse problems in rural Oklahoma.  Police in Oklahoma’s rural towns arrest individuals for drug crimes at a rate 4x higher than the urban centers of Tulsa and OKC, while non-metropolitan counties are 28x more likely to have drug violations reported to local sheriff offices than metropolitan counties. The creation of 988 has helped relieve some of the pressure but still these rural disparities exist. This is not a uniquely Oklahoma problem, with a national study showing individuals with a criminal history are more likely than those without a criminal history to receive substance abuse and mental health treatment. This reveals that the criminal legal system is filling in the gap for  treatment options nationwide. However, the problem is especially dire in Oklahoma because the criminal justice system is particularly ill equipped to deal with this crisis.

Local jails bear the brunt of this impact. According to Governor Stitt’s MODERN Taskforce, the most common charges in rural jails are DUI and simple drug possession, both of which implicate mental health and substance abuse issues. However, less than 10% of Oklahoma jails report having substance use, alcohol abuse, or mental health/psychiatric treatment options. Meanwhile, there is no state requirement for jails to support an individual's reentry upon release. At the state level - Oklahoma barely supplies enough funding to keep its specialty treatment courts active instead relying on grants and private donations. The criminal legal system is ultimately both under-resourced and under-trained to effectively deal with this public health crisis, especially in rural areas.

The Problem with Depending on the Criminal Justice System

Oklahoma currently doesn’t dedicate the appropriate amount of resources into the criminal legal system to effectively deal with these issues which ultimately creates numerous problems for our State, including creating an environment in our rural communities that is conducive to violent crime. First, each stay in jail reduces the chances of formal sector employment upon release, and these effects are magnified the longer an individual is detained, meaning the constant cycle of individuals with mental health and substance abuse issues in and out of county jails has an economic impact on both the individual and the community. This will have a real effect on future crime rates, as a child's family income is highly correlated with future incarceration.

As it stands now, rural violence is on the rise and the utilization of the criminal legal system as a tool to battle addiction and mental health issues has only made the situation worse. There are rural communities in our State that are drowning under the weight of extreme poverty, that was, at least partially, created by the State’s approach to mental health and addiction needs, and as a response, have very high crime rates. This leaves Oklahoma with a critical choice - would we rather invest in jails and prisons or would we rather invest in evidence based community resources so these problems, which are ultimately a matter of public health policy, can begin to be solved before the criminal legal system even has to intervene.

Some tools to solve this problem are already at our disposal. Increasing and expanding SQ781 funding, which for the first time since its passage in 2016, has provided 12.5 million dollars to counties for mental health and substance abuse treatment programs, pretrial diversion, housing and education programs. There are also opportunities at the state level to better fund treatment courts and expand them geographically so that all Oklahoma residents get a fair chance at treatment.


The reliance on the criminal justice system to address mental health and substance abuse issues in rural Oklahoma is proving to be not only ineffective but also detrimental to the well-being of individuals and communities alike. By treating these complex health concerns as primarily matters of law enforcement, we perpetuate cycles of incarceration, stigma, and economic hardship. The disproportionate burden on rural jails underscores the urgent need for a paradigm shift towards prioritizing evidence-based community resources and treatment options.

Rural Oklahomans deserve the same access to justice as everyone else. To truly address this public health crisis, Oklahoma must redirect its focus and resources towards preventative measures and holistic support systems. Investing in accessible mental health and substance abuse treatment programs, expanding funding for diversionary initiatives, and bolstering support for reentry services are essential steps towards breaking the cycle of incarceration and promoting healthier communities. By adopting a proactive approach that emphasizes compassion, support, and rehabilitation, Oklahoma can pave the way for a more equitable and effective response to mental health and substance abuse challenges in rural areas, ultimately fostering stronger and more resilient communities for generations to come.