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.

    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.

    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.

    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 Arizona’s Central Arizona Shelter Services (CASS) and CBI

    How are we helping people with SMI at CASS?

    Dr. Vicki Phillips DSW, MSW, LSW, Chief Clinical and Development Officer

    Dr. Vicki L. Phillips, Chief Clinical and Development Officer for Community Bridges, Inc. (CBI). Her career began as a front-line worker and has evolved into a key leader in the organization. Dr. Phillips leads a collection of rural crisis solutions and peer-response models and is highly experienced in working with diverse community stakeholders to build cohesive partnerships designed to meet the unique needs of each community. She is responsible for the oversight of clinical best practices, large grants, and resource development, and housing/shelter programs.

    Lisa Glow, JD Chief Executive Officer

    Lisa Glow, JD Chief Executive Officer for CASS. With more than two decades of experience in nonprofit leadership, Ms. Glow is a graduate of the James E. Rogers College of Law at the University of Arizona. Early in her career, she practiced law with the international law firms of Gibson Dunn & Crutcher, and Steptoe & Johnson. Working for former Arizona Governor Janet Napolitano as a senior policy advisor and director of the Governor’s Office for Children, Youth, and Families, she was able to see firsthand the needs of our citizens. Ms. Glow recently ran a consulting firm providing resources and sustainability solutions to nonprofits.

    Lisa Glow (CASS Chief Executive Officer ) and Dr. Vicki Phillips (Chief Clinical Officer) CBI will talk about the homeless with serious mental illness at CASS and interventions being done with unique programs.

    They will discuss:

    Whether the demographics of homelessness changed?

    Whether they are seeing people with SMI at CASS, and what percentage (can be approximate )?

    Have they frequently seen patients coming from an urgent psychiatric center or hospital (if known)

    Do they see folks with apparent psychosis?

    What is done to try and get them into services?

    What type of services is available on site?

    Topic: ACMI Stakeholder’s Meeting

    Time: October 11th, 2022 04:00 PM Arizona

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

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    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 Arizona’s implementation of 988 (a mental health emergency line).

    988 in Arizona– Come hear about the implementation!

    Beth Brady is the chief brand and development officer at Solari Crisis & Human Services

    Beth Brady oversees Solari’s marketing, communications, development, community engagement, education and culture programs. She is a dynamic leader with clinical mental health, suicide prevention, communications and employee engagement expertise. Beth was a Phoenix Business Journal Health Care Hero Finalist and ranked as one of two top Mental Health First Aid instructors in the state of Arizona.

    Beth has been in the mental health field for more than 15 years. She is a Licensed Associate Counselor (LAC), International Council for Helplines crisis center examiner, and is trained in performing psychological autopsy investigations. Beth earned her Bachelor of Psychology and her Master of Clinical Mental Health Counseling degrees from Argosy University. She currently serves on the Board of Directors for Mental Health America of Arizona.

    Her clinical background fuels her passion for effective communications, marketing, and design to reduce the stigma of mental illness, promote well-being, and reduce mental health disparities.

    Topic: ACMI Stakeholder’s Meeting

    Time: October 11th, 2022 04:00 PM Arizona

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

          Nov 1, 2022 04:00 PM

            Dec 6, 2022 04:00 PM

            Jan 3, 2023 04:00 PM

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    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 Arizona’s implementation of 988 (a mental health emergency line).

    988 in Arizona– Come hear about the implementation!

    Beth Brady is the chief brand and development officer at Solari Crisis & Human Services

    Beth Brady oversees Solari’s marketing, communications, development, community engagement, education and culture programs. She is a dynamic leader with clinical mental health, suicide prevention, communications and employee engagement expertise. Beth was a Phoenix Business Journal Health Care Hero Finalist and ranked as one of two top Mental Health First Aid instructors in the state of Arizona.

    Beth has been in the mental health field for more than 15 years. She is a Licensed Associate Counselor (LAC), International Council for Helplines crisis center examiner, and is trained in performing psychological autopsy investigations. Beth earned her Bachelor of Psychology and her Master of Clinical Mental Health Counseling degrees from Argosy University. She currently serves on the Board of Directors for Mental Health America of Arizona.

    Her clinical background fuels her passion for effective communications, marketing, and design to reduce stigma of mental illness, promote well-being, and reduce mental health disparities.

