Chick Arnold is known to most Arizonans as the name behind a class-action lawsuit that changed the way the state addressed the mental health care needs of its residents. His participation in the 1981 Arnold v Sarn case helped guarantee every citizen in Maricopa County the right to mental health care. The Sarn in the lawsuit, Dr. James Sarn, was director of the Arizona Department of Health Services.
Nearly three decades later, the lawyer and longtime Phoenix resident said the state still has failed to provide the care required by statute and the Supreme Court.
The lawyer and long-time resident of Phoenix said the solution is simple, even though it’s not one likely to be embraced by the Republican-controlled Legislature. The Governor’s Office, though, is a different story. Arnold has a long history of working with Gov. Jan Brewer and hopes her ascent to the Ninth Floor will prove to be just what the doctor ordered.
Are you surprised that you have become the figurehead of mental health advocacy?
No. It is not hard to distinguish yourself in a field in which you are the only practitioner. Lawyers don’t do this kind of stuff. As the public guardian, I was kind of thrust into that role.
Can you explain what a public guardian does?
The reason I am in that case is that I was the guardian, the Maricopa County public fiduciary appointed by the Board of Supervisors in 1979. Our public fiduciary — that is the formal term — serves when there is no family available to act on behalf of a person who is determined by the court to be incapacitated.
As you know, the demographics of our community are rather unique in that people move here and leave their families and social networks elsewhere. When there is vulnerability, there often isn’t a family available to support them as there might be in some of the older communities in the country.
Were you appointed to this position because of a previous record of working with the mentally ill?
No, I hadn’t done anything in that regard. I was a regular lawyer. I went to law school not to be a lawyer but to get a legal education. I practiced law for a while and decided I would move on and apply for a job. The job I applied for was as a legal guardian.
Why that position?
I had, until a year ago when my sister died, a profoundly disabled sister. I don’t think that had anything to do with my decision, though.
I went to law school to get what I thought would be the keys to the kingdom. I wanted to do something positive. I wanted to leave my fingerprints. I wanted to be able to use the blessing I had of a legal education in some positive way. I didn’t know what that would be. I knew the term behavioral health, and that is what got me the job. I saw it as an opportunity to connect people with their legal rights.
What led to the filing of the lawsuit?
I have to kind of set the stage. De-institutionalization was going on in the country, and here, like in many communities, we did the second half without doing the first half. The process is supposed to first develop the community services into which individuals could be placed after the person is released from institutional care.
What happened here, and in many urban settings, is that this was seen as a way of saving money by stopping what was very expensive institutional care. In the context with mental illness, people were released into a community that lacked the basic support services needed to provide what these folks needed.
What happened instead was the creation of what I called, and still call, a mental-health ghetto. There was an area comprised of single-room-only boarding homes into which folks moved in exchange for their then $335 or so seriously mentally ill check. These were scary places. They housed all kinds of folks, including those coming out of prisons.
John Goss was one of my protected people. At that point, I was the guardian of 600 people. He would be seen walking the streets every day because he was afraid to stay in his boarding home, which had burned down three or four times. Every day during his walk, he would stop by my office.
I had been involved in the passage of a statute the year before in 1979 that provided for the state and the county to be responsible for a full range of services for people who had severe mental illnesses. That is what the lawsuit was about.
Was it harder than you thought it would be to win the lawsuit?
I had filed about 30 lawsuits for the county at this point, but this one was a bigee. As was protocol, I went before the Board of Supervisors to tell them about the case before it was filed. The case was filed on a Thursday. I was fired on Friday. They decided the case was an embarrassment to the county.
On Monday, I filed a suit to be reinstated, and on Tuesday the court reinstated me. But, as you can see, the lawsuit was unpopular from the beginning.
What role did you play during the trial?
The case was filed in 1981 and went to trial in 1985. At this point, I was not terribly involved in the lawsuit. I was the named plaintiff, but I wasn’t the lawyer.
Have you ever been actively involved?
Well, there is a lot in between. The lower court found in favor of the plaintiffs in 1985, but the Department of Health Services appealed the case. The defense from the beginning was that there wasn’t enough money to do what the statute anticipated. The trial court told them that was not a defense and, if they believed that, they needed to go back to the Legislature and ask for more money.
