True or False: Three out of four patients with schizophrenia report substance use. 

True!

A review of electronic medical records of patients with schizophrenia spectrum disorders in a community teaching hospital’s psychiatric unit found that more than three-quarters used substances such as tobacco and cannabis. Researchers presented their findings in a poster at the virtual 2021 American Psychiatric Association Annual Meeting.

Among patients with schizophrenia, 62.3% used tobacco, 41.5% used cannabis, 40.2% used alcohol, and 27.4% used cocaine. In patients who reported using tobacco, unadjusted odds ratios were 7.24 for comorbid alcohol use, 5.00 for cocaine use, 4.62 for synthetic cannabis use, and 2.80 for cannabis use, according to the study. Multivariate analysis results supported the findings.

Posted on 6/17/2021 Quiz: Do Three Quarters of Patients with Schizophrenia Report Substance Use? (hmpgloballearningnetwork.com)

With that information, one would hope that the behavioral health providers would do a better job at treating dual diagnosis individuals. Often families of loved ones that have serious mental illness and substance use disorders hear that the person needs to get sober before mental health treatment can be effective. However, they are also then told that the person is too ill to be in the substance use treatment because of their serious mental illness. Kind of a Catch 22 situation. Treatment needs to address both illnesses.

A class action suit—Arnold v. Sarn—was filed in 1981 against the State of Arizona, alleging that the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) and Maricopa County did not provide a comprehensive community mental health system as required by statute. The case proceeded through the court system (slowly), and an agreement was reached between the parties in 2014, which resulted in a Stipulation for Providing Community Services and Terminating Litigation. There were other decision points made during this case, one of which was that the number of long-term psychiatric care beds available at Arizona State Hospital (the only hospital in Arizona which offers long-term psychiatric care) for Maricopa County would be 55 (for those committed under Title 36, i.e., civil commitment). This number, seemingly plucked out of thin air, is absurd considering the size of the population it serves (about 4,500,000 people in Maricopa County, so this equates to 1.2 beds per 100,000 available for long-term psychiatric care).

As you can see from the article by Research weekly, a publication of the Treatment Advocacy Center, the optimal number of long-term psychiatric beds available in any population should be around 60, with 30 beds acceptable as a bare minimum.

As an organization devoted to the care of people with SMI, ACMI is intent on removing this absurd artificial limit to bed capacity at ASH for those unfortunates who happen to live in Maricopa County, Arizona, one of the largest counties in the US, with the smallest capacity to serve people with this terrible disease.

Charles Goldstein, M.D. ACMI Treasurer

    RESEARCH WEEKLY: Two New Studies on Psychiatric Bed Number Targets – Treatment Advocacy Center

    RESEARCH WEEKLY: Two New Studies on Psychiatric Bed Number Targets

    By Elizabeth Sinclair Hancq 

    (March 2, 2022) Two research reports on the optimum number of psychiatric beds have been published in the past few months, both of which validate the Treatment Advocacy Center’s recommendation for 40 to 60 beds per 100,000 population. 

    In this week’s Research Weekly blog, I will first review the Treatment Advocacy Center recommendations and then summarize the two new studies that support those numbers. 

    Treatment Advocacy Center bed recommendations

    Treatment Advocacy Center published a study in 2008 that included a safe minimum number of psychiatric beds, concluding that there is “a need for 50 (range 40 to 60) public psychiatric beds per 100,000 population for hospitalization for individuals with serious psychiatric disorders.” This is considered a minimum number because it assumes the availability of good outpatient programs, including assisted outpatient treatment. 

    This recommendation was developed utilizing the Delphi method, a structured technique to develop a consensus from a variety of experts. Treatment Advocacy Center collected input from 15 experts on psychiatric care in the United States to inform the estimates. The experts were instructed to take into consideration a variety of factors that impact the need for psychiatric beds, including the number of people with serious mental illness who may need hospital care, the adequacy of community outpatient services, how long individuals usually remain in hospitals, short stay versus long stay beds, and how the psychiatric beds are financed. 