    Topic: ACMI Stakeholder’s Meeting

    Time: October 11th, 2022 04:00 PM Arizona

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

          Nov 1, 2022 04:00 PM

            Dec 6, 2022 04:00 PM

            Jan 3, 2023 04:00 PM

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    The article which ACMI features this week will tug at our heartstrings.  And it prompts us to think about the intersectionality of homelessness, disability, and mental illness (here, paranoid schizophrenia) and the balance of individual civil rights versus our community responsibility to protect those who cannot defend themselves.   

    You see, Mr. Rippee has been on the streets for years. The streets took his sight one night after years of little treatment for his schizophrenia when Mr. Rippee wandered into traffic.  Not only did he lose sight, but he also suffered a skull fracture, brain bleed, shattered elbow, dislocated shoulder, and crushed leg.  He endured multiple surgeries. And after each bout in the hospital, Mr. Ripper returned to the streets. “Health care professionals” drove him to his favorite street corner, unloaded him physically and figuratively, and drove away. 

    While Mr. Rippee’s story is a California tale, he also would struggle to get services in Arizona. We have far better laws, but these are overlaid on a continuum of care for those living with serious mental illness that was not designed to accommodate physical and neurological co-morbidities like those that Mr. Rippee endures. My clients with SMI, plus developmental disabilities or TBI or autism, often are poorly served by their clinics. And if the client is a patient at the Arizona State Hospital, their treatment plans simply ignore their non-mental illnesses.  There is no “intersectionality” at ASH. 

    It’s time we start looking at the “red” end of the continuum of care and asking ourselves: 

    “How would Arizona help Mr. Rippee?”  I figure we can do better than California. 

    Holly Geiszl

    ACMI Board Member


    Vacaville man is blind, homeless and schizophrenic. Why can’t California help him?

    BY MELINDA HENNEBERGER UPDATED AUGUST 14, 2022 3:39 PM

    California fails to help this blind homeless man in crisis | The Sacramento Bee (sacbee.com)

    Mark Rippee, 59, blind, mentally ill and homeless, uses a broken broom stick to navigate Vacaville in the summer of 2022. He lost his vision at age 24, after a motorcycle crash caused a serious head injury. His sisters struggle to find him help. BY RENÉE C. BYER

    “I think that’s him,” Linda Privatte says as we creep down Monte Vista Avenue, looking in all the usual spots for her younger brother, James Mark Rippee, who has been living on the streets right around the Solano County Building here for 15 years now.

    It is Mark, kneeling beside the 7-Eleven, feeling around on the sidewalk for the debit card he keeps losing. One of the day laborers waiting in the parking lot next door thinks that we must be from the county and comes over to offer his own assessment: “Are you doing an evaluation? He decided to be this way. He decided.”

    A lot of us tell ourselves that as we walk on by, annoyed and alarmed, not without reason, that the number of people yelling f-bombs into traffic as they push their carts around and around just keeps growing.

    But no, Mark did not decide to lose his sight, along with part of his frontal lobe, in a 1987 motorcycle accident on his way back from a Father’s Day barbecue when he was 24. He did not decide to start hearing voices in the years that followed. He never chose to sleep in bushes instead of a bed after those voices convinced him to tear apart his garage apartment at Linda’s home; it’s just that the walls were talking to him, and he wanted to shut them up.

    Mark Rippee, 59, who is blind, rests on the ground holding a cigarette in Vacaville on July 27. He said he needs someone to give him a ride to look for apartments and a job. Renée C. Byer rbyer@sacbee.com

    He never set out to burn down two different trailers in her backyard, either, though he did start those fires. And his longstanding “decision” to refuse all psychiatric treatment has been a symptom of his schizophrenia, too.

    OPINION Yet the system, if you can call it that, has done everything to protect that decision, and nothing to protect Mark.

    As a result of that disconnect, we aren’t failing only him, but thousands of unhoused individuals across California. As is too often the case, his survival has depended on the stubborn heroism of his family, in particular his 65-year-old twin sisters. But his predicament shows that even with the strongest possible advocates, in a state willing to spend billions on this challenge, you can still be left to die on the streets. And most of all, what his story illustrates is why the “simple” solutions touted by politicians over the decades have so far solved nothing at all.

    Before Mark’s accident, he worked in construction and loved playing the guitar. More than anything else, he looked forward to getting married and raising a family in his Northern California hometown, where the population is just under 100,000 and, as of a year ago, had just under 100 homeless people.

