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Issue: Association for the Chronically Mentally Ill

Reform Psychiatric Security Review Board now

Arizona State Hospital

Christopher Lambeth is accused of the horrific murder of a fellow resident in a group home in Gilbert on April 12. There is no doubt this will spark public debate about the risks associated with group homes in residential areas, solidifying the position for Not-In-My-Backyard, or NIMBY, understandably so. The public deserves an expectation from our elected officials at the state and local levels to ensure the utmost standards of safety in our cities and neighborhoods. People living with disabilities like serious mental illness deserve to be provided for with dignity and in a safe environment. 

holly-gieszl
Holly Gieszl

Before this preventable tragedy occurred, the Association for the Chronically Mentally Ill was already working on a solution: reform Arizona’s Psychiatric Security Review Board, Christopher Lambeth murdered his own grandparents in 2005. Because Christopher was found guilty except insane, he fortunately was committed to the Arizona State Hospital, not an Arizona prison. As someone who was so gravely ill, Lambeth deserved treatment, not punishment and a life behind bars. But the public and taxpayers also deserve safety and accountability from the state agency, the Psychiatric Security Review Board, charged with deciding when individuals sent to the state hospital for treatment are safe to be released and monitoring individuals released into the community.   

The Psychiatric Security Review Board decided to release Lambeth to a group home in August of 2020, and his treatment then fell to his serious mental illness clinic and treatment team in Tucson. In August of 2020, Lambeth asked the board to let him move to Phoenix. He wanted to live alone, but a “transitional” plan placed him in a group home with only eight hours a day of staff on site. The Psychiatric Security Review Board made this decision without even hearing from a psychiatrist and without having an assessment of Lambeth’s risk of living with such minimal supervision. The entire hearing on Lambeth lasted about 20 minutes.    

Moving to Phoenix meant a change in clinics and treatment team contracted through Phoenix-based Mercy Care. After the change, Lambeth’s treatment team was supposed to provide monthly reports to the Psychiatric Security Review Board. How many reports, if any, were provided on Lambeth and whether they were reviewed are unknown.  But between August and the grisly murder, Lambeth did not re-appear before the board.  

Deborah Geesling
Deborah Geesling

For over two years, and after a state audit two years ago that found problems in the way the board operates, Association for the Chronically Mentally Ill has been seeking to reform the board. All efforts to improve the board’s effectiveness and accountability are met with opposition from the board, especially Dr. James Clark, the board’s chairman.   

Arizona citizens deserve better; taxpayers deserve better; the other residents of group homes and our neighborhoods deserve better.  

Pending before the Legislature are two bills, SB1029 and SB1030, both introduced by Sen. Nancy Barto, R-Phoenix, a tireless advocate for safety and better services for individuals living with serious mental illness. SB1029 requires more information and reports for the board to ensure that it treats patients fairly and protects the public. The board now operates without enough information on patients when it makes decisions. The bill proposes a retired judge be the judge, so the board operates by fair rules. 

Because the Psychiatric Security Review Board opposes any changes and claims that it operates perfectly, SB1030 terminates the board and sends the functions that the board performs to the Superior Court in each county. This saves the state money and will ensure that patients get a fair hearing in front of a judge who follows the law. 

Both bills passed out of the Senate and all House committees. They are currently waiting to go to the House floor for a vote.  

You can help by calling and emailing your Arizona representatives and urge them to support SB1029 and SB1030. This victim’s life mattered. 

Deborah Geesling and Holly Gieszl are founding members of the Association for the Chronically Mentally Ill.  

Shelter for seniors, seriously mentally ill top advocates’ wish list

house-keyd

After a one-time windfall from the Legislature, affordable housing supporters who’ve advocated for restoring the State Housing Trust Fund to pre-recession levels are looking at how to best stretch the new money and make the case for more.

This year’s budget appropriated $15 million to the fund, reversing a nearly decade-long trend of capping it at $2.5 million annually.

As the Arizona Department of Housing finishes collecting public comments about what to do with the additional funds, it’s hearing a few common themes – older adults increasingly experience homelessness; renters need protection from evictions; families of people with severe mental illness are desperate for secure living situations for their relatives, and $15 million is nowhere near enough.

Sen. Lela Alston, D-Phoenix, said, “I’m really excited that we got what we got, and I’m really hopeful that we’ll get more next year as people seem to realize what a desperate problem this is. It’s not just homelessness but low-income housing and workforce housing as well.”

The fund

The State Housing Trust Fund, created in 1988, is funded through the sale of unclaimed property. Prior to the recession, it contained more than $30 million and the Department of Housing was able to use those funds as a match to leverage more than $350 million in federal funds, according to the Arizona Housing Coalition.

