ACMI ADVOCACY TO IMPROVE  PUBLIC HEALTH AND SAFETY

BY IMPROVING THE SMI SYSTEM OF CARE

ACMI has a proud history of advocacy to protect the rights of those living with SMI and to expand innovative services, housing, and inpatient and outpatient treatment options for these individuals.   A robust, evolving system of care is in the interest of patients, families, and society. A stronger care system for those living with SMI promotes public health and safety. ACMI strives to assure that such a system of care exists in Arizona and that it operates transparently, is accountable to taxpayers, and is respectful of patients and families.  

ACMI Board Members are active policy advocates. Every member of ACMI’s Board has testified to committees at the Arizona legislature …. often remaining at the Capitol late at night to cover hearings. ACMI Board Members draft bills “from scratch” and assist others — on a bipartisan basis — in drafting and revising bills.   ACMI Board Members regularly meet with the leadership of Arizona’s legislature, the governor’s office, the executive branch, and regulatory agencies. ACMI successfully advocates growth and change in Arizona’s system of care through relationships, technical legal work, and policy analysis.

This year, the Arizona legislature passed — and Governor Ducey signed — six important bills that improved multiple aspects of Arizona’s SMI system of care. These change aspects of how the SMI system functions daily. For example, these bills strengthen patient privacy and confidentiality. They expand transportation options for individuals requiring screening and evaluation and create new treatment options for incompetent/non-restorable individuals. Most impressive, these bills were amended several times to reflect informed analysis and compromise among stakeholders, often from across the state. 

Five of this year’s mental health bills were sponsored by Senator Nancy Barto, who has long been Arizona’s strongest legislator in mental health.   In response to growing publicity and concerns about the quality of care and safety at the Arizona State Hospital, in 2022, Karen Fann, President of the Senate,  introduced a “leadership” bill to improve the Arizona State Hospital administratively. 

Ultimately, and reflecting growing acknowledgment of the importance of mental health to public health and safety, there were no “close” votes on any of the SMI bills introduced in 2022. Some bills passed unanimously. The Republican (Majority) and Democrat (Minority) caucuses recommended each bill as a “do pass.”   Governor Doug Ducey promptly signed all.   As the summer of 2022 draws to an end, ACMI is planning its legislative priorities and agenda for 2023.   We are exceedingly pleased with the results in 2022; however, much more must be done. As Winston Churchill said, “Success is not final; failure is not fatal: It is the courage to continue that counts.”  

                                                Holly Gieszl and Josh Mozell

                                                On behalf of the ACMI Board of Directors

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2022 LEGISLATION STRENGTHENING ARIZONA’S SMI SYSTEM OF CARE

Adopted from Summary by Deborah Geesling, P82 Project Restoration

And Former ACMI Board Member

SB1114. Court-Ordered Treatment; Case Records; Confidentiality.

Prime Sponsor: Senator Nancy Barto.

Protects privacy of individuals receiving court-ordered treatment (COT) by sealing court records. Modifies application requirements for emergency admissions for court-ordered evaluation. Outlines circumstances in which courts have concurrent jurisdiction over a patient subject to court-ordered treatment.

SB1210. Mentally Ill; Transportation; Evaluation; Treatment; Law Enforcement; Title.                                                   

Prime Sponsor: Senator Nancy Barto.

Allows a court, admitting officer, mental health treatment agency or evaluation agency to authorize apprehension and transportation of a patient to an evaluation agency by an authorized transporter instead of law enforcement. Helps assure transport of individuals with SMI in a more humane, less traumatizing, and potentially less expensive way. Permits law enforcement to focus more on their primary jobs, not transporting individuals with SMI unless necessary for safety. Establishes a Study Committee on Alternative Behavioral Health Transportation.

SB1310. Dangerous; Incompetent Person; Evaluation; Commitment. 

Prime Sponsor: Senator Nancy Barto.

Establishes procedures regarding detainment, commitment, conditional release, and discharge of criminal defendants deemed incompetent, non-restorable, and dangerous. Outlines requirements for treatment of committed defendants. Requires a court to admit individuals who are not-competent, not-restorable, and dangerous into a secure residential behavioral health facility.