    RAND Corporation bed recommendations for California

    The RAND Corporation is a nonprofit and nonpartisan research organization that conducts research to inform public policy challenges. RAND was contracted by the California Mental Health Services Authority to conduct a research analysis to estimate psychiatric bed need in California for the next five years, including variations for types of beds and regional needs throughout the state. The results of the study were published in January. 

    The study authors first determined the current psychiatric bed capacity in California, breaking down the beds to acute and subacute type beds. Acute beds were described as those for higher acuity patients and shorter lengths of stay (days to weeks), typically utilized to stabilize patients. Subacute beds were defined as those used for individuals with moderate to high acuity needs but for a longer duration (multiple months). 

    They estimated the bed needs in the state using multiple methods. In one method, they convened a panel of technical experts, of which I was a member, to discuss estimates of bed need and the various factors that impact psychiatric bed capacity numbers, including how they are utilized and what types of patients they serve. Secondly, they utilized regional variation in rates of serious psychological distress to estimate how bed need may differ by region of the state. Thirdly, they computed the number of beds required by using a formula that includes how many beds currently exist and current bed occupancy rates, wait list volumes, average length of stay and transfers needed to higher or lower levels of care.

    The RAND report authors found that California requires 50.5 inpatient psychiatric hospital beds per 100,000 adults, which is consistent with the Treatment Advocacy Center findings. The authors further break these numbers down by type of bed, suggesting that these bed targets include 26 acute beds per 100,000 adult population and 24.6 subacute beds per 100,000 population. Taking into account how many beds California currently has, the results suggest that California is short 1,971 acute beds and 2,796 subacute beds. In addition, the authors conclude that the shortage of psychiatric beds will only worsen over time, predicting a 1.7% increase in psychiatric bed need by 2026. 

    International Delphi Method 

    The other new research report on psychiatric bed supply need per capita was an international effort conducted by a group of researchers from around the world and published in Molecular Psychiatry in January. These researchers again utilized the Delphi method to reach a global consensus on the minimum and optimum number of psychiatric beds per population. The Delphia panel included 65 experts, including me, from 40 different countries. These included individuals from all six World Health Organization regions and those from high- and low- income countries. 

    The results of the Delphi process concluded that 60 beds per 100,000 population is the optimal number, and 30 beds per 100,000 population is the absolute minimum. A psychiatric bed supply range of 25-30 was considered a mild shortage, 15-25 as a moderate shortage, and less than 15 per 100,000 population as a severe shortage of psychiatric beds. The results from this international panel of experts are again consistent with Treatment Advocacy Center’s psychiatric bed recommendations. 

    These two new psychiatric bed capacity target research studies further validate Treatment Advocacy Center’s previous report on the subject, suggesting a given jurisdiction should have at least 40-60 inpatient psychiatric beds per 100,000 population to meet the needs of their community. 

    References

    Elizabeth Sinclair Hancq is the director of research at Treatment Advocacy Center.

    To receive Research Weekly directly in your email inbox on a weekly basis, click here

    Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.

    What will it take for the Centers for Medicare & Medicaid Services (CMS) to realize that an amendment is needed? The cost to society of not providing care and treatment results in the use of emergency rooms, fire and police resources, and public community environments. It comes with a high price tag and dismal results. Refer to the report “Housing is Healthcare https://morrisoninstitute.asu.edu/housing_is_health_care.

    People with serious mental illness live in squalor and end up dead or in jail or prison, often for crimes of street survival. Mental illness is the only “medical” condition that is criminalized (e.g., while psychotic, destroying property while failing, or not complying with officers, vocalizing against perceived threats, and creating a public disturbance ).

    Laurie Goldstein- ACMI Vice President

     Matt H. Wade via commons.wikimedia.org | CC BY 3.0


    REGULATION

    Why One State Is Pushing Back Against Medicaid’s IMD Exclusion

    By Chris Larson | January 20, 2023

    Why One State Is Pushing Back Against Medicaid’s IMD Exclusion – Behavioral Health Business (bhbusiness.com)

    New York state hopes to strengthen and remake state-managed behavioral health care by getting around the so-called IMD exclusion.

    It’s doing so by securing federal Medicaid funds typically forbidden from covering facility-based behavioral health through its latest 1115 waiver amendment.

