I've seen this journalist doing research in the field - excellent reporting. Between her and Bob Ortega, the prisons have been getting a close look at by the AZ Republic these days. What's about to happen here is catastrophic. The Arizona Department of Corrections is the last place we should be sending people with mental illness - and it's the next place many will be heading. Someone has to fill all those new private prison beds, after all...the good prisoners will go to them, and the mentally ill will be kept in the fire traps they call state prisons.
Paul Rubin's Phoenix New Times article about the murder of Shannon Palmer comes to mind when I think of people who never should have been in prison to begin with - and wouldn't have, if our mental health system wasn't already so damaged and our communities so gutted of basic resources. Phoenix is so certain that more police are the answer that they're taking it out of the food tax - thank God we have the resources to arrest the poor when they steal to feed their families now.
Anyway, if we don't spend our tax dollars in the community folks - BEFORE people feel the need to call the police - we'll be spending it keeping a lot of these folks in horrendous conditions behind bars. We already are, sadly - for every one mentally ill person we hospitalize in Arizona, we put over nine more in jail or prison. Only Nevada is more brutal to their mentally disabled.
Needless to say, our disability rights advocates in this state have a lot of catching up to do if they're going to protect these folks all the way to prison and back. Most seem to stop at the courtroom door, I'm afraid...
---------from the Arizona Republic-------
Mary K. Reinhart - Sept. 22, 2011 12:00 AM
The Arizona Republic
Arizona taxpayers are providing fewer services to fewer people with serious mental illnesses than they were last year, for annual savings of roughly $50 million.
But the short-term savings from state budget cuts threaten to have long-term consequences for patients, providers and the community, mental-health experts say.
The budget reductions eliminated services for about 12,000 Arizonans who don't qualify for Medicaid, removing the foundation of a system intended to keep the seriously mentally ill, healthy and out of emergency rooms, hospitals, jails and prisons.
State lawmakers instead provided money for generic medication and additional funding to beef up a statewide crisis-response system to help prevent people from falling through the cracks. But in the 15 months since this population lost case management, brand-name prescription drugs, therapy, transportation and other benefits, more than 2,000 people have stopped receiving any state-funded services and are unaccounted for.
Local and county jails, emergency responders and hospitals often shoulder the costs when people with untreated serious mental illness, such as schizophrenia and bipolar disorder, fall into crisis.
The precise financial costs to those entities are unknown, but health professionals do know that it's far more expensive to treat people who have spiraled into crisis than to keep them stable. And once in crisis, health professionals say, it's more difficult for people to rebound, which means those higher costs continue to recur.
"It's a penny-wise and pound-foolish approach," said Bill Kennard, former executive director of the National Alliance on Mental Illness' office in Phoenix. "More people in jail and prison with mental illness, more time that law enforcement spends dealing with a health issue as opposed to a public-safety issue."
The costs
The state has not conducted an analysis that compares ongoing treatment with crisis costs.
But a March 2011 study that examined proposed mental-health cuts in Texas put the average daily cost of services at $12 for adults, compared with $401 a day in the state's mental hospital, $137 a day for a jail inmate with mental illness and $986 for an emergency-room visit.
The study, by Health Management Associates for the Texas Conference of Urban Counties, also showed that gaps in services put those discharged from psychiatric hospitals and jail at greater risk of relapse, readmission and recidivism.
Janey Durham, who is in charge of a workshop program at Mesa's Marc Center, said she lost 120 people to the budget cuts, including a man diagnosed with schizophrenia who deteriorated almost before her eyes. The non-profit agency center provides job training and other services to the mentally ill and developmentally disabled.
Durham said the man, a former alcoholic in his 50s, worked hard at his job in the manufacturing warehouse, at maintaining his sobriety and in treating his mental illness. But soon after the budget cuts forced him to switch to a generic medication, Durham said, he stopped taking his medication, started drinking again and grew increasingly paranoid, plagued by voices in his head.
Over the past year his erratic, disruptive behavior led Marc Center employees to call Mesa police at least once. He is believed to be homeless, she said, but contact with him has been sporadic since last winter.
Clarke Romans, who runs the NAMI office in Tucson, said a once-eager volunteer has been reluctant to leave her house since last summer, when her anti-psychotic Seroquel was replaced with a generic drug. Many of the most commonly prescribed brand-name psychoactive medications have no generic equivalent. Generics in some cases are less effective or have side effects that deter people from taking them, health officials say.
