Arizona has an historic public health opportunity to use 93 acres of state-owned, deed-restricted land in the heart of Phoenix to create a 21st century psychiatric center of excellence. As always, the devil is in the details.
Determining what psychiatric services should be provided necessarily means prioritizing among populations receiving psychiatric services and specific services. The possibilities are endless – community mental health clinics, emergency/urgent psychiatric services, private practice condos, a private pay hospital, more beds for stabilization and civil commitment. But who is in greatest need? Who has the fewest alternatives? Who has been left behind in the current behavioral health system?
We, the Association for the Chronically Mentally Ill, advocate that the proposed request for proposals for the center include more inpatient beds, residential treatment facilities, and innovative forms of long-term housing with on-site services for individuals living with chronic serious mental illness.
According to Treatment Advocacy Center, a minimum of 50 beds per 100,000 people is necessary to provide minimum adequate treatment for those living with serious mental illness. Arizona fails to meet this minimum standard and ranks 48th in the nation in number of SMI beds needed per capita. No RFP to accomplish the “highest and best use” of the land at the State Hospital should omit this compelling fact.
Let us not look back in a few years and reminisce about what “might have been.” SMI has always posed the most difficult treatment challenges and created the greatest disruptions and threats in daily life for those living with the illness, their families, and the community. Yet treatment beds and long-term housing options have not kept pace with needs. Why?
Nationally, 20 percent of adults over 18 have a diagnosable mental illness. But only 4 percent have a serious mental illness, including the 1.1 percent with schizophrenia and the 2.2 percent with severe bipolar disorder. Many go untreated in any given year. These individuals need longer term services care, indeed, lifetime services. These individuals cannot “recover” completely and will always require housing with in-place services.
Let us be frank. Our neighbors living with serious mental illness are the most vulnerable precisely because they are the least likely to be eligible for or welcomed into or to be successful in community programs, the most expensive for the publicly funded behavioral health system to manage. Not surprisingly, that makes them the most likely to run afoul of the criminal justice system and be incarcerated in our jails or prisons.
A subset of the serious mentally ill are so ill they don’t know they are and will not accept treatment. Known as anosognosia, one does not “recover” or learn how to “live independently” or become “rehabilitated” from it in jail or prison.
The proposed center can provide a different treatment system for those living with serious mental illness, but only if Arizona Department of Health Services issues a RFP designed around the realities of the need for housing for the most ill of those living with SMI. This requires accepting the fact that people who care for their seriously mentally ill loved ones often are unable to keep them at home because they cannot keep them in treatment. When untreated, hallucinations, delusions, outbursts, and anger create a dangerous, untenable home situation and, when homelessness ensues, a threat to the community and individual.
We need beds, housing, and associated services to create a new system that recognizes our current system failures and clinical realities of managing severe mental illness. We should not continue to talk about the social determinants of mental health and continue to ignore the realities of lack of housing with associated treatment for those in greatest need.
Urge ADHS to use the Arizona State Hospital’s historic, unique, and valuable land in ways that fill the most serious gaps in our behavioral health system. Ask ADHS to require all who respond to the RFP to include more inpatient beds, residential treatment facilities, and long-term housing options for those living with the most severe chronic mental illness.
The strength of any community is measured, in part, by how it cares for its most vulnerable neighbors. Please join us in making a difference on behalf of those who have no voice. Let us consider our rich history and the current reality of services to imagine a true 21st century Center of Psychiatric Excellence that includes a better way forward to provide housing and treatment for those living with SMI.
— The authors are parents of seriously mentally ill children and members of the Association for the Chronically Mentally Ill