SB 1392. State Hospital; Placement; Court-Ordered Treatment.

Prime Sponsor: Nancy Barto

Removes red tape when patients need a higher level of care at the State Hospital. Allows medical director of local mental health treatment agency that is assigned to supervise and administer patients’ treatment program to request the court to order a patient placed in the Arizona State Hospital (ASH).

SB1444. State Hospital; Administration; Oversight. 

Prime Sponsor: Senator Karen Fann.

Reforms Prohibits administration and employees of the Arizona State Hospital (ASH) from retaliating against a patient due to family participation in Arizona State Hospital Independent Oversight Committee (ASH-IOC) meetings. Requires the ASH CEO/Superintendent and CMO to attend and participate in ASH-IOC meetings. Directs ASH administration to develop and implement an innovative clinical improvement and human resources development plan. Modifies membership and duties of the Joint Legislative Psychiatric Hospital Review Council (Council).

SB1651. Behavioral Health Expenditures; Behavioral Health Services; Public health &  Safety; Serious Mental Illness; AHCCCS Annual Report. 

Prime Sponsor: Senator Nancy Barto.

Requires Arizona Health Care Cost Containment System (AHCCCS) to annually report outlined statistical information relating to expenditures, services, and outcomes of services provided to individuals living with SMI. Provides baseline and provisions for longitudinal analysis.

The first Tuesday of each month from 4-6 pm Arizona time except for holiday weekends.

We will have a featured guest that will discuss a relevant Behavioral Health topic, followed by discussions with attendees on current issues with the Behavioral Health System. This month learn about our AHCCCS (Medicaid) eligibility rules.

AHCCCS eligibility specialists Brandon Ruiz and Julie Swenson will discuss Medicaid eligibility rules and review common misconceptions.

Topic: ACMI Stakeholder’s Meeting

Time: August 2, 2022 04:00 PM Arizona

        Every month on the First Tue, until Jan 3, 2023,

    Aug 2, 2022 04:00 PM

        Sep 6, 2022 04:00 PM

        Oct 4, 2022 04:00 PM

        Nov 1, 2022 04:00 PM

        Dec 6, 2022 04:00 PM

        Jan 3, 2023 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

https://us02web.zoom.us/j/86317760372?pwd=MUJLZnl3cTFqSDRrbllmOUI0Sk82Zz09

Meeting ID: 863 1776 0372

Passcode: 795774

One tap mobile

+16699006833,,86317760372#,,,,*795774# US (San Jose)

+12532158782,,86317760372#,,,,*795774# US (Tacoma)

Dial by your location

        +1 669 900 6833 US (San Jose)

        +1 253 215 8782 US (Tacoma)

        +1 346 248 7799 US (Houston)

        +1 312 626 6799 US (Chicago)

        +1 929 205 6099 US (New York)

        +1 301 715 8592 US (Washington DC)

Meeting ID: 863 1776 0372

Passcode: 795774

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

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by Andy Arnowitz, Information & Resources Coordinator Copa Health

SMI Advocacy Guidelines Presentation Video – YouTube

This video is the presentation I did at the 2022 Mercy Care Connections Conference on highlights from the paper I wrote, “Advocacy Guidelines for Working With a SMI Clinic, or Others (How to Achieve the Desired Result).”  

And the paper is available to read, print or download at this link: 

Advocacy Guidelines for Working With a SMI Clinic, or Others (How to Achieve the Desired Result)

Please feel free to share this with anyone advocating in the SMI system.

The first Tuesday of each month from 4-6 pm Arizona time except for holiday weekends.

We will have a featured guest that will discuss a relevant Behavioral Health topic followed by discussions with attendees on current issues with the Behavioral Health System. This month learn about our mental health court from Judge Sarah Selzer.

Commissioner, Superior Court of Arizona, Maricopa County
Sarah E. Selzer is a Superior Court Commissioner and presides over
civil mental health proceedings for patients in the Valleywise Phoenix-
Annex hospital and at the Arizona State Hospital.