    On Jan. 5, the Centers for Medicare & Medicaid Services (CMS) announced New York applied for a waiver to Medicaid’s now-antiquated institution for mental disease (IMD) exclusion. New York has asked for federal matching funds for Medicaid to be allowed to cover IMD services to address serious mental illness (SMI), substance use disorder (SUD) and serious emotional disturbance (SED) for adults and children.

    New York specifically is seeking matching funds to reimburse short-term inpatient, residential and other services for SMI and SUD by IMDs. The state is also applying for matching funds to help transition patients in state psychiatric facilities back to the community up to 30 days before their discharge.

    “The objective of the demonstration is to transform the role of some state psychiatric inpatient facilities and [SUD] residential treatment facilities, improve care transitions and access to community-based treatment and support services, and improve health and behavioral health outcomes in individuals with chronic and/or [SMIs] by transforming selected (pilot site) state-run psychiatric hospitals, facilities, and campuses from long-term care institutions to community-based enhanced service delivery systems,” the 1115 waiver amendment proposal states.

    Since the beginning of Medicaid in 1965, the Social Security Act forbade federal funds for Medicaid from covering treatment provided by facilities where 16 or more beds are dedicated to treating behavioral health issues of people aged 21 to 64.

    This move was intended to prevent states from offloading state psychiatric hospital costs on the federal government through the jointly funded and managed Medicaid program. It was also part of a political and regulatory retreat from treating behavioral health issues in large hospital-like settings, with champions of that movement including President John F. Kennedy.

    The movement is sometimes referred to as deinstitutionalization.

    However, some see the start of the deinstitutionalization movement as the start of the present psychiatric bed shortage, even within the federal government.

    “There’s been an understanding in the past several years that this lack of federal funding contributes to high levels of unmet need,” Madeline Guth, senior policy analyst for Kaiser Family Foundation (KFF), told Behavioral Health Business. “The federal government has been providing some new mechanisms in the past few years for states to get an exception to this exclusion and get some federal financing for IMD services for non-elderly adults.”

    The mechanisms, including the Medicaid 1115 waiver, allow states to secure some federal funding for certain IMD-related services.

    Medicaid 1115 waivers, if approved by the federal government, allow states to experiment with different ways of implementing the Medicaid program.

    There are three specific 1115 waiver benefit expansions that are related to behavioral health.

    KFF, which tracks these waivers, found that 34 states have received approvals for an IMD exclusion payment exemption for SUDs. Additionally, 10 states have an exemption for mental health treatment, with 23 states having other exemptions for community-based health and behavioral health. 

    Recent presidential administrations have enabled ways around the IMD exclusion through the 1115 waiver.

    In July 2015, the Obama administration allowed for 1115 waivers to “develop a full continuum of care for individuals with SUD, including coverage for short-term residential treatment services not otherwise covered by Medicaid,” which included the IMD exclusion. 

    The Trump administration announced in November 2019 that it approved the first-ever 1115 waiver related to IMD exclusion for SMIs and SEDs for adults and children.

    Addressing the IMD exclusion did come up during the legislative work in 2022 that culminated in a sweeping behavioral health bill included in the omnibus funding bill passed just before Christmas. However, it was not included in the final bill that was signed into law on Dec. 29

    While New York’s latest 1115 waiver application is not unprecedented, it does reflect a two-for-one application for two IMD exclusion exemptions — including both SMI and SUD funding.

    Further, the New York waiver and the other waivers tracked by KFF show that states of all political leanings seek to address mental health via innovations to Medicaid.

    Medicaid is the single largest payer of mental health services in the U.S. 

    Advocates across the country are fighting against barriers to healthcare for people seeking mental health treatment. The IMD exclusion (explanation in the OP-ED) continues to eliminate the stability period that is necessary for many people with serious mental illness. Let’s continue to ask for reforms to the IMD exclusion rule; waivers are not enough.