    A family photo shows Mark Rippee before he was injured in a motorcycle crash.

    For the first 20 years after the night a car swerved into his lane on an S-curve, forcing him off a country road into an abandoned grain harvester, his family was able to care for him. Even with in-home help, this was an all-consuming effort for seven people, Linda says. “It took Cathy” — that’s Catherine Rippee-Hanson, Linda’s twin — “me, Mom, my father when he was alive, a full-time county caregiver living with him,” plus Linda’s husband and later, Catherine’s son.

    After the fires that Mark admitted were no accident, Linda still let him stay with her, because how could she turn out her own brother, the baby of the four siblings? “But different things kept happening, and I could tell that it was scaring my children and making them anxious.” Then he got his own place, and then another and another, finally losing the last one the day he threatened to kill their mother with an ax, thinking she was an impostor who had come to hurt him.

    “We called the authorities, and he went out on the porch and started a fire,” Linda says. “He lost my mom as his caregiver. He lost his housing voucher that day, and he got evicted. That’s the day he became homeless” back in 2007.

    Linda Privatte, 65, caresses her brother Mark Rippee’s hand as she gently tries to wake him up on a sidewalk in Vacaville on Aug. 1. “Is it okay for me to clean your cart out for you so I can see what you need?” she asked. Renée C. Byer rbyer@sacbee.com

    ROBBED ON THE STREETS OF VACAVILLE

    This morning, the morning I first meet Mark, who is 59 now — “as mankind measures time,” he tells me — Linda has brought him another new sleeping bag, plus bacon, eggs, sausage and a thermos of coffee the way he likes it, with half a cup of sugar. But first, he must finish his morning routine. This involves swallowing a huge mouthful of salt — “I need sodium” — and rubbing his face raw with a toothbrush. Then he pours a bottle of water over his head and his shirt, which is dotted with cigarette burns.

    Mark is not alone on the street, and his friend Teresa, who lives out here, too, shouts hello as we sit down in a shady spot to talk. Maybe to control what she can control, she’s sweeping the small strip of sidewalk in front of her with a broom.

    Other people Mark knows on this block beat and rob him on a regular basis, though, and when that happens, he says, he fights back as viciously as possible, because he wants to survive. Dangerous as his situation is, he believes that if he leaves this area right around the county building, he’ll lose the protection of the “force field” around it and will die.

    Mark Rippee brushes his teeth at a bus stop in Vacaville on July 27. Blinded after a motorcycle accident at the age of 24, he is homeless and often is beaten up and has his belongings stolen while trying to survive on the streets. Renée C. Byer rbyer@sacbee.com

    It’s beyond ironic, Linda says, that “he always comes right back to the county building — back to the people who won’t help him.” Or can’t. Over time, she’s decided that it isn’t really cruelty, or even indifference, that keeps them from doing so.

    “At first I was angry with the police, and then I figured out that they’re only following the laws, right? And then I was angry with the city, because my God, this is his hometown, where he has lived his whole life, and how can they go past him every day and not try to do something?” Now, she says, she believes that it’s laws that have to change.

    Meanwhile, authorities “don’t even go to Mark when we call. They just say we know who he is, and he has the right to refuse any services.”

    His sisters worry more all the time that it’s his “right to refuse” that will kill him. “We’re all getting older,” Linda says. “Nothing is happening, he’s getting worse, he still hasn’t been treated. He’s dying out on the streets in front of everybody.”

    The many protectors of her brother’s civil rights are adamant that he should get to choose whether to be treated for his severe mental illness, says his sister Catherine, in an interview later at her place, where she’s long been homebound by blood cancer. But as the result of his illness, he effectively “has no free will.”

    Mark Rippee’s twin sisters Catherine Rippee-Hanson, left, and Linda Privatte, both 65, say he needs treatment for his severe mental illness and feel California’s system has failed him. Renée C. Byer rbyer@sacbee.com

    Linda finds it harder and harder to get out to see him. Because she’s lost sight in one eye and has no depth perception in the other, she has never been able to drive. And many of those who used to bring her to Mark have either moved away or dropped out of her life. “Some people who took me weren’t prepared for what they were going to see.”

    Now, after not getting out here for a few weeks, Linda has lots of questions for her brother, like “what happened to your face?” and, “someone said you were asleep in the middle of the road?”