After graduating from the University of Arizona’s James E. Rogers
College of Law, Sarah began her legal career by clerking for Judge
Patricia K. Norris on the Arizona Court of Appeals. She subsequently
worked in the non-profit, government, and private sectors: she practiced
commercial litigation at Lewis and Roca, represented licensing agencies
at the Arizona Attorney General’s Office, worked as a career law clerk
for a U.S. Magistrate Judge, and was Associate General Counsel for
Chicanos Por La Causa.

Sarah has served on the board of Trees Matter and the Maricopa Chapter of the Arizona Women
Lawyers Association as well as various committees for the Osborn and Creighton school
districts. Sarah studied environmental science at Wellesley College and she recently completed
a master’s degree in educational policy from Arizona State University.

Topic: ACMI Stakeholder’s Meeting

Time: July 12, 2022 04:00 PM Arizona

        Every month on the First Tue, until Jan 3, 2023,

Jul 12, 2022 04:00 PM

        Aug 2, 2022 04:00 PM

        Sep 6, 2022 04:00 PM

        Oct 4, 2022 04:00 PM

        Nov 1, 2022 04:00 PM

        Dec 6, 2022 04:00 PM

        Jan 3, 2023 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

https://us02web.zoom.us/j/86317760372?pwd=MUJLZnl3cTFqSDRrbllmOUI0Sk82Zz09

Meeting ID: 863 1776 0372

Passcode: 795774

One tap mobile

+16699006833,,86317760372#,,,,*795774# US (San Jose)

+12532158782,,86317760372#,,,,*795774# US (Tacoma)

Dial by your location

        +1 669 900 6833 US (San Jose)

        +1 253 215 8782 US (Tacoma)

        +1 346 248 7799 US (Houston)

        +1 312 626 6799 US (Chicago)

        +1 929 205 6099 US (New York)

        +1 301 715 8592 US (Washington DC)

Meeting ID: 863 1776 0372

Passcode: 795774

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

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The first Tuesday of each month from 4-6 pm Arizona time.

We will have a featured guest that will discuss a relevant Behavioral Health topic followed by discussions with attendees on current issues with the Behavioral Health System. This month learn about Community 43, which is Phoenix’s Fountain house.

Since its inception, Kara Cline has been Community 43’s, Chief Executive Officer.  Kara Cline has a long career in leadership positions in the valley.

She will discuss the Fountain house model and programs offered by Community 43, the referral process, some cool events, and what is different about the Fountain house model. It is fine if you are currently in another program for supported employment or have a fantastic clinical team and do not wish to change, maybe there is an event for you.

Topic: ACMI Stakeholder’s Meeting

Time: June 7, 2022 04:00 PM Arizona

        Every month on the First Tue, until Jan 3, 2023,

        Jun 7, 2022 04:00 PM

        Jul 5, 2022 04:00 PM

        Aug 2, 2022 04:00 PM

        Sep 6, 2022 04:00 PM

        Oct 4, 2022 04:00 PM

        Nov 1, 2022 04:00 PM

        Dec 6, 2022 04:00 PM

        Jan 3, 2023 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

https://us02web.zoom.us/j/86317760372?pwd=MUJLZnl3cTFqSDRrbllmOUI0Sk82Zz09

Meeting ID: 863 1776 0372

Passcode: 795774

One tap mobile

+16699006833,,86317760372#,,,,*795774# US (San Jose)

+12532158782,,86317760372#,,,,*795774# US (Tacoma)

Dial by your location

        +1 669 900 6833 US (San Jose)

        +1 253 215 8782 US (Tacoma)

        +1 346 248 7799 US (Houston)

        +1 312 626 6799 US (Chicago)

        +1 929 205 6099 US (New York)

        +1 301 715 8592 US (Washington DC)

Meeting ID: 863 1776 0372

Passcode: 795774

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

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The IMD exclusion was enacted into Medicaid law in the mid-1960s. At that time public sentiment, fueled by atrocities at asylums, caused a wave of the desire for community treatment. The end result over many decades was the reduction of inpatient psychiatric beds to 5% of what it had once been; community treatment was now the answer to the treatment of persons with serious mental illness aided by the new psychiatric drugs. The problem is that it wasn’t enough and some people require longer treatment in a secure setting. This population is now overrepresented in jails, prisons (which have become the de facto psychiatric institutions of our time), and on the streets. They deserve more dignity in their lives.