But in 2010, as part of statewide budget cuts caused by the Great Recession, the Legislature capped the State Housing Trust Fund at $2.5 million per year. Building affordable housing typically takes multiple different grants, low-interest loans, tax breaks and donations, but having less money available from one source can have a domino effect on others.

“When you create affordable housing, the amount of different funding streams that are necessary to create affordable housing projects, it’s almost mind-numbing,” said Joan Serviss, executive director of the Arizona Housing Coalition. “The housing trust fund has historically served as gap financing for the creation of affordable housing.”

In addition to being used to get more federal funding, the State Housing Trust Fund can be more flexible than federal funding streams, Serviss said. For instance, she said she knew of one family in the eastern part of the state that was able to use housing trust fund money to help pay for an extended pantry connecting their home to an outhouse on the property, making it easier for the older family members to remain living in their family home.

“You can sprinkle housing trust fund dollars on a house and make it more accessible for seniors to age in place, create wheelchair ramps, that kind of thing,” she said.

Also unlike federal grants that are restricted to helping families earning a certain percentage of their area’s median income, the housing trust fund can be used in other areas. The Department of Housing focuses on extremely low-income households and cost-burdened households where residents pay more than 30 percent of their income toward rent, Serviss said.

Earlier this year, the department used money from the Housing Trust Fund to launch a pilot program to help low-income renters in some parts of the state by providing emergency grants and case management to families who receive eviction notices for unpaid rent. By intervening before families are evicted, the department hopes to prevent them from falling into a spiral of unstable housing.

“Once you get evicted, it’s that much harder,” Serviss said. “It becomes a black mark.”

Senior homelessness

A theme reflected in public comments at a packed public meeting the Department of Housing held June 21 was the need for support for older adults who are homeless or at risk of becoming homeless.

“We’ve been hearing a lot about the need for shelters for the older population that have unique medical needs that the typical shelter can’t provide,” Serviss said.

Representatives from Arizona AARP became aware of the meeting after touring Central Arizona Shelter Services and learning that 31 percent of the people staying there are seniors, Arizona AARP Director Dana Kennedy said.

Kennedy said she learned that some seniors are discharged from the hospital directly to the shelter, but it’s not designed for older adults.

“We advocated to look into the potential of providing a shelter specifically for seniors,” she said. “Once there, they can get connected to services and case management and back into housing.”

Rep. Robert Meza, D-Phoenix, said he was pleased with the additional money obtained for the State Housing Trust Fund this legislative session, but he already has his eyes on next year.

He noted more and more elderly residents of Maricopa County in particular are being priced out of their homes, a trend he called “the silver tsunami.” He described grandmas and grandpas forced to move in with their children and grandchildren, or wind up on the street.

They’re on fixed incomes and unable to keep up with a housing market that is increasingly in demand, Meza said.

And, Kennedy said, seniors who still can afford to live in their homes may do so at the cost of other necessities. She said she can’t stop thinking about the death of Stephanie Pullman, a 72-year-old Sun City West woman who died from heat last September after Arizona Public Service turned off her electricity for not paying her bill in full.

As baby boomers get older, Kennedy said they’ll need more help. More older adults will face chronic health conditions and dwindling savings, making it harder for them to continue to afford housing or other basic needs.

“Your Social Security is only going to go so far and your savings are only going to last for so long,” she said.

Homes for the seriously mentally ill

This year’s $15 million appropriation to the State Housing Trust Fund contains a stipulation that $3.5 million be set aside for beds for housing people who are seriously mentally ill and resist treatment. It stems from a separate bill supported by the Association for the Chronically Mentally Ill.

Laurie Goldstein, the association’s vice president, is seeking state funding for a program like the one that ultimately helped her son. He was diagnosed schizoaffective, and spent years cycling between homelessness, apartments his parents rented for him and short stays in hospitals.

Finally, his parents were able to have him held in a state mental hospital until he reached a level of stability. Now, he stays at a community home, where he’s still supervised.

“The system right now, there’s a gap in the care and folks like that are being thrown out of programs,” Goldstein said. “What they don’t need is short seven-day stays in psychiatric hospitals.”

The model she wants to see is similar to the community living center where her son now lives. Residents would be ordered there by the courts, and they could end up staying for months or more than a year, with an ultimate goal of learning how to live independently.

“It’s not a forever home,” Goldstein said. “It’s not like the old asylum where you get in and don’t get out.”