    He’s too agitated to answer, at first motioning as if reeling in a fish, and then as if punching a ghost. “I’m not a game, sir!” he yells at no one, and later explains that the voices are being broadcast from a military submarine. Using “mind warfare” that has turned “almost every single person in my life against me,” the guilty parties are, Mark believes, doing all kinds of experiments on homeless people.

    Linda has seen him in worse shape: “Some days he’s so depressed he doesn’t talk.”

    But she’s also seen him a lot better, and not that long ago. He was hit by a car in February of 2021, and after refusing treatment for those injuries, he fell and broke his hip during a rainstorm. Even then, he refused medical treatment for 25 more days. But during the long hospitalization that finally followed, he was put on anti-psychotic drugs for the first time in his life, other than during 72-hour psychiatric holds years earlier.

    Linda Privatte guides her brother Mark Rippee, who is blind and mentally ill, across an intersection in Vacaville on Aug. 1. “He has delusions that won’t allow him to leave this particular area. It’s all that he remembers before he went blind,” said Privatte. Renée C. Byer rbyer@sacbee.com

    “The 8½ months he was in there,” Linda says, “we were thinking this is it, they’re going to see that this is what he needs. Look at him, he’s clean, he’s healthy, he put on weight, we’re talking to him normal.”

    But as soon as he was well enough, “they just brought him back in a van, took him out in front of here and dropped him off” in the parking lot of the county building.

    Before his sister leaves him, he asks her to bend down, hold both of his hands and help him “unplay” several years worth of the messages he’s been sent from the submarine. “You’re saving my life right now, sis,” he tells her.

    IF HE ISN’T ‘GRAVELY DISABLED,’ WHO IS?

    It makes no sense that a man as ill as Mark is still stumbling around on his own. So why is he?

    Teresa Pasquini, a Contra Costa County activist whose son is severely mentally ill, is well acquainted with both Mark’s situation and treatment in California. And as she sees it, Mark has essentially been “locked out” by gaps that make it absurdly hard for some of those most in need of help to get it.

    In his case, that’s because as someone whose initial diagnosis was a traumatic brain injury, he supposedly doesn’t qualify for help for his severe mental illness on a medical basis. (Yes, though mental illness is a medical condition.) And in Solano County, he doesn’t qualify for a conservatorship based on his mental illness, either.

    Linda Privatte patiently waits as her brother Mark Rippee who is blind and mentally ill, rants on the sidewalk while she was visiting with him in Vacaville earlier this month. “When he was in a nursing home for 8 1/2 months he made vast improvement. We thought that was our proof that he had been treated with medication, that he had been fed and he had been housed and the difference was amazing and then they put him right back on the streets,” said Privatte. Renée C. Byer rbyer@sacbee.com

    Say what? There are two types of conservatorships in California. The probate conservatorship, which is what Britney Spears had, is more typically for someone with dementia, or some other incapacitating medical problem, who needs help taking care of himself. Those under probate conservatorships can’t be put in a locked facility against their will. Because Mark’s traumatic brain injury and blindness are considered his primary diagnoses, you’d think he’d qualify on that basis, but because he’s also severely mentally ill, he does not.

    An LPS conservatorship — named after Frank Lanterman, Nicholas Petris and Alan Short, the three lawmakers whose 1967 bill ended most involuntary commitment of the mentally ill — is for someone who is so severely mentally ill that he is either a danger to himself or others, or else is “gravely disabled.” People under this type of conservatorship can be forced into treatment.

    Yet though Mark is certainly a danger to himself, because he accidentally wanders into traffic on a regular basis, and is also what you and I would consider “gravely disabled,” he somehow doesn’t qualify for that, either.

    Mark Rippee uses a broken broom stick as a cane as he navigates along Monte Vista Avenue in Vacaville on July 27. He has been hit by cars and police have been called to rescue him after he’s walked out into traffic. Renée C. Byer rbyer@sacbee.com

    That’s because each of California’s 58 counties interprets “gravely disabled” — incapable of taking care of one’s food, clothing and housing needs — a little differently. In Solano County, a man whose clothing is covered with cigarette burns, who can’t keep housing and pushes around a cart full of rotten food is somehow seen as insufficiently compromised.

    In 2019-20, according to the Department of Health Care Services, 1,459 people were on temporary LPS conservatorships in the whole state, and 3,672 on permanent ones.

