Deficiencies in Arizona’s mental health system, increasingly complex patient needs and staffing shortages are challenging Arizona state hospital leaders, according to a new report.
The 390-bed state hospital, known as ASH, is the last resort for patients with serious mental illness in Arizona and provides the highest level of care. Critics calling for independent oversight of ASH say conditions at the facility, staffing levels and transparency are at issue. Our clinic operates on a “recovery-based” philosophy. The goal is for patients to stabilize and eventually return to living in the community, but critics say that doesn’t always happen.
The legally mandated reports are strictly clinical improvement and human resource planning. The 103-page document was submitted by ASH chief executive Mike Sheldon and published this month.
Some of its key points are:
- Of the 116 patients discharged from civilian hospitals over a four-year period, nearly 10%, or 11, were readmitted after becoming medically decompensated in supervised group homes. These outcomes could have been avoided with “stronger community resources.”
- The number of high-risk patients is increasing. In July 2022, an average of 16 patients were ordered to be placed under close observation by their doctors because they were at risk of harming themselves or others, compared to 16 patients per day in June 2023. The number rapidly increased to 23.
- The hospital is not equipped to provide many of the evidence-based treatments that are standard treatment for acutely psychotic patients, including electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation.
- Almost 90% of patients admitted to the civil side of the hospital and 72% of patients admitted to the forensic side have a primary diagnosis of schizophrenia or another psychotic disorder.
- Almost one-third of all patients on the civilian side of the hospital have either a neurocognitive disorder or a neurodevelopmental disorder, and sometimes both.
- Arizona has the lowest number of state-run psychiatric beds per capita set aside for individuals under civil enforcement orders in the nation.
- ASH has 729 full-time employee positions available, but as of June 30, only 629 of those positions were filled. The hospital relies on staff who volunteer to work overtime shifts and contracted registered nurses and behavioral health technicians to make up the difference.
- ASH will need to add 117 full-time employee positions at an additional cost of $10 million to meet regional standards of care.
Gov. Katie Hobbs: Reflects ‘years of disinvestment’ in mental health care
A written statement from Arizona Governor Katie Hobbs’ office said the report “improves access to mental and behavioral health care at all levels after years of disinvestment in the system. It clearly shows that there are tasks that need to be done to achieve this goal.”
“The Governor, ADHS, and ASH leadership take the state’s management of ASH extremely seriously and hope this report will be a starting point for meaningful change in the next legislative session.”
Will Humble, a former state health director and current incumbent, said the report was “extremely transparent” and showed “huge, huge gaps” in Arizona’s mental health care system, and that private patients He said this limits hospitals’ ability to easily discharge patients to less restrictive settings. Executive Director of the Arizona Public Health Association.
Several areas of the report articulate how Arizona’s mental health system is in need of repair, including “outpatient (mental health) providers losing contact with patients”. This includes health care providers who “too often” send patients to ASH “out of a sense of hopelessness.” “This is due to lack of resources.
The hospital’s civil and forensic wards, which have 259 beds, cost about $256,000 per patient annually to house them, according to state estimates in June. A separate 131-bed Arizona Regional Custodial Treatment Center on the 93-acre ASH campus is for patients who have committed sexually violent crimes and are deemed unsafe to return to the community, with a per-patient annual It will cost about $100,000.
Holly Gieschl, a Phoenix attorney who represents several patients at ASH, said gaps in the continuum of mental health care keep people with mental illnesses in prisons, jails and on the streets. He said he would do so.
“I believe 100% that the justice system is part of the continuum of care,” Gierschl said.
Part of the problem, Humble said, is that while ASH is a division of the Arizona Department of Health Services, since 2016 the state’s public system for behavioral health (including mental health) has been a separate agency. It is said that this lies in the fact that it is entrusted to them. Arizona Health Care Cost Containment System, Arizona’s Medicaid program.
“If AHCCCS was also responsible for ASH, we would have seen the consequences of the lack of step-down facilities,” Humble said. “Because they have that responsibility, there will be more urgency to solving the problem. But if you are not responsible for the problem, you are less likely to be interested in solving it.” Become.”
The report presents several scenarios, along with budget estimates, on how to improve ASH services. Add more clinical staff. Build a gradual community reintegration unit. Build facilities for patients diagnosed with more specialized care, including those with disabilities such as dementia and autism.
The report says the state should engage an independent third-party consultant to conduct an ongoing analysis of behavioral health care in Arizona, including quantifying unmet treatment needs. .
Losing $25 million for behavioral health facility was ‘absolutely tragic’, former lawmaker says
Humble said it’s unfortunate that this year’s budget doesn’t include the $25 million earmarked in last year’s state budget to build one or more secure residential behavioral health facilities in Arizona. Stated. He said this funding could have greatly improved the continuity of care for chronically resistant psychiatric patients.
Hobbs spokesman Christian Slater wrote in an email that the $25 million was for one year of spending that lapsed due to lack of legislative action.
Safe residential behavioral health facilities “do not help solve the larger problem of reintegration into the community after successful treatment at ASH,” Slater added, noting that “safe” does not mean an individual is not allowed to leave their home. He pointed out that it meant a locked facility.
But Nancy Burt, a former state representative who has been active in pushing for legislation to improve the state’s mental health system and advocated for safer residential beds, disagrees. She told The Arizona Republic this week that the loss of $25 million paid for secure facilities is “absolutely tragic” for people with severe mental illness.
“We have long needed a safer facility to support the continued care of mentally ill people,” Barto said. “We need a lower level than a hospital for a variety of reasons. There is no place between unlocked group homes and ASH.”
Unlike hospitals and inpatient facilities, the ASH report says group homes and behavioral health residential facilities in Arizona do not require the physical presence of a registered nurse at all times.
“Instead, these facilities tend to be overseen by a behavioral health technician or equivalent, with a rotating staff of clinical specialists providing services to residents according to a treatment plan,” the report states. .
Some patients need a transition place where they can stay away from treatment after being released from ASH, Barth explained. Some people need to be closely monitored to make sure they are taking their medication, she said.
“There’s something called anosognosia, where people don’t realize they have a mental illness,” Barth says. “If we can’t help them by keeping them in a safe place where they can get the treatment they need, and we don’t have a place like ASH, where will they go? They will go to prison. .They go to the streets…so now we are spending the same money over and over again.”
It is important to recognize that ASH is just one of hundreds of interdependent organizations that provide critical services in the state’s psychiatric health care system, Sheldon wrote in the report’s introduction. “The perception that hospitals are not functioning optimally is indicative of a larger problem,” he said. A series of systemic deficiencies in that continuum of care. ”
Contact medical reporter Stephanie Innes at Stephanie.Innes@gannett.com or 602-444-8369.Follow her on her X, formerly known as her Twitter @Stephanie Innes.