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. 

    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

    Every month on the First Tuesday until December, 25th, 2023,

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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.

    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,

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    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!

    Research shows that leaving a person with untreated psychosis can have long-lasting dangerous implications. Early and consistent treatment has been shown to produce the best long-term outcomes. Dr. Lisa Dixon of Columbia University medical center articulates the balance a psychiatrist must consider in determining the best treatment options.

    Laurie Goldstein

    This was originally published on October 29, 2019, and it is relevant today. Dr. Dixon Says Going Upstream Is Right but Not Without Risk – #CrisisTalk (crisisnow.com)

    Dr. Dixon Says Going Upstream Is Right but Not Without Risk

    Researchers, over decades, have found a robust association between the duration of untreated psychosis (DUP) and outcomes. When measuring the period between the onset of psychosis and treatment, they consistently find that the longer the duration, the worse the outcome overall. Peeling back the layers of first and new episode psychosis often leaves researchers with more questions, including whether antipsychotics are neuro-protective or -toxic, or both depending on the person, and what constitutes treatment. Lisa Dixon, M.D., M.P.H., a Professor of Psychiatry at the Columbia University Medical Center, says it becomes messy. “Treatment marks the end of the DUP, but what defines treatment? Would it include a person admitted to the emergency department who receives two-days worth of antipsychotics but no further treatment? It gets murky, making it essential to get into the details.” 

    Dr. Dixon says while recent studies have used a broader definition of treatment, for the most part, the end of the DUP means the use of antipsychotic medication, and what remains a consistent finding is that the longer the period of untreated psychosis, the poorer the outcome over the short and long term. She’s careful to point out that correlation doesn’t mean causation but says there’s no need to invoke causation to justify intervening early and shortening a person’s length of psychosis. “Who wants people struggling with the pain, fear, anxiety, and terror of psychosis without support and treatment? In 99 out of 100 people, it’s safer, more ethical, and better for us to treat the person earlier.” Once psychosis has been around for a certain amount of time, researchers think it can’t be fully treated or undone. Dr. Dixon says that similar to a tumor that grows and grows: once metastasized, psychosis becomes harder to control. This indicates that there might be a critical period where, if intervention happens early enough, it could potentially alter the course of the disorder. She says people deserve early identification and effective treatment that is person-centered and recovery-oriented. 

    Early detection is a general principle that’s being applied to many illnesses in medicine and psychiatry, and it stands to reason that for many, if not most, disorders that detecting early will provide some benefits. At the same time, there are many conditions where premature action can be harmful, and watchful waiting would have better. Dr. Dixon says psychosis and schizophrenia can have a traumatic impact on a person’s life, and the early and first episode programs have successfully helped to change the lens, giving hope that people can live with these disorders successfully and meaningfully. “It’s our duty to provide services that do so maximally, but we shouldn’t ignore the potential problems associated with it.” 

    Dr. Dixon highlights that going upstream can have an adverse impact if not implemented thoughtfully. In the movement toward early intervention, there is great excitement in the mental health field around whether identification could happen early enough to prevent onset. The problem, says Dr. Dixon, is that the majority of people who exhibit attenuated psychotic symptoms that might precede the development of psychosis don’t go on to develop psychosis. “You can see how it gets complicated. Let’s say clinicians want to offer treatment that prevents psychosis to this group of people, and the treatment has toxicity or is problematic in some other way, and only 20-30% would have ever gone on to develop psychosis. It could interfere with outcomes, potentially causing problems for people who wouldn’t ever have developed psychosis.” 

    Dr. Dixon says the objective is to precisely understand the young people who are at risk, not just depend on a phenotype, and offer treatment that could change the development of the disorder. All of which should happen in conjunction with communities, schools, professionals, and families. She says some people may be more vulnerable to developing psychosis, particularly if exposed to structural and psychosocial adversity. “There’s a lot of work to be done,” says Dr. Dixon, “but those in the field need to be careful not to do more harm than good because we don’t know, and don’t have great markers at this point, to predict psychosis.” One population-based approach she thinks is up to meeting this challenge is to focus on youth mental health, including young people who may be having a prodrome, a phase that precedes psychosis. She says perhaps they won’t go on to develop psychosis, but they may have other struggles that benefit from treatment. “As long as what the clinician is trying to provide maps what the person needs, as opposed to what they are at risk for, then you are contributing to the greater good.” She notes that many, if not most, of the mental health conditions that cause pain, suffering, and disability in the world start in the late teens and young adulthood, and not just psychosis, but also depression, post-traumatic stress disorder, and anxiety. “A population-based approach to help mental health and wellness that meets the needs of all of these young people could allow the needs of a larger group to be addressed.”

    The challenge, says Dr. Dixon, is there is a fine line between identifying people who are vulnerable and stigmatizing. When talking about young people and early identification, there has to be an awareness that it can shape how they view themselves and what labels they carry as a result, both to themselves and others. What clinicians tell youths, says Dr. Dixon, must be delivered in a way that’s actionable along with adequate support to help them understand what it does and doesn’t mean. “When a clinician says to a 17-year-old, you’re at risk for having breast or ovarian cancer, that teen may begin to think of herself differently. We want to be sure that what we are telling young people about their potential risks is the correct message.” 

    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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            Dec 6, 2022 04:00 PM

            Jan 3, 2023 04:00 PM

    Feb 7, 2023 04:00 PM

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