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How Can Mental Health Care In Arizona Be Improved?
Keynote Speech at the 2007 Mental Health Fair Glendale Public (Main) Library May 19, 2007
But, I believe, there are ways to improve Arizona's mental health
care.
These are my 9 Strategies (+ 4 others):
First, mandate mental health insurance parity.
Arizona should prohibit health insurance companies from
discriminating against individuals with mental illness. But
legislation equalizing benefits for mental and medical illness has
been defeated in the Arizona Legislature almost every year from
1994 including 2007 - despite the passage of Insurance Parity
Laws in 39 other states.
If mental health insurance parity were law in AZ, more people would
receive mental health care and earlier treatment when there is a
higher rate of therapy success.
In 2001, State employees received insurance parity
by administrative rule change instead of another attempt to pass a
parity bill. Part of the strategy of covering the state
employees was to evaluate the cost of parity in AZ as many
legislators would not accept the minimal increases of 1-2% of
insurance premiums from other states or even data from the Federal
Government. After waiting for 2 years, however, the health
insurance company refused to give the Parity Coalition the cost data
citing confidentiality!!!!
There is hope that the 2007 Federal Insurance Parity Bill
(called the Wellstone Bill after Senator Paul Wellstone from MN, who
was killed in a 2002 plane crash, will pass the U.S. Congress and be
signed into law by President Bush. Senator Wellstone's brother has
schizophrenia.
Second, improve jail and prison programs.
Despite the fact that care in the community mental health system
costs a fraction of that of incarceration, jails and prisons have
become the largest providers of mental health care in Arizona. In
fact, more mentally ill people are housed in jails and prisons than
at the Arizona State Hospital. Criminalization of mentally ill
individuals in Arizona is rampant.
Police officers and courts should focus on violent crimes and
dangerous felons and divert non-violent mentally ill offenders into
the behavioral health system where they can receive better
treatment. Phoenix & Tucson have implemented jail diversion
programs for persons with mental illness charged with non-violent
crimes. Other cities and counties in Arizona should develop Jail
Diversion programs.
Also, a system of mental health courts in each county in Arizona
should be instituted. Mental Health Courts decrease the number of
mentally ill individuals who are incarcerated.
Furthermore, mandate that lawyers and judges have to take mental
health continuing education courses to renew their license. Because
of the efforts of mental health consumer advocate and attorney,
Angela Vickers from Jacksonville, FL, Florida has implemented this
law. Why can't Arizona?
Third, educate youths about mental illness.
Offer age-appropriate mental health information in schools (grades 2
thru 12) to increase awareness of possible warning signs of mental
illness and suicide. Arizona has the 3rd highest rate of teen
suicide in the nation. Each year nearly 25, 000 teens in Arizona
attempt suicide This mental health education would also reduce
discrimination & stigma against persons who struggle with mental
illness.
Fourth, integrate mental health with physical health.
Encourage primary-care physicians (PCPs) and psychiatrists to work
together, so people can receive more comprehensive health care.
Studies have shown that, at least, 40% of the PCP's patients suffer
from a mental illness. Mandate that primary care physicians be
required to take mental health continuing medical education to renew
their medical license This will help persons with mental illness
obtain earlier diagnosis and better treatments.
Fifth, lower the 90 percent rate of unemployment for persons with serious mental illness.
Part of the very high unemployment rate is because working at
a minimum wage job and having to pay for their psychiatric care that
is often far more expensive than staying unemployed and keeping
their federal benefits. If more people with mental illness had jobs,
they would earn more money, have better self-esteem, require fewer
government entitlements and become taxpaying citizens.
Sixth, increase police awareness and sensitivity training about
mental illness.
Hardly a month goes by in which a seemingly "violent" mentally ill
individual is confronted by the police and, at times, the mentally
ill individual gets tasered, shot or killed and/or there is injury
to the policeman. Law enforcement needs more mental illness
training in awareness, sensitivity and crisis management.
A great model includes the use of specially trained Crisis
Intervention Teams, (referred to as CIT) that was developed in 1989
by Major Sam Cochran of the Memphis Police Department. The Memphis
Model has led to a decrease in officer involved shootings of
disabled persons and a reduction in officer injuries. In fact, from
1990-2000 in Memphis there were 2 police officer involved shootings
of disabled individuals and both were by non-CIT trained police
officers. The Memphis CIT Model has spread across the country and,
at least, 150 cities have instituted CIT programs. In Arizona 3
cities, Phoenix, Mesa & Tucson Police Departments have CIT programs
and many more Police Departments across the state want CIT training
for their officers.
Unfortunately, a comprehensive CIT bill with a $2 million
appropriation to fund the program died in the Arizona Legislature
in 2006 and in 2007 the CIT appriopriation bill is almost dead.
Seventh, publicize the Psychiatric Advance Directive or PAD.
The PAD became law in Arizona in 1999 but no funds were
appropriated by the Arizona Legislature to educate consumers, family
members and mental health providers about the new law. The Arizona
Center for Disability Law attempted to start a PAD program but did
not have the needed funds. The Psychiatric Advance Directive, as
many disability laws passed by the legislature was set-up to fail -
an unfunded mandate.
Unfortunately, PAD is the only way consumers can state what they
want done or not done if they become incompetent. For example, the
consumer can indicate what they want or do not want for treatment,
what hospital they want to be admitted, even what psychiatrist they
prefer. The consumer signs the form when they are competent to take
effect if they become incompetent.