    Laurie Goldstein- ACMI Vice President

    Congress must stop blocking mental health clinics from needed money

    By Cheryl Roberts

    New York Daily News

    Jan 24, 2023 at 5:00 am

    Newly elected Congressman Dan Goldman’s announcement about reintroducing the Michelle Alyssa Go Act is welcomed news. The Act, named after Michelle Go, the young woman pushed to her death in front of a subway train by Martial Simon, a homeless man with serious mental illness, would amend the decades old federal rule at the root of our broken mental health system.

    The Institutions of Mental Disease or “IMD Rule” was enacted in 1965 as part of the Social Security Act and denies Medicaid to patients admitted to psycho-therapeutic facilities with more than 16 beds including hospitals, nursing homes and community or so-called congregate care facilities. By restricting federal Medicaid dollars to small residential institutions, Congress rightly figured that service providers would never achieve “scale,” making it impossible for IMD providers to break even, let alone make a responsible profit.

    Instead, Congress hoped that by funding community services and eliminating large asylums, poor people with serious mental illness would be served elsewhere, and they have been — in prisons, jails and at the undertakers.

    Michelle Go (left) and Martial Simon
    Michelle Go (left) and Martial Simon

    The need for more psychiatric beds whether in-patient or congregate care, is an uncomfortable fact that some would rather ignore, a luxury not possible for parents like Teresa and Dan Pasquini, sisters like Hilary de Vries, or members of Michelle Go’s family.

    Like it or not, some people living with serious mental illness would do better having access to financially viable, reasonably sized congregate care residential facilities located close to family and loved ones. Yet for many people, this community-based option has been off the table for nearly 60 years because of the IMD Rule. Without this option and others, including in-patient hospitalization and residential facilities where residents are not completely at liberty to come and go, the much heralded “continuum of care” is not achievable, at least not for everyone.

    There is no better proof of this reality and the need for a range of such facilities, than the fact that over the same time period, many of these options have been available to those who can afford private pay residential and in-patient facilities. This reality demonstrates that IMDs above 16 beds are not inherently bad, we just don’t want to pay for good ones, at least not for poor people. Instead, we have stood by and watched as our prisons and jails filled up with poor people living with mental illness, especially Black and Brown people, who landed in the criminal justice system after the mental health system failed them, their loved ones and the innocent victims and their families.

    Ironically, in the end, the IMD fundamentally undercut the gold standard of our mental health care system: ensuring access to community-based mental health services as part of a broad continuum of care. By drawing a crude line in the sand at 16 beds for all IMDs, Congress over-simplified both the problem and the solution needed to address the very real concerns associated with the large, underfunded snake-pit mental health asylums of old.

    As Goldman reintroduces legislation to amend the IMD Rule, rather than seeking a wholesale repeal of the rule, the amendments should be drawn with more precision. Otherwise, not only will complete repeal of the IMD be dead on arrival due to its high cost, it will also unnecessarily raise real concerns about the government’s ability to control very large scale asylums and prevent some of the abuses of the past.

    Rather, instead of once again taking a crude, one size fits all approach to Medicaid funding for mental health treatment, Congress should create different bed limitations for different kinds of facilities. For example, members might find that 36-bed congregate care facilities would be both humane for clients and financially viable for service providers. Similarly, raising the legal bed capacity for in-patient psychiatric hospitals to 100 or 150 might enable New York City’s public Health + Hospitals to offer high quality, safe, therapeutic and humane options for New Yorkers in need of that level of care.

    Not only would extending the continuum of care be the humane option for those living with serious mental illness and their families, but it would also improve public safety and save money by preventing people with serious mental illness from entering into the criminal justice system in the first place.

    It’s time for Congress to get this one right. To be thoughtful but to delay no longer. Michelle Go and Martial Simon deserved better, so did their loved ones.

    Roberts is a part-time City Court judge in Hudson, N.Y., where she presides over the Mental Health Court and is the executive director of the Greenburger Center for Social and Criminal Justice.

    This report was released in Psych News Alert on Monday, January 23, 2023

    When it comes to the risk of metabolic side effects, not all antipsychotics are equal, suggests a meta-analysis published in World Psychiatry. The analysis revealed that patients with schizophrenia who took chlorpromazine or clozapine for more than 13 weeks experienced the most weight gain on average compared with those taking placebo.

