The Arizona Department of State Health Services' Arizona State Hospital in Phoenix provides the “highest and most restrictive” level of care in the state, according to AZDHS. (Photo by Crystal Aguilar/Cronkite News)
PHOENIX – Mental Health America ranks Arizona 49th in the nation for adult mental health care. The country's nonprofit organization bases its rankings on the prevalence of mental illness and access to mental health care. Arizona's 2023 ranking is 49th out of 51, based on the state's high prevalence of mental illness and low access to insurance and treatment.
The ranking was no surprise to Arizona Mad Moms organizer and member Rachel Streif. She and her other family members, caregivers, and friends of people with severe mental illness have been advocating for appropriate psychiatric services and treatment on their behalf for quite some time.
“It (Arizona Mad Moms) was really organized,” Streif said. “The result of not providing this long-term, acute level of care is that families are feeling a huge burden.”
Streif was granted legal guardianship of her 31-year-old friend (who identified herself only as Kelsey) in 2022 and has overseen her medical needs ever since.
“She has been in and out of the hospital for years and has not received effective long-term stabilization or treatment,” Streif said. “Her illness is extremely complex and beyond the scope of current community health services.”
Rachel Streiff, host and member of Arizona Mad Moms. (Photo provided by Rachel Strife)
Kelsey currently lives in a behavioral health facility and, with her mother's permission, was placed in Streif's care.
Streif said going to court to obtain guardianship can be difficult and very expensive.
“Families that can't afford a lawyer or can't afford a medical practitioner don't have the ability to obtain such an order,” Streif said.
“I took on her case because her parents are aging and her father recently passed away,” Streif said. “She just didn't have anyone to advocate for her,” she said.
Legal guardianship allows Streif to be present at doctor's appointments, and Arizona law requires Streif to participate in all conversations about Kelsey's medications.
“In these discussions, people with SMI (severe mental illness) can't really tell if their medication is working or not,” Streif said. “They may also have the wrong idea of what is actually helpful.”
Streif said in January that Kelsey was given the wrong dose of a drug given to her after she was discharged from the hospital, causing a seizure two days later.
“I looked at the medication on the sheet she left the hospital with, but I didn't look at what was actually on the prescription that arrived at her residence,” Streif said. Ta. “How could an ordinary person with severe mental illness and no guardian know that his treatment was flawed?”
According to the Arizona Health Care Cost Containment System, SMI is a “chronic, long-term mental health condition that impacts the ability to perform daily activities and interactions.”
SMI is most commonly treated with psychotherapy and medications such as antidepressants and mood stabilizers. Some people with SMI require close supervision, while others do not. Ms. Kelsey requires the level of supervision that would be provided in a residential facility, such as the one she is currently in.
Thanks to Streif's guardianship, she was able to place Kelsey in a behavioral health residential facility (BHRF). “She (Kelsey's) family and friends have the means to do that and that's why she's doing well in this situation,” Streif said.
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Kelsey does not require restraint, but does require full-time care and decision-making assistance. Strief said so-called “voluntary” facilities have capacity for individuals who can advocate for themselves, but lack the resources for highly vulnerable individuals like Kelsey who require ongoing care. point out that it is lacking.
Acute lock-down facilities, like the Arizona Department of State Health Services' Arizona State Hospital in Phoenix, provide the “highest and most restrictive” level of care in the state, according to AZDHS. Patients who cannot be treated in local facilities or who cannot receive treatment because of their criminal legal status are admitted to the hospital. The Arizona State Hospital can accommodate 260 patients, with 117 beds at the Civil Hospital and 143 beds at the Forensic Hospital. As of April 28, 92% of beds at both facilities were occupied.
As of 2019, Arizona had 8,923 supportive housing and residential care beds available to patients with SMI who were eligible for Medicaid but did not require the level of care at Arizona State Hospitals.
To obtain admission to the BHRF, patients must exhibit at least one serious functional impairment or psychosocial impairment, including displaying a significant risk of harm, such as suicide or homicide, and an inability to self-harm; Must be diagnosed with a condition with symptoms and behaviors that require residential treatment. Stay safe within the patient's current environment.
Kelsey currently lives in a residential SMI clinic run by Copa Health and Mercy Care, an Arizona nonprofit that serves people with disabilities, but Streiff told her said they are facing displacement because they don't qualify for Medicaid and state funding is limited. . Her family's income is too high to qualify for Medicaid, but not high enough to afford her private medical care.
