Sen. Kirt’s study examines gaps in mental health treatment that can leave families in the dark

OKLAHOMA CITY – Senate Democratic Leader Julia Kirt held an interim study at the state Capitol examining a critical but often overlooked issue in Oklahoma’s mental health system – what happens when a loved one is too sick to make medical decisions for themselves, but the family member legally responsible for helping them cannot get the information they need to help. The study focused on the role of legal guardians and caregivers in mental health treatment and how Oklahoma’s policies and procedures could make sure patients get the best care.

Testimony came from the National Alliance on Mental Illness Oklahoma (NAMI), the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), and family members who serve as legal guardians for loved ones with serious mental illness.

Guardianships can be approved by a court when a person is unable to make certain medical or financial decisions for themselves. Because of the significant rights involved, general guardianship requires a high burden of proof and is relatively uncommon. But once a court has appointed a guardian, families told lawmakers they can face another barrier – getting state agencies and treatment facilities to recognize and communicate with them in that legal role.

State officials discussed the importance of verifying guardianships while also complying with medical privacy laws. Family members, however, described the devastating consequences when that process takes too long or when facilities fail to communicate with them about treatment, discharge plans or a loved one’s whereabouts.

“The stories I’ve heard from guardians are stark. Caregivers have described not being able to speak to doctors to provide health history or even know where their loved one is,” said Kirt, D-Oklahoma City. “We’ve heard about patients being checked out without the guardian even being told, and loved ones ending up in jail. It’s a huge danger for people with serious mental illness and their families, as well as a huge cost to our communities.”

One of the central challenges discussed during the study is the intersection between federal medical privacy laws and legal guardianship. Under federal privacy protections, health care providers generally cannot share a patient’s medical information without authorization. Families told lawmakers that, in practice, determining who can receive information and verifying a guardian’s legal authority can create significant delays. For families and patients, those delays can have serious consequences.

Sarah Smith described waiting for a treatment facility to verify her guardianship on the day her sister was being released. Before Smith could provide the health information needed or participate in the discharge process, her sister was released to a shelter without Smith being notified. Charla Collins shared a similar experience involving her adult daughter, who has a traumatic brain injury and has experienced multiple psychotic episodes. Collins described repeatedly struggling to communicate with Oklahoma’s mental health system and said her daughter had been discharged from facilities without her knowledge. Then, Collins said her experience was dramatically different when her daughter became involved with the mental health and criminal justice systems in California. There, she said, her guardianship was recognized and she received a level of communication and support she had not experienced in Oklahoma. Collins told lawmakers that families need greater accountability and that facilities should not be able to discharge patients during a mental health crisis without adequately involving the people legally responsible for their care.

Kirt said it was critical to improve current procedures, fix the gaps, and make sure guardians can quickly be included in the care so those guardians are kept in the loop and can fulfill their legal role to support their ward’s wellbeing. 

“When someone is experiencing a serious mental health crisis, their family shouldn’t have to fight the system just to find out where they are or help provide doctors with critical information,” Kirt said. “If a court has determined that a person needs a guardian, we need to make sure that guardian can actually fulfill that legal responsibility. We need to make sure people can thrive with stability and proper medical treatment.”

Kirt said the goal is to identify gaps in the current system, while protecting patients’ privacy and rights.

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For more information, contact:  

Sen. Julia Kirt at 405-521-5636 or Julia.Kirt@oksenate.gov