    In an email, Solano County Supervisor Skip Thompson’s office explained to Mark’s sisters that he could not be conserved because whenever he’s on even a brief involuntary hold, he improves so much that he must be released under the law: “This is not a situation that we have ignored, nor that we condone,” the email said. “Simply the law requires stringent standards to impose conservatorships — standards that so far we cannot meet.”

    “Laura’s Law,” which provides court-ordered treatment in the community for a small number of severely mentally ill people, doesn’t apply to people with traumatic brain injuries.

    SOLANO COUNTY OFFICIALS ‘DO FEEL FOR HIM’

    Solano County’s director of Health and Social Services, Gerald Huber, tells me that though Mark “may not look like it, he does have the ability to make some decisions for himself,” and that has so far made it impossible for him to get the long-term residential treatment he needs. Which, Huber adds, wouldn’t be available anyway because even the prospect of funding something like that “is pretty bleak for small counties like ours.”

    “Everybody knows Mark quite well,” Huber says, and “we do feel for him. If I hear he’s in a hospital locally, that’s when I know he’s the safest.” But then he gets well, has to be released, and quickly declines all over again. And even worse, “every county has a Mark. Every county has multiple Marks.”

    Linda Privatte said that this is where her brother Mark Rippee gets dropped off after his hospital or doctor visits in Vacaville, even though she’s told the social workers this is not where he lives. She says he has been living around this area for the past 15 or so years. Renée C. Byer rbyer@sacbee.com

    Vacaville City Councilman Nolan Sullivan, who in his day job is director of Yolo County’s Health & Human Services Agency, tells me that “it’s hard when folks have a TBI that leads to a mental decline.” But no one can say for sure that Mark would not have developed schizophrenia even if he hadn’t had that accident, right?

    True, Sullivan says. “But from what has been represented to me, Mark has declined service, and that makes it almost impossible to serve him. I’ve wracked my brain. There have been dozens, if not hundreds of attempts to help him.”

    Yet his sisters insist that he hasn’t had a proper psychiatric assessment in years, even when he was in the hospital. After they complained that he’d been arrested for nuisance crimes almost 100 times, police stopped doing that, but also stopped responding to reports of psychotic episodes, so that now, according to Linda and Catherine, he isn’t getting assessed for even a temporary psychiatric hold, much less a conservatorship.

    ‘THEY SAY IT HELPS KEEP THE VOICES DOWN’

    What a surprise, then, when on another visit with Mark, I happen to arrive just as a psychiatric physician’s assistant for the county is giving him his first long-acting shot of Seroquel, an antipsychotic drug used to treat schizophrenia. He screams for just a second as the physician’s assistant, Jaron West, does this, but Mark did agree to it, he says, because “they say it helps keep the voices down.”

    “We’ve been trying to help him for some time,” West tells me, “but the county doesn’t have any resources.”

    Mark Rippee rubs his eye socket where his eye is no longer visible while complaining that it’s gone but he can still feel something inside. He became blind at age 24, after a motorcycle accident that also caused a serious head injury. Renée C. Byer rbyer@sacbee.com

    His sisters are incredulous that he was even briefly lucid enough to say “yes” to a shot. Mark doesn’t think it will help, because “the sounds come from outside the ears.” Still, he’s very interested in the other thing that I heard West tell him, which was, “I’ll talk to Officer Potter’’ — Sgt. Aaron Potter, who heads the Vacaville Police Department’s Community Response Unit — “about that housing lottery.”

    That’s a major incentive, because as Mark sees it, “what I need instead of a bunch of blankets is rent to get into a place.” He does need that, and in fact is worse off than when last we met, because he’s recently been roughed up and rolled again, relieved even of his cane, and so is using a broken off broom handle to help him navigate.

    But without a lot more than drive-by treatment, it’ about s hard to see how Mark could possibly get and keep housing.

    It isn’t that he doesn’t know about or believe in mental illness. At one point, he even suggests that he’s actually a little worried his sisters on that front: Linda “and my sister Cathy have some kind of phobia; they always think they’re sick.”

    He just doesn’t think there’s anything wrong with him that wouldn’t be remedied by an apartment and the extermination of the extraterrestrials who are tormenting him.

    He describes his life as one perpetual “mind rape, just as bad as a woman getting brutally raped. I want privacy in the most intimate areas of my brain.”

