Here and Now - Mental Health Issues

You need to look at the state buying several former Osco buildings to create stand alone facilities to warehouse serious mentally ill customers. Why did the state buy these former drug stores and what does it plan to use them for? Does this provide the 'least restrict' means of treatment?

In 2001 Atty General Napolitano signed the JK Settlement Agreement in the class action lawsuit against Arizona's public behavioral health system for children and their families. In 2003 Gov. Napolitano ran on a platform of protection for Arizona's children, and ordered statewide reform of the state's mental health and child welfare systems for children.
Arizona began to attract very positive national recognition of its improvements in those systems, but last spring Arizona's Dept. of Health Services suddenly abolished its Children's Bureau, making our state one of only four in the nation without a distinct office to focus on the behavioral health needs of children. The Dept's former focus on improving service to children and families has been distracted by the unsettled 25 year old lawsuit on behalf of adults with serious mental illness, and late last year the state had to accept an extension of the six-year JK Settlement for three more years. Will that case, too, drag on now for year after year? Why has Gov. Napolitano allowed the elimination of the Children's Bureau and the distraction of the Health Dept.'s attention away from the children's service system?

I have a Family Member who has a serious mental illness and is receiving services from Value Options. What is the state and VO doing to help support Family Members who care for their loved ones?

A question - how does the state tollerate that ValueOptions can take home to Virginia over 6 million dollars in profits from earmarked Medicaid monies in one year and yet severly cut services under the guisxe of not having sufficient funds for the County programs. It seems that profits are the agenda rather than services. The Auditor General sees this - does the ADHS Director not see it ????

The Az. mental health system in Maricopa county has a hugh disparity in serving Latino children, somewhere around 62% eligible versus 35% enrolled, and even less beging serviced. This is an ongoing chronic issue since AHCCCS included behaviroal health in its coverage. Where is the accountability for this disparity and why is it not being seriously addressed

The regional behavioral health authorities (RBHAs) that have contracts with the Arizona Department of Health Services (ADHS) to provide public behavioral health services also have authority to determine the medically necessary level of care and the array of services to be delivered to their enrolled clients. It is my understanding that the RBHA contracts with ADHS allow the RBHAs to take a profit only after meeting the needs of their clients. Since patient needs are determined by the RBHAs, does this contractual arrangement provide an incentive to deny care in order to take a profit? It is my experience that many enrolled clients receive higher levels of care and more authorized services only after appeals are filed on their behalf.

The JK suit occurred because ADHS failed to provide the appropriate and necessary services to children and their families. The state addressed this lawsuit by using the “Children’s Bureau” to develop 12 principles in which the REBA’s are to use to provide these necessary services and support to AZ’s children and families. The ADHS website has Technical Assistance Documents that are to guide the delivery of theses services. The Governor backed ADHS by establishing a children’s cabinet to support and monitor this process. The idea’s and agreements made it from thoughts to paper and at one time a slow but steady progress was being made from paper to the actual delivery of services. ADHS was pulling together CPS, JPO and other entities and a state wide reform of children’s services was taking root. This reform was being recognized nationally.

Then suddenly Eddie Broadway appears and they eliminate the Children’s Bureau? My two big questions are how? We still have thousands of children with behavioral health needs in AZ. The Governors office needs to explain why they have allowed Christie Dye and Eddie Broadway to push out every individual that was leading the way in the state reform. Is this state waiting for another lawsuit to be filed? Second question, what specific tool is being used to monitor the REBA’s and the actual delivery of their services? The CFT (Child and Family Team) process created that brought families hope has now turned into alphabet soup. The needs of our children has been washed down the drain.

Personal experience with the system causes me to have major concerns with its effectiveness. My son has had more case managers than I can count in his three years in the system. They are not trained (his first was a refugee from the insurance industry that lasted a couple of months). These case managers have more than any human can do effectively. They are poorly trained and poorly paid. Why does the state contract out to a profit making organization when they could run the system themselves, and money that goes for profits could go to services for consumers? They did this when I lived in Philadelphia at a huge savings. Secondly, what are we going to do about using the prisons to house people who have committed crimes because of or related to mental health issues?
Thanks, katherine

There are two main problems:

1) lack of accurate information to the treating doctor because he/she relies on the patient. Case workers are necessary but there are not enough and they change frequently
2) mentally ill people frequently don't realize they are ill and need treatment. It is very difficult to force treatment on a resistent person unless they are a danger to himself or others. Ten percent of people in prison for murder have schizophrenia. A change of laws and enforcement is needed to force people into treatment.

I have been with Valueoptions for over ten years and have had a few problems but overall had had a good timie with them. They recently helped me get e job and get transportation there. I am grateful for them. They are helpful with there numerous casemanagers that handle hundreds of consumers issues. I feel that VO will be a huge provider in the future witha few changes in the style. I just want to shout out thanks for them inn helping my mental health

VO literally saved my life. I've been with them for over 5 years. They got me stablized with medication and counseling. We are encouraged to go to groups and classes to further our recovery. I do believe some of the case managers have large case loads, which makes it difficult to do their jobs. I go to SOON West. It's a haven for people that are SMI. We do various activities that we wouldn't otherwise. And we have access to food and clothing we normally couldn't afford on SSI. All and all VO provides a much needed service. I wouldn't be here today if it wasn't for them.
sincerely,
Mary

I have been diagnosed with Anxiety/Depression and have had particular trouble maintaining my medication supply since moving to Arizona in 2001. I was under the impression that I was just had with bum luck choosing doctors, but listening to your guest, I guess I am not the only one having these problems. While it does make me comfort me to know that I am not alone, it saddens me that this is such a problem. Maintaining a supply of medication can be essential to keeping a good mental state. Why does this occur only in Arizona? Is this an issue with individual doctors or just an overall policy with Arizona Mental Health Care?