ACMI feels strongly that the IMD exclusion should be repealed!

ACMI Board


Here is a nice article by Peter Earley discussing the same topic:

Posted April 15th, 2022 Advocate Tells SAMHSA To End IMD Exclusion That Prevents New Hospital Beds – Pete Earley

Untreated SMI – Courtesy of Pixabay

(4-15-22) Is the federal government’s Institutions for Mental Disease (IMD) Exclusion outdated and actually harming Americans with serious mental illnesses?

Leslie Carpenter, the co-founder of Iowa Mental Health Advocacy and a member of the National Shattering Silence Coalition, told a federal panel that advises Congress and the Substance Abuse and Mental Health Services Administration (SAMHSA) that it is.

She made her argument during the public comment session at Wednesday’s (4-13) Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).

In her remarks – limited to three minutes – she explained.

“This policy was enacted in hopes of ending atrocities occurring at our large state psychiatric hospitals by prohibiting Federal Matching Medicaid funds from being used by any facility with more than sixteen beds for people with “Mental Diseases” who are aged 18 – 64. This well-intentioned policy has been a legal form of discrimination on this population of people who have brain illnesses, which are not their fault and no one chooses, and no one deserves.

“The IMD Exclusion didn’t end the atrocities, it both relocated them and worsened them. It has resulted in 169,000 people being left untreated and under-treated across our country on our streets and unsheltered…In addition, 383,000 people with serious brain illnesses are in our jails and prisons, where far too many are untreated and, in many cases, in solitary confinement.

“And many more are dying every single day. They are clearly not better off “in the community.

“The shear fact that 51% of people with Bipolar Disorders and 40% of people living with Schizophrenia are untreated, totaling 4.2 million people should shake everyone on this committee and those listening to the core.

Representative Grace Napolitano’s bill, HR 2611, * (press release about bill below) would end the IMD Exclusion, so that federal matching Medicaid funds could be accessed for not only hospitals, but also many other facilities along the continuum of care up to and including true #HousingThatHeals. This bill now has fourteen co-sponsors and is gaining momentum.

“A recent article in Psychiatry Times is titled, “Psychiatric Care in the US: Are We Facing a Crisis?” Are you kidding me?

“We have had a humanitarian crisis for decades for people with the most serious psychiatric illnesses! Sadly, too few people know it is happening, and even fewer seem to care.

“We implore you to help us to bring this crisis both to the attention of the country and to help us to bring it to an end. It is well past time.”

Steady Decline In Beds

State hospital beds have been steadily declining since the 1960s during the deinstitutionalization era. In 1955, there were 558,922 state hospital beds. By 2005, that number had dropped to 50,509 and by 2016, the number was 37,679. According to the WHO Mental Health Atlas (2017), the median number of psychiatric beds per 100,000 population is around 50 in high income countries.  According to an article in JAMA, Journal of the American Medical Association, the US has 21 psychiatric beds per 100,000 which suggests an overall moderate shortage of beds.” JAMA adds, “There is also significant variation between the 50 US states with respect to psychiatric bed numbers.”

There are many reasons why we’ve eliminated mental health crisis care beds, but the results are the same. According to Modern Healthcare, “Psychiatric patients wait disproportionately longer in emergency departments before receiving treatment and experience longer stays compared to other patients, according to reports released  by the American College of Emergency Physicians…”Almost 21% (of responders) said patients wait up to two to five days for an inpatient psychiatric bed.” In some incidents, psychiatric patients are handcuffed to gurneys while waiting.

