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Our broken mental health system – with specificity


Tucson. Sandy Hook. San Bernardino. Orlando. Las Vegas. And now Parkland. Since 2011, a new location is added to the list of mass shootings every 64 days. After each mass shooting the public discussion inevitably turns to what factors may have contributed to the mass murder – guns, cultural disintegration, the perpetrators’ desire for fame and notoriety, mental illness – and how such tragedies can be prevented.

In theory, the mental health system should offer a meaningful, albeit partial, solution to preventing some of these mass shootings. However, when the discussion turns to the mental health system, the conversation inevitably ends in frustration with the statement: “Well, the mental health system is broken.” That phrase is commonly the last word on many discussions, because it lacks the specificity necessary to take any action. This over-used adage is where mental health conversations go to die. Yet, if we want real changes, this cannot be so. To understand how the course can be adjusted on bad and broken systems, we need to appreciate, with specificity, how the system is broken.

Josh Mozell

Josh Mozell

To better understand the frustration with the mental health system, it is first important to understand how it could help. The laws of every state allow authorities to involuntarily detain and evaluate mentally ill persons if they are a danger to themselves or to others. Arizona law goes further by allowing an individual to be detained for evaluation before they become a danger. To do so, a person must meet the definition of persistent or acute disability (PAD).

Arizona’s law was drafted to permit a person afflicted with a severe mental illness to be picked up by law enforcement when it can be shown that they 1) would benefit from treatment, 2) do not understand the need for treatment, and 3) without treatment are likely to come to harm. This law allows for involuntary evaluation and treatment before imminent danger arises out of the mental illness. It allows for involuntary evaluation and treatment before the severely ill person endures a long period of untreated psychosis. It allows for involuntary evaluation and treatment before the person ends up in jail. It allows for involuntary evaluation and treatment before the person hurts themselves or others. For concrete and haunting examples, the persistent or acute disability law would squarely fit the Parkland shooter Nikolas Cruz, and would have been appropriately applied to a person like Jared Loughner.

Arizona law states that any responsible person can begin the process for a PAD by filing an application at a “screening agency.” The screening process includes interviews with an applicant, a prospective patient, and a review of any pertinent documentation submitted to the screening agency. The screening process is required to be completed and a determination is to be made within 48 hours as to whether the proposed patient should be taken in for evaluation.

But here is where our system is broken, at least as it exists in Maricopa County. Rather than completing the screening process within 48 hours as the law requires, the system in most cases does not respond for weeks. It is not uncommon for the system to wait over 40 days to complete the screening process. During these long weeks, the persistent or acute disability patient, who is initially perceived to be non-dangerous, becomes dangerous. Rather than obtaining the treatment they need, a PAD patient may transition from simply being psychotic or depressed, to being suicidal or a danger to others. Rather than being committed to a hospital for treatment, they end up on the streets, or in jail, which exacerbates the mental illness. In the case of Jared Loughner, rather than receiving help, he became more ill, more psychotic, bought ammunition at Walmart, and ended up shooting 18 people in a Safeway parking lot.

Arizona has laws that could prevent such shootings. However, the laws are not followed by the agencies charged with executing them. Our system has the capacity to handle these screenings within 48 hours but because of custom and long misguided standards, it does not. The result is that people do not get the treatment they need and they, and our communities are harmed. Our Legislature, which drafted these laws, should not allow them to go unfollowed. Public hearings should be held to address the situation. The Maricopa County Board of Supervisors should not allow this dangerous error to continue. It should use its jurisdiction over the issue to demand the law is followed. If so, real change could be made, and one specific area of our broken system could be mended.

— Josh Mozell is an attorney with Frazer Ryan Goldberg and Arnold and practices mental health law.


The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

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