Therefore, because of no state funding very few mental health
consumers are aware of or have completed the Psychiatric Advance
Directive.
For example, a woman who was severely depressed was strongly advised
by her psychiatrist to be hospitalized. She refused because she did
not have anyone to take care of her cat. A behavioral health worker
helped her to draw up a PAD that stated that her neighbor, who had
agreed, would care for her cat. She then was hospitalized.
The PAD is very empowering since a consumer can designate an
agent to follow his/her instructions if they become incompetent.
Since PAD is in Arizona statute, thanks to Mental Health Attorney
Charles Arnold, if a hospital or doctor refuses to follow their PAD,
they are breaking the law. Also, the PAD will decrease the number of
mentally ill persons under involuntary commitment.
The only exception when the Psychiatric Advance Directive can be
overridden is if the consumer is in a psychiatric emergency.
Eighth, Provide better public education about the mental
illnesses.
Despite recent gains, we still have a long way to go to end stigma,
fear and discrimination against consumers and their family
members. The public needs to understand that mental illnesses are
no-fault biologically based brain disorders, which should be viewed
no differently than cancer or diabetes. They need to learn
about the types of mental illnesses and the new, more effective
treatments that could help the thousands of Arizonans feel
comfortable seeking mental health care.
Ninth, Mental Health Legislative Advocacy.
Just think how much state and federal government's
laws affect consumers and family members!! Parity legislation,
Americans With Disability Act (A.D.A.), SSI & SSDI, AZ Department
of Health Services' Budget and many more. AZ's mental health
community has made great strides in the last decade in becoming
more politically active, lobbying for state and
federal legislation they favor and opposing bills
they are against.
A brief example - The Civil Rights bill for employment
discrimination often referred to as the "Two Little Word" bill
added 2 little words, "or mental" to the Civil Rights Statute
which previouly stated that only physical disabilities were
covered in employment discrimination cases. The "Two Little Word"
bill was killed every year from 1996 to 2001. In 2002, with the
help of then Attorney General, Janet Napolitano, the bill
passed both the House and Senate and was signed into law
by Governor Hull.
With the assistance of the mental health advocates' email and
telephone lists, the mental health and other
disability communities were alerted to the developments of the Two
Little Word bill as it passed through the Arizona Legislature and
was transmitted to the Governor. Arizona Legislators and Governor
Hull were swamped with calls and emails which helped the "Two
Little Word" bill become law.
We still have a long way to go. We need more mentally ill
individuals to register to vote and vote on election day.
Nation-wide, 20% of consumers are registered to vote. It is much
easier to vote since AZ passed a law to allow voters to use the
Mail-In-Ballot.
Furthermore, the so called "Motor Voter Law" was passed by the
federal government in 1993 which mandated that all government
offices and behavioral health providers were required to register
consumers to vote at intake. The law in Arizona is rarely
followed and not enforced. The more members of the mental health
community become voters and legislative advocates, the more
political power we will have.
Due to time constraints, I will briefly mention some other
issues that I think would improve mental health care:
1) Encourage Governor Napolitano to establish a commision, as
she did for the business community, to evaluate the cost of the
new ASH Forensic Hospital that is "falling apart" according to
an April 2007 expose by reporter Mary Reinhart of the East
Valley Tribune. Also, enact a task force to evaluate
the care of incarcerated mentally ill individuals caught up in
the jails and prison system.
2) Eliminate the 23 hour/day solitary confinement of persons
with mental illness (referred to as the "BOX") except those who
are trully violent felony offenders . Mentally ill individuals
in the BOX" frequently decompensate and have a significant
suicide rate.
3) Develop a pool of mental health advocates who can go with the
consumer to doctor visits as well as to their appeals and court
hearings as Kathy Palmer did when she was Executive Director of
the Mental Health Advocates Coalition of Arizona (MAHACA). Frequently,
the consumer, especally if he/she is depressed, does not
understand what is happening.
4) Large mental health agencies such as the Mental Health
Association of Arizona and NAMI should develop Political Action
Committees (PACs) to be able to compete with the other business
organizations with PACs. PACs are able to give more money
to politicians' campaigns than an individual can. Unfortunately,
that is the name of the game in 2007.
5) Finally, encourage certain consumers to have specially
trained and licensed ESSAs (Emotional Support Service Animals)
- [dogs, cats, birds, ferrets and other animals]. ESSAs have
been documented over and over again to help and even improve the
person's mental illness.
If these strategies were adopted, I am certain we would see dramatic improvements in Arizona's mental health care. There would be better mental health insurance coverage, fewer incarcerated individuals with mental illness, fewer teen suicides, more people with mental illness in the work force, fewer police officer involved shootings and many other improvements. In addition, more individuals would receive proper diagnosis and treatment. There would be new hope and optimism for persons with mental illness, for their families, for their friends, for mental health care providers and for the general public - many of whom are now touched in one way or another by mental illness. Arizona's mental health system would become a model for the nation. Mental illness would then be regarded like any other medical illness and the stigma and discrimination against people living with mental illness would dramatically decrease and, hopefully, soon disappear. I will end with a quote by the great Opera singer, Dorothy Sills:
"You may be disappointed if you fail, but you will be doomed if you
don't try."
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