In the past, Congress has shown little interest in ending the IMD Exclusion. Former Rep. Tim Murphy (R-Pa.) tried to eliminate it when he wrote the Helping Families In Mental Health Crisis Act, but by the time it was signed into law during the Obama Administration as part of 21st Century Cures Act, that language had been eliminated. Democrats and groups representing individuals with lived experience argued that patients needed to be treated in community settings, not hospitals.

Sadly, what that well-intended argument misses is that when someone is experiencing a medical crisis, few community mental health providers are equipped to help them. Too often this leads to them ending up in jail.

It is encouraging that Rep. Napolitano, a California Democrat, is now pushing for an end to the IMD Exclusion, but my sources on Capitol Hill tell me there remains little interest among most of her colleagues to change the law and no interest within SAMHSA leadership. Opposition by civil rights organizations and peer groups remains high.

Rather than constantly fighting between community services and building more hospital beds, we should recognize there is a need for both. We should meet the needs of each individual based on what would best help them. Instead, we end up fighting among ourselves for table scraps.

Thank you Leslie for your public comments and your ongoing efforts to improve our system.

News release about Rep. Grace Napolitano’s bill.

Napolitano’s Increasing Behavioral Health Treatment Act Supported by LA County Board of Supervisors

April 20, 2021Press Release

WASHINGTON, DC – Today, the Los Angeles County Board of Supervisors unanimously moved to support Rep. Grace F. Napolitano’s H.R. 2611, the Increasing Behavioral Health Treatment Act. The bill would repeal the Medicaid Institutions for Mental Disease (IMD) payment prohibition and require states to submit a plan to: increase access to outpatient and community-based behavioral health care; increase availability of crisis stabilization services; and improve data sharing and coordination between physical health, mental health and addiction treatment providers and first-responders.

“Medicaid is the largest payer of mental health services in our country, and expansion of this critical coverage is long overdue,” Napolitano said. “Without in-patient beds, individuals experiencing mental health crisis are often released from emergency departments and forced to deal with their illness without professional care. They tragically too often end up in prison or on the streets, which not only worsens mental health conditions, but increases the cost of care to the state and the federal government. Providing relief from the IMD payment prohibition would finally give California and other states the ability to use federal funds to cover Medicaid-eligible individuals in need of behavioral health treatment. I thank the Board of Supervisors for supporting my legislation and recognizing that we must do all we can to provide life-saving care to any resident in need.”

“Through my motion, unanimously approved today, the Board of Supervisors will send a 5-signature letter in support of H.R. 2611, the Increasing Behavioral Health Treatment Act, introduced by Representative Grace Napolitano,” said Supervisor Kathryn Barger, Los Angeles County Board of Supervisors, 5th District. “This is important federal legislation that will help provide adequate inpatient or residential mental health treatment beds for individuals between the ages of 16-64 in need of critical services.  I am grateful for Representative Napolitano, who shares my commitment and dedication for providing compassionate mental health care, and ensuring individuals receive the most appropriate care in the most appropriate setting.

The IMD payment prohibition is a long-standing policy that prohibits the federal government from providing Medicaid matching funds to states for services rendered to certain Medicaid-eligible individuals, age 21-64, who are patients in IMDs. The term “IMD” is defined as a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.

“Repealing the IMD exclusion is not only necessary to address the mental health care needs of individuals requiring and deserving adequate residential services to heal, it is also an important step in resolving both the critical parity gap between physical and mental health care that continues to plague this field from a fiscal perspective, as well as the societal stigma that interferes with access to treatment at the expense of those most impacted by brain illness,” said Dr. Jonathan Sherin, Director of Los Angeles County Department of Mental Health.

LA County Board of Supervisors Letter Supporting H.R. 2611

5sigletterSupportforHR2611(Napolitano).pdf

PDF icon5sigletterSupportforHR2611(Napolitano).pdf

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. People like you have donated money to help ACMI reach our previous goals. Ever dollar counts! Please consider what can you can contribute.

Today only, a generous donor is matching all gifts made, dollar-for-dollar, up to $15,000!