“They (SMI patients) often stay at home with their mothers and other family members, who often cannot afford to care for them, which is a very difficult situation,” Streif said. Ta. “So we have caregivers who are carrying a huge burden and are often at risk.”
Because Kelsey is not receiving AHCCCS assistance, she was given a maximum stay of six months in the facility. Streif said Kelsey is “doing well” at BHRF's level of care, but her next option is flex care, a short-term program that combines treatment within the apartment.
“Discharge planning begins as soon as a member is placed somewhere,” Streif said in a text message. “This (flex care) is not supported at all by non-Medicaid or state funds. So it's not really an option. Families are considering a number of discharge possibilities, including private payment.” The clinic sent us several private payment options, some of which were $25,000 a month, which very few families could afford.”
Medicaid disparity
Will Humble, executive director of the Arizona Public Health Association, an advocacy group, said the new law requiring AHCCCS to collect and analyze data on clinical outcomes for patients with SMI will not provide statistics for court-ordered evaluations. Said it was helpful.
Will Humble, executive director of the Arizona Public Health Association, an advocacy group. (Photo courtesy of Arizona Public Health Association)
“Right now, we don't have enough data about patients to make appropriate decisions about whether to receive court-ordered treatment or not,” Humble said. “So one of the weaknesses in our behavioral health system right now is that state Medicaid agencies only collect processed data like, 'Was this person with a mental illness assigned to an active community treatment team?' “Are they receiving outpatient treatment in a day program?''
The bill, SB 1311, was signed by Governor Katie Hobbs on April 16 and requires AHCCCS to improve the information collected in the SMI community and provide access to people who need mental health services but are not eligible for trial. Request that recommendations be made to provide assistance. Ordered evaluation.
“What we really want to know is: How often do people with severe mental illness get arrested, end up in the emergency room, be hospitalized, get arrested and end up homeless,” Humble said. said. “This will require AHCCCS and its managed care plans to collect better outcomes data and become more accountable for public funds.”
According to the National Alliance on Mental Health, the average cost of community hospital psychiatric treatment for SMI patients can range from $3,616 to $8,509 for less than two weeks. As of April, more than 1.9 million Arizonans were enrolled in Medicaid, and the per-person income limit is set at $1,670 per month.
Humble also said the impact affordability has on employee numbers at state facilities extends beyond patient care.
“Arizona's (labor) shortage is worse than any other state,” Humble said. “Whether we like it or not, clinicians follow the money. If a state has a reputation for poor reimbursement in its Medicaid system, over time fewer and fewer clinicians will visit that state. I guess.”
According to data from the University of Arizona reported in May 2023, the state needs 142 to 233 full-time psychiatrists to address the current mental health shortage.
Matt Jewett, director of health policy at Children's Action Alliance. (Photo courtesy of Matt Jewett)
Matthew Moody, president of Arizona Mental Health America's board of directors, said the state's sober living fraud could be a reflection of poor access to mental health services in Arizona. This scam preyed on vulnerable people, especially Native Americans, who were lured into a residential facility where he was encouraged to enroll in AHCCCS to pay for non-existent medical bills. Officials estimate that the state may have lost up to $2 billion in payments to fraudulent providers by the time the program was shut down early last year.
“Arizona's system of protecting these people and making sure people get proper care has been a complete failure. I know they are working hard to find a way to fix it.” “We're working hard,” Moody said.
While Arizona ranks 29th out of 51 on the MHA's national list for youth mental health access, adult mental health access Health is said to have a profound impact on the mental health of children whose parents lack the necessary resources. .
“Children's mental health will be influenced by their parents' mental health, especially their mothers,” Jewett said. “Experiences of childhood adversity are extremely important. In Arizona, children have higher rates of multiple adverse childhood experiences, including maternal depression, parental prison time, and family history. Possibly domestic violence.”
Jewett said that despite these barriers to adult mental health care, children are receiving better care with services provided by schools.
“One of the things we have been asking for is reimbursement by AHCCCS for services provided in schools,” Jewett said. “Children may have access to quality care from health care providers…but not all young people have access to it. In some cases, the most convenient place to receive services is at school. .”