    Yet, like all of us, Mark is also more than his problems, and he tells me several times that he still wants love: “I got desire, too. It has to have meaning. It can’t be just any girl.”

    As he walks away that day, toward the bus stop where he can sit but can’t board because the drivers have run him off so many times, his friend Jackie Burnside stops to tell me what a good friend he is. “I’m homeless, too,” she says, as the result of domestic violence and other experiences that inspired the hand-drawn tattoo on her arm: “Property of Jackie Only.”

    Mark “gets mad sometimes and yells,” she says, “but he’s a good-hearted person. When I’m hungry, he buys me food. Don’t get on his bad side, but we’ve been there for each other,” often sleeping near one another beside the tire shop, “just as friends,” for mutual protection.

    Mark Rippee shields his face from the sun while trying to take a nap in the shade at a bus stop along Markham Avenue in Vacaville last month. Renée C. Byer rbyer@sacbee.com

    CARE COURT COULD OPEN TREATMENT OPTIONS

    People like Mark are the reason that Gov. Gavin Newsom and others are pushing so hard for the CARE Courts that would temporarily mandate treatment for those too sick to know they need help.

    Thirty-four miles northeast of Vacaville, in Sacramento, we have many such severely ill people, too, of course. Elizabeth Kaino Hopper, of Carmichael, has a 33-year-old daughter who has been homeless on and off since her mental illness swamped her ability to agree to treatment. Those still capable of agreeing to treatment are the ones writing to the ACLU, she says, while “people whose illnesses are harder to treat are the voices we don’t hear.”

    Since April of this year, though, her daughter has been much better, because since her arrest for assault with a deadly weapon — “trying to protect herself on the street” — she’s been living on the third floor of the Sacramento County Jail.

    Three months earlier, a clinical social worker had assessed her daughter and found her “gravely disabled.” But when Sacramento County dispatched a fire truck — yes, a fire truck — and sheriff’s deputy to transport her, those officers said, “No, she knows her name, knows what day it is, has a box to live in and a dumpster to live out of — that’s food and housing” so she was not considered gravely disabled after all.

    As a result, Hopper was reduced to hoping that her daughter would commit a crime that hurt no one and yet was serious enough to “win the golden ticket to get to the jail,” where she’d finally be treated, monitored and often reassessed, none of which was happening otherwise.

    So yes, Hopper is a big supporter of the CARE Court idea, despite enormous pushback.

    Critics argue that forcing people into treatment would be counterproductive, a horrible civil rights violation and, what’s more, under-funded. (That last objection reminds me of the old Woody Allen joke about two friends complaining about the meals at a Catskills resort. “Boy, the food at this place is really terrible,” says one, to which the other replies, “I know, and such small portions.”)

    No one thinks such courts would constitute any kind of cure-all. But as Vacaville’s Nolan Sullivan says, it would at least open up “some new pathways” for helping in situations where right now, “localities are powerless” to intervene.

    More treatment would have to be made available, too, it’s true. Because right now, Pasquini asks, “where do you place somebody who is blind, has a traumatic brain injury and the symptoms of schizophrenia? That’s the million-dollar question. You can’t find a bed for a person with schizophrenia, let alone all those other things.”

    Mark Rippee, appears lifeless as he sleeps on a sidewalk in Vacaville on Aug. 1 when his sister Linda Privatte spotted him in the early morning. His shopping cart was filled with mostly garbage that she cleared out before giving him a hot breakfast of eggs and coffee with sugar. Renée C. Byer rbyer@sacbee.com

    Sullivan says that’s because providers have no choice but to play a numbers game: “For every Mark, you’ve got 100 people in opioid addiction, so how do you triage?”

    But there is at least a corner of hope that long-acting monthly injections, if Mark continues to accept them, could calm the voices that torment him enough to make other interventions possible.

    Kate Grammy, the Behavioral Health Services Administrator for Solano County, says that a small homeless outreach team that’s been operating for several years is, as of April of this year, working with a mobile crisis team. It’s part of a pilot program that’s shown a lot of promise elsewhere in the state. That’s the team that gave Mark his first shot.

    “I’m ecstatic with what I’m seeing,” from the new mobile crisis teams, says Catherine Moy, a city councilwoman in Fairfield, Solano’s county seat, where she ran a shelter for many years. “We piloted that program here,” starting about two years ago, “and one gentleman who had lived on the streets for years,” and became violent on a regular basis, has now been on medication for seven months, “and he no longer has that situation. It takes a long time, and it’s expensive, but I’ve seen it work, and we owe it to them.”