    Angelika Burschinski, M.D., of the Technical University of Munich and colleagues compiled data from 137 clinical trials that compared outcomes of patients who had schizophrenia, schizophreniform disorder, or schizoaffective disorder and took antipsychotics or placebo for more than 13 weeks. The combined sample included 35,007 participants who had taken 31 different antipsychotics (both oral and injectable) that are available in the United States and/or Europe. The researchers compared the effects of these medications on body weight as well as fasting glucose, cholesterol, and triglyceride levels.

    The median age of the participants in the analysis was 39 years, and the median length of follow-up was 45 weeks. The researchers found that five antipsychotics contributed to significant average weight gain relative to placebo:

    • chlorpromazine (5.13 kg, or over 11.3 lbs)
    • clozapine (4.21 kg, or over 9.3 lbs)
    • zotepine (3.87 kg, or 8.5 lbs)
    • oral olanzapine (3.82 kg, or 8.4 lbs)
    • long-acting injectable olanzapine (3.60 kg, or 7.9 lbs)

    Seven other antipsychotics, including risperidone and quetiapine, were associated with average weight gains of 1 to 2 kg (2 to 4.5 lbs) over the study period.

    The medications associated with the highest weight gain in participants were also associated with greater changes in glucose, cholesterol, and triglyceride levels. Olanzapine was associated with the greatest effects on glucose, total cholesterol, and LDL cholesterol; amisulpride (which led to an average weight gain of 1.43 kg, or over 3 lbs), was associated with the greatest effects on HDL cholesterol and triglycerides.

    “[M]etabolic side effects of antipsychotics are likely to contribute to the average 14.5 years reduced lifespan of individuals with schizophrenia. Furthermore, weight gain is associated with decreased quality of life and treatment nonadherence, the latter resulting in poor treatment outcome and psychotic relapses,” Burschinski and colleagues wrote. “As antipsychotic drugs are often taken for long periods of time, our results represent more valuable clinical information on these health consequences than previous analyses based on short-term studies, which on average only lasted 6 weeks.”

    The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest that will discuss a relevant Behavioral Health topic; after the speaker, we will have discussions with attendees on current issues with the Behavioral Health System.

    “Autism in Adults: What does that look like, and what to do about it” by Dr. Christopher Smith

    Dr. Christopher J. Smith is an experimental psychologist with expertise in diagnosing autism spectrum disorder and measuring associated traits. Dr. Smith oversees all diagnostic evaluations and assessments for our clients while also directing all internal and external research projects. Prior to joining us at SARRC, he worked as an assistant professor in the Department of Psychiatry at the Mount Sinai School of Medicine, where he still maintains a faculty position. Originally drawn to study autism because of the complexity of the disorder, here at SARRC, Dr. Smith values the ability to work with clients across all age groups and engage in out-of-the-box research endeavors.

    Topic: ACMI Stakeholder’s Meeting

    Time: February 7th,, 2023 04:00 PM Arizona

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    As we celebrate these holidays, let’s resolve to help the less fortunate.  The article below, by Steve Twist and Seth Leibsohn, vividly describes the misery of homeless persons in our community.  The most tragic are those who suffer from Serious Mental Illness (a pathological brain disorder) and co-occurring addiction and homelessness, living in our streets and jails.  Approximately 30% of homeless persons and 30% of incarcerated persons are Seriously Mentally Ill.   

    Some are so mentally ill they believe their internal voices and delusions are real and, hence, they are pathologically unable to participate in their own treatment.  Some seek relief with illicit substances, which exacerbates their illness and misery.  To help these Chronically Mentally Ill persons, we need (a) more group homes with staff inside the homes 24 hours per day and 7 days per week, (b) well-regulated and secure residential treatment facilities from which residents cannot leave without authorization, to allow enough time for their treatment to become effective and (c) more beds and more accountability for care at the Arizona State Hospital, including removing the 55-bed limit on persons who reside in Maricopa County.

    These three steps would provide better clinical outcomes at less cost than we now spend on recycling these persons through our emergency rooms, hospitals, short-term treatment programs, the streets, and jails, as their mental and physical health deteriorates.

