The Governor of Oklahoma appoints the Commissioner of Mental Health and Substance Abuse Services to serve as the chief executive officer of the Department.

This service structure is vastly different from the organization's original model for treatment in the mid-1960s, which was primarily in the form of institutionalization in large state hospitals.

In FY13, services were provided to approximately 187,000 individuals through the ODMHSAS system, but fewer than 5 percent of required hospital care.

Most treatment takes part in mental health and substance abuse outpatient programs, targeted community-based services, prevention efforts and educational initiatives.

For individuals with mental illness, the Department supports a continuum of programs from community-based treatment and case management to acute inpatient care.

The remaining $56 million (19%) comes in the form of grants from the federal Substance Abuse and Mental Health Services Administration.

The ODMHSAS operates within this political-type framework and therefore must provide evidence to the public and the legislature that the organization focuses on the mission and goals of the agency by effectively delivering the services it has been statutorily commissioned to do.

Nevertheless, the amount of funding available to the state and allocated to ODMHSAS ultimately determines the effectiveness and the ability to meet the overall goals of the organization.

Despite the lack of funding, Oklahoma's mental health system scores among the top states in its delivery of treatment.

For example, the National Alliance for Mental Illness (NAMI) has scored Oklahoma's mental health system as one of the top 6 states, giving it a “B” in NAMI's grading of the states[5] Noting that lack of funding prevented Oklahoma from receiving an “A,” the NAMI reported that if the Department can successfully implement its state plan through added funding, “it could become a national leader in comprehensive, recovery-oriented mental health care.”[6] Some major reasons for Oklahoma's success is the fact that it has implemented nationally recognized telemedicine system which enables treatment in rural areas where doctors are scarce, as well as its implementation of programs such as its: “systems of care,” “programs of assertive community treatment (PACT),” specialty courts, and others that have stretched funding while improving outcomes.