    It’s also expensive to go on as we have been, watching people die.

    Mark Rippee rests on the side of a bus stop after urinating outside in Vacaville on Aug. 1. “I would like to see my brother receive treatment for the no fault brain disease that he has. I would like to see him have safe housing. He just needs someone to care for him,” said his sister Linda Privatte. Renée C. Byer rbyer@sacbee.com

    Grammy acknowledges that staffing for mobile crisis teams is an issue, here and everywhere. But persistence in offering services makes a difference, which is why some people who’ve long said no to services are agreeing to work with these teams.

    Even if those teams expand, laws and attitudes will have to change, too, if we’re really going to reach those hardest to treat.

    The definition of “gravely disabled” should certainly be expanded to take account of anosognosia, a condition associated with schizophrenia, Alzheimer’s disease and other medical problems, which prevents people from understanding that they need treatment.

    And state Sen. Henry Stern’s important bill guaranteeing a right to treatment for unhoused and severely mentally ill Californians ought to be paired with the CARE Court bill, because what does mandated treatment mean if none is available?

    ‘OUR FAMILY IS HIS MENTAL HEALTH SYSTEM’

    After Mark got that first shot of Seroquel, his sisters were briefly ebullient. But then, only two days later, they got a bunch of calls reporting that he was walking on a freeway ramp straight into traffic.

    Mary Borchers, who was driving on I-80 toward Vacaville that day, tells me, “I saw a big rig slam on his brakes” on the exit, “and then I saw Mark, and holy crap, someone’s going to fricking run into him!” She called 911, was told that several others had already reported the same thing, and that California Highway Patrol officers were on their way.

    By the time she was able to circle back around to see if he was OK, he was with law enforcement who then “left him to fend for himself once again.”

    The morning Linda next sees Mark, he’s still asleep on the sidewalk and for many minutes too groggy to talk. One homeless man walking by taunts him — show these ladies your Super Bowl rings why don’t you — and another asks Linda why she can’t take Mark home with her.

    On this day, Mark urinates into a cup right in front of us, and never does come around enough to answer her questions about the Seroquel, which most likely won’t kick in for weeks.

    Mark Rippee goes behind a bus stop in Vacaville to urinate in a cup and complains there are no bathrooms near where he stays in Vacaville. Renée C. Byer rbyer@sacbee.com

    He is able to explain walking onto the freeway, though: He and a friend had been out looking for an apartment, and after that friend disappeared, he somehow got turned around and walked into harm’s way: “I was trying to get us off the street!”

    But then suddenly he’s channeling the voices he’s hearing, shouting, “Mark, goddamn you!” and “I turned the controls over to James Mark Rippee!” He is the voices, and how scary would that be?

    As we walk away, Linda is crying a little. She always feels guilty leaving him, she says, because “it makes me feel like I’m as bad as our U.S. mental health system.”

    That isn’t true, but this is: “Our family is his mental health system.’’ Until laws change, it’s the only one he’s got.

    After exchanging “I love you’s” back and forth, Linda Privatte and her brother Mark Rippee embrace in Vacaville after a visit earlier this month. “It’s hard to leave because then it makes me feel guilty and it makes me feel like I’m just as bad as our U.S. mental health system,” said Privatte. Renée C. Byer rbyer@sacbee.com

    This story was originally published August 14, 2022 5:00 AM.

    MELINDA HENNEBERGER Melinda Henneberger is The Sacramento Bee’s local columnist. She has covered crime, local and state government, hospitals, social services, prisons and national politics. For 10 years, she was a reporter for The New York Times in New York, Washington, D.C., and Rome. She won the Pulitzer Prize for commentary in 2022, was a Pulitzer finalist for commentary in 2021, for editorial writing in 2020 and for commentary in 2019. She received the Mike Royko Award for Commentary and Column Writing from the News Leaders Association in 2022 and 2019, as well as the Scripps Howard Walker Stone Award for Opinion Writing in 2018.

    Read more at: https://www.sacbee.com/opinion/article263602568.html#storylink=cpy

    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: September 6th, 2022 04:00 PM Arizona

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    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

    *****************************************************************************************************************************************************************

    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

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