    We at the Association for the Chronically Mentally Ill (“ACMI”) welcome the attention Mr. Twist and Mr. Leibsohn bring to the problems described in their article.  And we believe the three steps indicated above would be significantly helpful as to the persons who are homeless due to their Chronic Mental Illness.

    Dick Dunseath, Board Secretary of the Association for the Chronically Mentally Ill, and father of an adult suffering with Chronic Mental Illness

    ____________________________________________________________________________________________________________________________

    Phoenix neglects homeless, ignores rampant crime in ‘the Zone’ (azcentral.com) published Nov 17th 2022

    Phoenix neglects the homeless, ignores rampant crime in drug-riddled ‘Zone’

    A homeless person, who was included in the annual Point-in-Time homeless street count, sleeps on the [edestrian bridge, Jan 25th, 2022, at Seventh and Lopp 202 in Phoenix (Mark Hemie/The Republic

    Opinion: Nearly 1,000 homeless folks exist in disease, filth and crime. Phoenix is guilty of not only neglecting them but setting a policy to not enforce laws.

    Steve Twist and Seth Leibsohn

    Within an area of central Phoenix, bounded roughly between Seventh and 15th avenues and Jefferson and Harrison streets, there is an ongoing dystopia. Euphemistically and casually, it’s referred to as “the Zone.”

    This past week, an unborn child, at 20-24 weeks of gestation, was found dead in the middle of the street – burned to death.

    There, nearly a thousand of our fellow citizens exist in disease, filth and crime. They are “living” on the streets, in makeshift tents and under tattered tarps, amid scattered garbage, human waste, chronic illness, drug paraphernalia, fire and fear.

    These are the unseen, forgotten and abandoned. They are the mentally ill, walking the streets, talking to the air, battling unseen demons. They are the drug and alcohol addicted, so desperate for another fix or drink they will do anything except seek treatment. They are routinely victims of both crime and neglect.

    No decent society abandons its fellow citizens to live this way; Darfur or Beirut is not our human or scenic aspiration. Not only is Phoenix guilty of shocking neglect of these most needy among us, it seems to be the policy of the city not to use the tools at its disposal to intervene as a force for help and repair.

    Drug crimes, assaults define life in ‘the Zone’

    Nicky Stevens (left, with MAG) interviews a homeless person during Maricopa County's annual Point-in-Time count, Jan. 25, 2022, near Seventh Avenue and Roosevelt Street in Phoenix.
    Nicky Stevens (left, with MAG) interviews a homeless person during Maricopa County’s Point-in-time count Jan 25, 2022, near Seventh Avenue and Roosevelt Street in Phoenix. Mark Henie/The Republic

    Take the cases of crimes being committed against those in the Zone. Those living there are both routine and regular perpetrators and victims of serious crime. Not only are drug crimes the basis for regular escape and anesthesia, but sexual and aggravated assaults, robberies, arsons and thefts regularly define the contours of daily subsistence in the Zone.

    In its 2020 report, Strategies to Address Homelessness, the city of Phoenix acknowledged, because of “Gaps,” “(t)he result is a fluctuating level of encampments along the streets, defecation in public – sometimes on private property, litter and debris, public drug use, lewd acts, theft and other property and violent crimes.”

    It’s only become worse.

    According to a recent complaint that area business operators filed in Maricopa County Superior Court, the city “refuses to enforce in and around the Zone quality-of-life ordinances prohibiting loitering, disturbing the peace, drunken and disorderly conduct, drug use, domestic violence, and obstructing streets, sidewalks, or other public grounds.”

    So, the victims are abandoned.

    People call for help thousands of times

    Article 2 of our state constitution recognizes victims of crimes have the rights to “justice” and “to be treated with fairness, respect, and dignity.” These constitutional rights are promises made by the people of Arizona to every victim of crime, rights that city officials from the mayor on down have sworn to uphold.

    Yet they have become a mockery as city officials refuse to enforce the very laws that have been written to protect victims from harm.