Alston said she supports additional housing for the seriously mentally ill population, but she’s concerned about how the money was set aside this year. Lawmakers shouldn’t be able to earmark specific projects, she said.

“We’re not the experts, and by doing it once, that opens it up to the other 89 (legislators) to find their little special housing project to earmark, and that’s wrong,” Alston said. “We should leave it to the experts.”

And she noted that the state already has a separate housing trust fund for the seriously mentally ill, under the direction of the Arizona Health Care Cost Containment System.

“They know that population much better than the housing people do, so I think it would have made a lot more sense to put that money directly into AHCCCS, who’s doing the work already and know what they’re doing,” Alston said. “I basically trust most of our people in state government to do a good job and to be the experts in whatever that field happens to be.”

Reporter Katie Campbell contributed to this article.

Tragedy strengthens effort to eliminate board

fine 3d image of dark grunge prison

Sen. Nancy Barto is spearheading an effort to abolish the state board that decides whether those who commit serious crimes but were found guilty except insane are fit to return to the community.  

The effort gained urgency after a man allegedly beat another resident of his Gilbert group home to death last month – 15 years after he killed his own grandparents and less than a year after the Arizona Psychiatric Security Review Board decided after a brief hearing that he needed less supervision. 

Legislative efforts to reform the board fell short last year, but have picked up steam this session. SB1029 looks to reform the board, and SB1030 would sunset it and move the board’s duties back to the courts in 2023. 

Barto, R-Phoenix, said the two bills – which are waiting for a floor vote in the House – are being rolled into one. SB1030 will have the reforms outlined in SB1029 while still dissolving the board in a couple years. 

Barto said she’d been hearing concerns about the board for years. When she attended a board meeting to see for herself how it operated, she described it as “haphazard” and unusual. 

“It’s hard to overestimate how lack of rules, really has potentially and actually harmed the public in this instance; we need to rectify it,” she said. 

Christopher Lambeth, 37, last appeared in front of the board in August 2020. Previously committed to the Arizona State Hospital after being found guilty except insane in his grandparents’ murder, Lambeth had been living in a transitional facility in Tucson. At the August hearing, which lasted 20 minutes, his request to move to the Phoenix area was unanimously approved and he was placed in a home with only eight hours of supervision a day. 

Nancy Barto
Nancy Barto

Advocates say the subsequent tragedy was preventable, but predictable, and that it speaks to a litany of problems with the board and how it’s run. They say the board handles cases inconsistently, provides inadequate time for clients and attorneys to prepare for hearings and has insufficient written guidelines and procedures.  

Holly Gieszl, a founding member of the Association for the Chronically Mentally Ill, said Lambeth’s case was a prime example of the board’s dysfunction. Gieszl often attends board meetings to represent her own clients, and she remembers Lambeth’s August hearing setting off alarm bells at the time.  

“Chris comes in, they don’t have a risk assessment; they don’t hear from a physician or psychologist, and they let him go to an eight-hour house,” Gieszl said. “Seven months later, he murdered someone.” 

Board members are appointed by the governor. The board is headed by a retired psychiatrist and has a psychiatrist, psychologist, parole officer and a public member. The board is responsible for deciding whether those who committed serious crimes but were found guilty except insane are fit to be discharged from the state hospital. It is also tasked with monitoring the progress of those on conditional release from the hospital. The board deals with roughly 100 cases a year. 

Some of the issues flagged by Gieszl and others were also noted in a 2018 auditor general report. The report stated that the board needed to develop rules and policies to guide its work, issue orders and notices as statutorily required and make sure it was getting consistent information on the patients’ mental health before making decisions.  

It also stated that some mental health reports were much more detailed than others, with some offering only “general conclusion statements with little or no support.” 

“The lack of sufficient information jeopardizes the Board’s ability to make timely and consistent decisions regarding GEI (guilty except insane) persons,” the report stated. 

While board chairman Dr. James Clark has said that the board completed the recommendations outlined by the audit, advocates disagree and also want more changes. 

“What the PSRB has not changed at all is the way that it has gone about assessing risk before it releases somebody,” Gieszl said, adding that her organization is backing the legislation to address those inadequacies. 

Among the changes proposed in the legislation are placing a retired judge as the chair of the board, giving a 45-day notice to patients before hearings and having the board explain its decisions on each patient. After the board sunsets in 2023, the cases would be transferred to the Superior Court where the person was sentenced as guilty except insane. 

Barto said that in stakeholder meetings, board members were resistant to any sort of change. 

“I think they just really think that the status quo is working,” Barto said. “When you look at what just happened, unfortunately, we’ve known this is coming, something like the tragedy that happened with Mr. Lambeth and who he killed. It’s unfortunate that we have such a prime example of the board’s inability to make a better determination of this man’s future.” 