In 1989, the Supreme Court affirmed the lower court’s decision in a poetic opinion that begins with the sentence, ‘There is no evidence that the Legislature intended to pass sham legislation.’ The decision concludes that the state has a mandatory duty, and they have to do it, period.
I became involved in 1991 when the parties all got together to actualize the lawsuit. I was appointed as the lawyer for the court monitor, who oversees the implementation of the 286-paragraph agreement. I have been in that role since 1991.
What were you feeling when the decision came back in your favor?
The case is a very simple lawsuit. I knew we were going to win. I was more shocked, frankly, that the defendants chose to argue that they didn’t have enough money. If that were a viable defense — my goodness, what is the point of passing any statute?
Why, then, more than a decade later is there still not a resolution of the lawsuit?
The original agreement between the parties was supposed to have been met by 1995. The time comes and it is not. The parties get together again and do an amended agreement, called the Exit Criteria Agreement to help the state get out of the lawsuit.
Another agreement was signed in 1998, which was supposed to be the time that the agreement had been met. The new agreement recognized that there was not enough money to fulfill the lawsuit. So they prioritized the people in the system according to those determined to be the sickest, as measured by whether they were in-and-out of the state hospital, in-and-out of jail or homeless.
The theory was that the available funds were to be used to help those people first. Now the state no longer has to provide all the needs for all the people.
That is the pattern. The parties make agreements that are not met by the deadline, and then the agreements are amended. That is why it has taken us 28 years and counting to put a system in place th
at will meet the state’s obligation.
How often are you called upon by legislators for advice?
A lot, in various different contexts. I believe I have come to be seen as sort of a technical adviser to legislators on mental health. I participate in the Arnold v. Sarn discussions. I am happy to step up when asked, but I don’t offer myself for that.
Has the governor called upon you?
Well, I have participated in meetings with the governor and her staff about this. I don’t want to personalize it and say that she has called upon me. The governor is talking to as many constituencies as she can within the community to get a feel for what to do.
Do you expect her support in defending the rights of the mentally ill?
Yes. I have known her a long time. During her time in the Senate and on the (Maricopa County) Board of Supervisors, we worked together. I have confidence that she will look really hard to do the right thing.
The right thing isn’t an easy thing to figure out, but I am confident that she has good judgment.
Do you agree with the state’s decision to contract services out to companies such as Magellan?
I worry about this more than anything. I feel really vested in our community and in these issues. Being a product of the 1960s, I also am of the belief that the government has a responsibility to provide for the people who live here. I note that we don’t subcontract out things like police protection that are deemed to be inherently governmental in their function. I would suggest that health care is the same way.
What has happened is that the health department has become contract monitors. They are the first to acknowledge that they are so far removed from the system that they don’t have a good sense of what is going on.
Does the specific provider matter, then?
Value Options or Magellan, it doesn’t matter who holds the contract. I would suggest that it is the very construct of the system that is the problem. We can get a company to manage the regional behavioral health authority, but as long as that is what the system is, we are just marking time.
Are you concerned that some lawmakers have suggested amending the original statute so that the state is free from the obligation of caring for the mentally ill?
That has been suggested every session since I filed the lawsuit. From the very beginning there has been talk of adding that the obligation was subject to appropriations or changing the “shall” to “may,” or some other way to mitigate the state’s responsibility.
What lawmakers should be asking is what happens to our mental health system if the statue changes and the lawsuit goes away.
What do you think is the solution to the problem of providing care for the mentally ill?
I would love for the state to get out from underneath the lawsuit, but what that means for me is different from what it means for many people. What I would love to see is the recognition that this is a state responsibility by statute. The state needs to take back the authority from the contractors and tackle this head on.
I recognize that I am not in the mainstream of political thought in this community, but to me the answer is clear. And how many tragedies do we need to suffer in our community before we change?
The state also can’t just be responding to the lawsuit. The lawsuit is the tail, not the dog. My answer to the governor when she asked me this question is to create a responsible system. The lawsuit will take care of itself. We need to be working from the top down. We wouldn’t have to worry about exactly how many people have their needs met if we were creating a system that encourages the proper kind of treatment.
Is life better today for a client in the system than it was before the lawsuit was filed?
If that client happens to be known as a priority client, and happens to be assigned to one of the clinics that works well, and happens to have a case manager whose been there for more than a week, then yes, life is much better. But there aren’t many of those people. As a practical matter, people struggle today just as much as they did 20 years ago.