    A model for others? Tempe parking lot will become affordable apartments

    In this limited area of a few city blocks, in just the first nine months of this year, people have called the police for help more than 2,800 times. On average, in just a few square blocks, more than 10 people need help from the police every day.

    Enforcing our criminal laws when a homeless person commits a crime against another homeless person does not stigmatize homelessness: it respects the rule of law and the rights of the victim essential to natural order. It recognizes a humanity that inheres in certain populations too many of us would, evidently, rather ignore. And these prosecutions can result in services being mandated for the homeless perpetrator.

    Actively police this area. Enforce the law

    But Phoenix is so wrapped in the dogma that pushes the failed policy of “housing first” and appeasement rather than treatment that it leaves the victims with neither justice nor respect. It leaves the homeless abandoned to the vicious cycle of desperation and misery.

    The city has been justifying its shameless inaction because of a misreading of a recent 9th Circuit Court of Appeals case. But that case, Robert Martin v. City of Boise, noted, “Nor do we suggest that a jurisdiction with insufficient shelter can never criminalize the act of sleeping outside.

    “Even where shelter is unavailable, an ordinance prohibiting sitting, lying, or sleeping outside at particular times or in particular locations might well be constitutionally permissible. So, too, might an ordinance barring the obstruction of public rights of way or the erection of certain structures.”

    Start policing the Zone. Enforce the rule of law.

    Start arresting those who break the law. Work with prosecutors and courts to screen for services and treatment. Start with a policy not of “housing first” but “protecting victims first.”

    That is what a sane and civil community would do – before it spreads, and before more lives are brutalized and lost.

    Steve Twist, a former chief assistant attorney general for Arizona, is the founder of the Arizona Voice for Crime Victims. Seth Leibsohn is a radio host at KKNT/960am and a senior fellow of the Claremont Institute, which advocates for limited government. Reach them at steventwist@gmail.com and SLeibsohn@salemphx.com.

    Not all unsheltered populations require the same solution. Each population is unique. Project Haven for seniors is suited for the older population. The rate at which CASS was able to find permanent supportive housing (PSH) for the senior population during the pilot is impressive.

    We need specialized solutions for people with serious mental illnesses, including supportive services. Without supportive services, most people will not be successful.

    St. Vincent de Paul’s Washington Model is another smaller shelter in Phoenix that accommodates persons with pets and has onsite services.

    ____________________________________________________________________________________________________________________________

    Phoenix leaders push for more shelters after 700+ unhoused people died in 2022

    Phoenix leaders push for more shelters after 700+ unhoused people died in 2022 – Axios Phoenix posted 12/20/2022 by Jessica Boedm.

    A rendering of The Haven after renovations. Courtesy of CASS

    Homeless service providers in Phoenix are trying to quickly open new shelters across the Valley to address the growing number of people living on the streets.

    Why it matters: Tuesday marks Homeless Persons’ Memorial Day, which is recognized on the winter solstice, the longest night of the year.

    By the numbers: Homelessness in Maricopa County increased 22% over the past two years and more than 700 people experiencing homelessness have died this year. That’s up from about 550 last year.

    Of note: Investigators reported an additional 450 deaths this year of people whose housing status could not be determined.

    What’s happening: Government agencies and nonprofits are using federal pandemic-relief funds to provide new shelter options, especially for seniors and people with mental illnesses.

    • For years, the 600-bed Central Arizona Shelter Services (CASS) location was virtually the only option for emergency housing.
    • Now, local leaders are looking to create smaller facilities that address specific needs for different populations.

    The latest: CASS is getting ready to renovate the old Phoenix Inn on Interstate 17 near Northern Avenue. When finished this summer, it will provide 170 beds for people 55 and older.

    • The Haven will have onsite medical care and other resources tailored to senior citizens.
    • CASS tested the model by renting out part of a hotel for seniors experiencing homelessness during the pandemic. Almost 70% of the people who stayed there got permanent housing, CEO Lisa Glow told us.
    • The group purchased the hotel outright with pandemic funding from the state housing department. The Phoenix City Council approved $4 million of their federal dollars for the renovation.

    What she’s saying: “It’s a more dignified, safer space for [senior citizens] than having to navigate 600 beds,” Glow said.