People who are in crisis, such as suicide attempts are currently waiting 2, 3, 4 or more days laying in emergency room at medical hospitals, waiting for critical psych beds in psych hospital critical care. There are simply no critical care beds for critical psych patients. Also no available 72 hour holds to determine safety of patients. All hospitals in the valley are even searching other states to find critical care beds.

Please remember than no healthcare system is perfect. As a registered nurse I also would prefere that my patients never ran out of thier perscriptions and had a place to live; but value options has done wonders in the last few years, especially consicering that their population is not always able to be cooperative. There are many changes that are needed.
I beleive that well paid and well trained case managers are a critical need for value options.

Are jail inmates seen by a psychiatrist to determine if they are competent to stand trial?

At the current time there are hundreds of individuals with a serious mental illness County jail; most of them are not on the psychiatric units. Most of the patienst are in for minor 'survival crimes' and are housed in deplorable and a non-therapeutic environment. Why is the state not reviewing the conditions of the SMI in jail; there does not appear to be any DHS oversight of patients in the jails or prisons. Why not??

I heard the comments from Amy Rex about partnering with Los Angeles for a program to train Sheriff's deputies to deal with mentally ill individuals.
My father died in LA County jail more than 15 years ago after being left in 3 or 4 point restraints for more than 5 days. His death was ruled as a direct result of this treatment. The mental health wing of LA County jail ignored the standards for care of individuals in restraints who require movement to keep their blood circulating properly.
We learned later that the LA County jail had gone for years unlicensed by the Calif State Board of Mental Health because jail administrators repeatedly blocked access by inspectors based on 'security concerns' and was therefore able to operate unsupervised.
What oversight is there over Maricopa County jail mental health facilities? I remember a couple years ago a nurse in the Maricopa county facility resigned in digust and went public with his concerns about the facility. Who oversees these facilities? And what is being done about these allegations of neglect?

After hearing your program, I am concerned that the State is even considering another major change to the Mental Health System. The State pulled the plug on Comcare almost ten years ago when the Govenor declared a "Behavioral Health state of Emergency". This put the entire mental health system into complete uphevile. Valueoptions was eventually hired, and over the past ten years, things have steadily improved. I do not believe that it would be in our best interest to go back to square one with another outside for-profit company who knows very little about our horribly complex mental health system. I have heard all of the bad press in recent months, however, in the Reader's Digest version of what went wrong the lion's share of the blame rests with the States inability to monitor and lead the mental health contractor, whether it was Valueoptions, Comcare, PGBHA, ACCMS, etc. We should focus more on improving the States ability, vision, and expertise to lead and monitor their vendors, rather than changing out vendors every few years when things get tough, which ultimately harms the very people that need our help the most while they learn to navigate yet another buracracy.

As a recipient of services from ValueOptions and an employee of the behavioral health system I would like to comment on several of the comments made during yesterday's discussion on Here and Now. First of all, I am not one of "those people" as we were often referred to in the discussion. I am an individual who happens to have a mental illness but I am fortunate enough to have the ability to work and keep a home. Many others are not so fortunate. Many individuals are unable to have their needs met because of the stigma attached to their illness. This stigmatization is the result of ignorance on the part of the public who still see people with a mental illness as dangerous, unworthy, and unable to recover. It is proven through studies done by many leaders in the recovery movement that recovery, yes true recovery, is possible for everyone not just a few select, privileged individuals. We are not just to be "stabilized so we do not decompensate and become unable to think for ourselves." Medication is only one facet of the treatment of mental illness. Many people, as Ms. Walton stated many times, are being given medications to control their symptoms. Yes, medications are a tool that can help people become less symptomatic but it is through other wellness tools that a person truly recovers. People with mental illness need the same basic human amenities as everyone else: support of family and other significant persons, education, a place to live, choice in all aspects of their lives, voice in their recovery, and responsibility for themselves. We are capable human beings and want to have our voice be heard loud and clear. We are demanding the respect that is due us and want to be included in all aspects of our recovery. Gone will be the hospitals, COT, restraints, overmedication, police brutality, and other limitations. As with other forms of oppression and discrimination, the stigma of mental illness shall be lifted. We,too, shall overcome.
Whoever gets the contract for the RBHA will need to address the people who are using their services as partners rather than "consumers" of services. It is this that the state needs to bear in mind as they review and evaluate the proposals which have been submitted. Arizona really has the opportunity to become a national leader in mental health recovery.

My son was recently diagnosed SMI. I have been very happy so far with his care. We were very lucky to have had him seen by a person in the Value Options Court Advocacy department when he was in jail. The process for getting help for him was smooth and went quickly. If it weren't for the people with whom we have worked, my son would still be on the streets.