"She's been suicidal. She has not been able to come in and volunteer. She kind of hides in her house," Romans said. "These are people who are suffering in silence."
Before the budget cuts last July, individuals with serious mental illness were entitled to a full array of community-based services, from supportive housing to intensive case management and in-patient hospitalization, regardless of their income.
Mental-health advocates argue that city and county law enforcement, hospitals, jails and homeless shelters have picked up some of the costs of caring for the seriously mentally ill who lost benefits. Over the past year, many of these venues have seen an increasing number of people with severe mental illness.
State lawmakers made the cuts to help close a $1 billion deficit in fiscal 2011. House Appropriations Committee Chairman John Kavanagh, R-Fountain Hills, said the state's financial crisis forced lawmakers to cut $3 billion over four budget cycles, and all of the cuts carried some consequences.
"The question is, are the consequences so dire that it shouldn't be done? We don't believe so," Kavanagh said. "The changes really were not dramatic. . . . We're still providing these people with treatment."
Treatment, recovery
Publicly funded mental-health treatment can be highly effective, and the vast majority of people can improve their quality of life and relieve symptoms, such as hallucinations or depression, with consistent therapy, medication and other support.
But experts say treatment and services must be comprehensive and consistent.
"I don't think these kinds of services are luxuries for people with mental illness. They are part and parcel of their treatment for an underlying disorder," said Dr. Paul S. Appelbaum, a Columbia University psychiatry professor and past president of the American Psychiatric Association. "Unless you provide a package of services, just throwing pills at them isn't going to do it."
Those who work closely with the mentally ill say that is the situation for thousands of Arizonans who are ineligible for Medicaid. And they worry that people who stopped showing up at their assigned clinics may have become incarcerated, homeless, hospitalized or homebound.
Dennis Culhane, a University of Pennsylvania professor and nationally known expert on homelessness, said studies show people with serious mental illness who are not receiving regular, supportive services are more likely to become homeless.
Culhane's own research has shown that it costs less to provide apartments and other permanent housing for people who are homeless than to provide emergency shelter and services. People with serious mental illness who become homeless, he said, "have significant secondary costs," including emergency, hospital and incarceration costs.
Once they have fallen into crisis, the road back to recovery can be much harder.
"Untreated psychiatric illness is just more difficult to treat," said Dr. Jason Caplan, chief of psychiatry at St. Joseph's Hospital and Medical Center. "You have an increased risk of relapse. It's just harder to get you back."
Repeat visitors
Case management was a key benefit lost to the non-Medicaid mentally ill. Among other things, caseworkers helped people who were jailed or hospitalized to transition back into society and tried to prevent their relapse.
People often lose their housing while they're locked up and, if they're on probation or court-ordered treatment, they have a list of rules to follow upon release.
Now, there is no one to meet people as they are released from jail or a psychiatric hospital.
In Maricopa County, 54 people with serious mental illness were released to the street or to a homeless shelter in the past year after being stabilized at one of the Valley's two urgent psychiatric care facilities, according to Magellan, the for-profit contractor that administers behavioral-health care in the county.
Dr. Dawn Noggle, mental-health director for Correctional Health Services, which provides health care at Maricopa County's jails, said the seriously mentally ill are staying in jail longer. And, she said, police have arrested some more than 30 times for a variety of crimes, mostly low-level non-violent offenses, such as trespassing or theft, or probation violations.
Incarceration and prosecution of the mentally ill doesn't just affect taxpayers who foot the bill, she says.
"What happens after they get felonies? And there is an incredible impact on families," she says. "It's not just the immediate financial costs. It's the social costs as well."
There also are repeat customers at the county's psychiatric hospital, where the budget cuts mean court-ordered evaluations must be completely redone for people discharged only weeks earlier. Staff at the county's Desert Vista Behavioral Health Center, which handles involuntary commitments, say it's a new phenomenon.
In the past, people were typically court-ordered to continue treatment for at least a year, long after they were discharged from the hospital. Since the budget cuts, judges have been dismissing court-ordered treatment for non-Medicaid patients upon their discharge, reluctant to require them to participate in services, such as therapy and job training, they no longer have. Within months, some of those people are brought back for a new evaluation, a costly legal and medical process that delays treatment for several days.
"It's taking an enormous amount of resources to redo something that's already been done," said Sherry Fraley, legal-services manager.
Reach the reporter at 602-444-8603.
