Were They Listening in at Our ACMI Meetings? How Two Separate Working Groups Came up with Very Similar Recommendations

A homeless person living on the streets of Phoenix and Van Buren and 1st Avenue in a business storefront. 13Nov2019

The Association for the Chronically Mentally Ill (ACMI) was created approximately two years ago by families with children that have serious mental illness and strong advocates that work helping such families. All board members are volunteers, and none work for any behavioral agency nor receive monies from AHCCCS or any provider agency. 

    The stories we often encounter are of persons with SMI who are not thriving nor able to advocate for themselves. They do not attend peer-run groups, their families have not received family support services, they often are isolated, and encounter law enforcement at alarming rates.  This is the small sliver of SMI population with Chronic SMI that is treatment non-adherent. Treatment non-adherence occurs when a person/patient’s decision-making process is most profoundly impaired (because their health condition is psychiatric in nature and happens to have core features, like anosognosia, which impair judgment about their health care). Another aggravating factor is the fluctuating nature of the impairment since people with severe psychiatric conditions experience variable periods of lucidity.

   Having a serious chronic medical condition that coincidently involves the brain should not result in a criminal sentence. We do not criminalize people with diabetes when their disease becomes unstable even if they are not adherent to the dietary requirements or medication schedules. A brain disorder is no different and should not be treated as a failure of proper moral behavior. It should be treated as a chronic disease. We also believe that not having appropriate housing is a harmful factor for those individuals that struggle with brain disorders. No one gets better when faced with the struggles of homelessness.

ACMI’s Over-arching principles:

  Our three specific goals are:

(1) develop more Lighthouse-Like Community Living Homes,

(2) develop a “Secure Residential Treatment Program”, and

(3) recommend criteria and processes for provider-selection, provider accountability (oversight), and implementation of person-centered provider culture related to (1) & (2). Passage of 2747, 2754, 2755 & 2756 will provide resources towards these goals. 

  Our biggest challenge is that many different sources fund society’s interactions with the Chronically Mentally Ill: AHCCCS, RBHA’s, Medicare, Medicaid, Counties, the State, City Police Departments, Courts, Jails, Prisons, Hospitals, Emergency Rooms, Etc. Major reform will require redeployment of public funds involving intense opposition from entities from which funding is redeployed, even though such entities would have a corresponding expense reduction.

From the Interim Report and Recommendations from the Committee on Mental Health and the Justice Reform System study: 

“Today, a person experiencing a mental health crisis is more likely to encounter law enforcement in a time of need than they are to receive medical assistance. Local law enforcement reports across the country reveal approximately one in ten police calls involve mental health situations.4 Local court users and jail populations reflect this reality. Nationwide, rates of serious mental illness in jails are four to six times higher than in the general population.5 According to the National Alliance on Mental Illness (NAMI), 2 million people with mental health conditions are booked into jails each year. Nearly 15% of men and 30% of women booked into jails have a serious mental health condition. Further, the majority of these individuals are misdemeanor offenders, or are serving time in jail for non-violent offenses. Many of the individuals are homeless and most of the crimes are “survival crimes”.  In fact, most people in jail have not yet gone to trial.6 “

   Over the next two years, the association and its members determined that appropriate housing, including secure housing, was a fundamental requirement for the treatment of those with SMI. Working with influential legislative leaders such as Nancy Barto, Heather Carter, Kate Brophy McGee, and Sylvia Allen, among others, the legislature passed a series of laws. These laws specifically included money set aside to provide secure housing for those persons living with SMI who are otherwise non-adherent to treatment and whose recovery therefore is made more lengthy and dangerous. The Appropriations Committee appropriated $3.5 million to launch this effort in 2019 with an RFP form the Arizona Department of Housing followed by competitive bidding in early 2020.  ACMI is proud of this remarkable success story and the hope it brings for the chronically mentally ill.

  In October 2019 The Committee on Mental Health and the Justice System issued a report with recommendations to the supreme court of Arizona, which included broad-based recommendations for changes to the justice system that would impact the way persons with SMI were treated. The Committee recommend legislation that would provide for “enhanced services” for people with SMI that are non-adherent to treatment. Specifically, in Appendix B(D)(1b) ,  the Committee recommended “housing or residential placement that provides the patient with stable, safe and, if necessary, secure residence to enhance compliance with the treatment plan and protect the safety of the patient and the public.”

 There is, therefore, a somewhat rare concurrence between the work of ACMI (a small start-up non-profit) and the legislative and judicial branches of our government with regard to the need for secure housing for those patients with SMI who are non-adherent to treatment. 

  ACMI and its members have every reason to hope, if not believe, that the executive branch of our government also approves of such necessary and appropriate housing.

The Committee’s report is a remarkably succinct and compelling overview of opportunities and challenges facing Arizona’s behavioral health industry and those who received services in that industry.  It bears reading by all engaged in mental health policy in Arizona.

The highlights of the recommendations

fall under the following categories:

• Legislation, Policy, and Procedure

• Training and Education

• Data Resources and Analysis

• Court Improvement

• Community Services and Supports

• Diversion and Early Intervention

• Programming and Partnerships

• Access to Technology 

The full report provides a blueprint for evolution and refinements of our behavioral health system for years to come.

Read the full Interim Report and Recommendations from the committee on Mental Health and the Justice Reform System https://acmionline.com/wp-content/uploads/2019/11/MHJS-FINAL-Interim-Report-Sept-2019.pdf 

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