    Flashback: Earlier this year, St. Vincent de Paul opened a new 200-bed shelter in south Phoenix.

    • The Human Services Campus opened a 100-bed structure next to the CASS shelter and is prioritizing people with significant barriers to housing, including individuals discharged from hospitals.

    What’s next: CASS is partnering with Copa Health to open a 54-bed transitional housing facility for people with a Severe Mental Illness in 2024 on the state hospital grounds.

    • Community Bridges, Inc., is looking to open a 100-bed behavioral health wellness center in Sunnyslope.

    This will be a positive step for diversion and supportive services, but what is lacking is affordable appropriate housing for those with mental health conditions. In Arizona, the wait lists have grown, and even people lucky enough to get a voucher face difficulties getting a rental unit.

    We need permanent supportive housing (PSH) to ensure stability and recovery.

    —————————————————————————————————————————————————–

    Originally posted on December 15th, 2022 Congress Approves the Justice and Mental Health Collaboration Reauthorization Act – CSG Justice Center – CSG Justice Center

    Once signed into law, the Justice and Mental Health Collaboration Reauthorization Act of 2022 will:

    • Strengthen support for mental health courts and crisis intervention teams;
    • Provide support for diversion programming and training for state and local prosecutors;
    • Strengthen support for co-responder teams;
    • Support the integration of 988 into the existing public safety system;
    • Amend allowable uses for grant funds to include suicide prevention in jails and information-sharing between mental health systems and jails/prisons;
    • Amend allowable uses to include case management services and supports; and
    • Clarify that crisis intervention teams can be placed in 911 call centers.

    The first Tuesday of each month from 4-6 pm Arizona time except for holiday weekends, ACMI will have a featured guest that will discuss a relevant Behavioral Health topic, After the speaker, we will have discussions with attendees on current issues with the Behavioral Health System.

    This month learn about ECT (Electric Convulsive Therapy) from Dr. Aaron Riley.

    ECT is not what it used to be!

    Dr. Aaron Riley is a psychiatrist in Mesa, AZ, and is affiliated with Valleywise Health. He received his medical degree from the Medical College of Wisconsin and has been in practice 10 years. He also speaks multiple languages, including Spanish. He specializes in addiction and psychosomatic medicine and is experienced in depression, bipolar disorder, schizophrenia, cognitive disorders, and behavioral neurology/neuropsychiatry. He is adept at using neuromodulation techniques like ECT and TMS.

    Topic: ACMI Stakeholder’s Meeting

    Time: January 3rd,, 2023 04:00 PM Arizona

            Every month on the First Tue, until Dec, 25th, 2023,

    • January 3rd, 2023 04:00 PM
    • February 7th, 2023 04:00 PM
    • March 7th, 2023 04:00 PM
    • April 4th, 2023 04:00 PM
    • May 6th, 2023 04:00 PM
    • June 6th, 2023 04:00 PM
    • July 11th, 04:00 PM
    • August 1st, 04:00 PM

    Please download and import the following iCalendar (.ics) files to your calendar system.

    Monthly: https://us02web.zoom.us/meeting/tZIudu6vqDspHdaOPI66YyVO1EYY3UYrWtCI/ics?icsToken=98tyKuGurTotHdKVsx6FRpwAA4j4KO3wpmJegqdcsy_MVXZqezXZZ8d7C-FKKcrn

    Join Zoom Meeting

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    Meeting ID: 863 1776 0372

    Passcode: 795774

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    Meeting ID: 863 1776 0372

    Passcode: 795774 Find your local number: https://us02web.zoom.us/u/kc1xiBw0Jl

    ACMI Giving Tuesday
    #GivingTuesdaysACMI

    Today is Giving Tuesday! Launched in 2012, Giving Tuesday is known as the global day of giving. Please join us in advocating for people with serious mental illness by showing your support. ACMI is Arizona’s most influential advocacy organization for people with serious mental illness. People like you have donated money to help ACMI reach our previous goals. Every dollar counts! Please consider what can you can contribute.

    Today only, a generous donor is matching all gifts made, dollar-for-dollar, up to $10,000!