Grading the States 2006: Arizona - Narrative
Arizona is a state struggling to swim upstream in a desert.
Its urban areas, Phoenix and Tuscon, have grown by 40 percent in the last decade, making it the nation's 18th most populous state. It has a very diverse population, including a large proportion of retirees. At the same time, it is expansively rural. With an average median income in the lowest one-third of the nation, the state ranked 18th in per capita spending for mental health services in 2001.
The future of the state's mental healthcare system depends on its ability to find more effective ways to deliver quality services through a regional mental health model and to provide appropriations that at a minimum keep pace with population growth. A network of regional behavioral health authorities (RBHAs) currently provides services throughout the state, blending Medicaid and indigent support. Quality varies widely.
A 25-year-old lawsuit in Maricopa County, Arnold v. Sarn, exemplifies RBHA problems. Individuals with serious mental illnesses filed the suit in 1981, and it is still ongoing. Two years ago, an audit by a court monitor revealed significant deficiencies in service planning and delivery. The state and RBHA have made progress since then, such as in case management and training clinical staff in recovery principles, but major gaps in service still exist—such as in employment and substance abuse treatment.
Other RBHA problems include difficulty in getting the right medication at the right time because of prior authorization restrictions or limited formularies, enrollment protocols, and the lack of evidence-based practices such as ACT and integrated treatment.
Arizona State Hospital is located in Phoenix. In May 2006, voters in the Tucson metropolitan area will vote on a $54 million bond issue to expand University Hospital in Kino to include a psychiatric urgent care facility and a psychiatric hospital with approximately 90 beds. Timely access to inpatient care is sometimes a problem, with poor treatment planning. Advocates also report a lack of discharge and transition services.
The pressure of population growth and increases in property values makes housing a special concern. In 2004, SSI recipients would have needed to spend 112 percent of their SSI checks for a one-bedroom apartment in the state. The state provides supported housing services in only two of the state's 15 counties, but is moving forward aggressively to address the need.
Arizona has invested in consumer and family education programs, which signals a desire to move in the right direction. Although gaps still exist in the planning process, the Arizona Department of Health Services, through the Division of Behavioral Health Services, has sponsored a Best Practices Committee that actively engages consumers and family members in the evaluation of initiatives.
Arizona has been slow to address the nuances of providing services to Native American or Latino communities, but is starting to catch up. The state requires providers to translate all materials whenever they know that either 10 percent or 3,000 of theirmembers speak a specific language and have limited English proficiency. In other instances, translators will be provided. This is an exemplary national practice.
Within the last few years, Arizona also has made progress in developing pre- and post-arrest diversion strategies to decriminalize mental illness and to get people into treatment. Programs exist in Maricopa and Yuma Counties, with encouraging developments also in Pima and rural northern counties. One caveat: some of this progress is the result of legal actions initiated by the U.S. Department of Justice. It is a shame that a state must be forced through legal action to do what's right.
Strong, consistent, and committed leadership is needed in order to move forward proactively.
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