Clark declined an interview, instead referring to his presentations to the Senate Judiciary Committee and House Criminal Justice Reform Committee. He declined to comment on whether the board handled Lambeth’s case appropriately. 

“(D)oing away with the PSRB and having Superior Courts assume jurisdiction and monitoring/oversight/supervision of individuals adjudicated Guilty Except Insane, as SB1030 proposes, would be a major policy change, a step backwards and would add an extra burden on the Superior Courts that is unnecessary,” Clark said in his written statement. 

‘Dysfunctional’ board for insane phasing out

Arizona State Hospital

Arizona will soon do away with the state board responsible for deciding the supervision and placement of those found to be guilty except insane for serious crimes, following years of concern about the board’s inconsistent practices and decision-making. 

The Psychiatric Security Review Board duties will shift back to the Superior Court where the judge made the initial guilty except insane determination. 

Sen. Nancy Barto, R-Phoenix, sponsored the legislation, which also changes the way the board will operate before it sunsets in July 2023.  

“I’m still a bit overwhelmed at our success in getting this through,” Barto said. “This board has been so dysfunctional over the years, and I’m so grateful because we are going to see a changed board in the meantime. They are going to have clear rules; they’re going to have information that’s going to inform their decision-making.” 

The effort suffered a brief setback when Barto’s bill was vetoed by Gov. Doug Ducey, along with 21 other bills, at the end of May when Ducey said he wouldn’t sign any more bills until the Legislature sent him the budget. 

Ducey signed the revived version of the bill June 29. 

Barto’s bill gained steam this legislative session, in part due to tragedy.  

In April, Christopher Lambeth, 37, allegedly beat to death another resident of his Gilbert group home. The incident came less than a year after the review board unanimously approved Lambeth’s request to move to a group home in the Phoenix area with less supervision – only eight hours a day.  

Fifteen years ago, Lambeth killed his grandparents. He was found guilty except insane and committed to Arizona State Hospital, later moving to a transitional facility in Tucson. 

The board’s decision to allow him to move to a home with less oversight came after a 20-minute hearing last August. The fatal beating occurred seven months later. 

“We can only surmise that this was bound to happen at some point,” Barto said. “Unfortunately, we didn’t have this law in place in time to prevent something like this from happening.”  

The law implements several changes to how the board conducts its remaining business. A judge will be appointed as chair, instead of the current retired psychiatrist. Risk assessments will be required for those who request a change in their supervision, and there are more requirements for obtaining certain information from the state hospital. The board will have to submit an annual report to the Legislature outlining its actions. 

Holly Gieszl, a founding member of the Association for the Chronically Mentally Ill, said one of the most important changes is requiring every case to be heard in-person or via video.  

“The PSRB will always be able to see individuals who are appearing before it, presumably lawyers, too, but certainly individuals who are out in the community on community release,” Gieszl said. 

Barto said the changes will also preserve the right to due process for those who come before the board. 

“The embarrassing part of the story is that because the board had such loose rules and procedures – I mean, basically nonexistent rules – in place, they were violating due process and were dragged into court,” Barto said. “They had to suffer the embarrassment of having their judgments overturned in court.” 

A 2018 auditor general report that noted the board’s shortcomings was key in getting the bill passed, Barto said. While the board’s chair has said that the board had followed the report’s recommendations, advocates disagreed. 

“The good work of our auditor general really, really was instrumental here in giving us some legs to stand on to get this through, to make the points that we needed to my colleagues and the governor that, hey, we have problems, and we’re going to fix them, and we did,” Barto said. 

Liana Garcia, Arizona Supreme Court director of government affairs, said the courts aren’t starting from scratch in implementing the processes necessary to oversee guilty except insane cases. Superior courts had jurisdiction over those cases before the guilty-except-insane statutes were overhauled in the 1990s. The psychiatric security review board was established in 1994. 

“So, there is a model for it, and the Superior Court that had jurisdiction over the case when the person was adjudicated guilty except insane would just retain jurisdiction over that person for the term of their sentence,” Garcia said. 

The board doesn’t sunset until July 1, 2023, in order to give the courts time to prepare to oversee the hearings now overseen by the board. Those hearings are to determine level of custody – whether a person found guilty except insane can be released from the state hospital and what level of supervision they need while on conditional release. 

Each year, the review board oversees about 100 cases from across the state and has about 100 statutory hearings. 

Psychiatric security review board Executive Director Hannah Garcia did not return multiple phone calls for comment.