This study examines how housing and in-home supports affect public spending on individuals with chronic mental illness in Maricopa County, Arizona.
It does so through a comparative analysis of average costs per person per year across three housing settings: permanent supportive housing, housing with unknown in-home support, and chronic homelessness.
Specifically, it analyzes costs for housing, health care, and criminal justice during the period of 2014-2019. It also features a small-sample (small-N) case study of a housing setting that provides individualized, 24/7 in-home support to individuals with chronic mental illness (CMI) who have high support needs, examining average costs per person before and after moving into that setting (2016-2019).
Finally, the study outlines recommendations from interviews with dozens of experts who work with and care for individuals with CMI in Maricopa County about reducing costs and improving care.
James Lee Carr, Photo courtesy of Maricopa County Sherriff’s office
Last Tuesday my husband called as I dropped our son off at his group home after spending the morning shopping and enjoying coffee together. He wanted to know where we were, and I could hear the unease in his voice. An officer had just been shot outside of a Federal court building in downtown Phoenix and given the recent escalation in violence, I could understand his concern.
We now know that this incident had nothing to do with our current political climate, but it had everything to do with another person with under-treated mental illness that resulted in a violent outcome and a ruined life. James Carr will likely be forgotten and spend the rest of his life in prison. A Federal court officer’s life has been significantly altered.
What can be done to decrease the number of heartbreaking tragedies? We need a laser-like focus on policy and resource efforts toward the gaps in care for those with more chronic forms of mental illness and who are most at risk. This is why ACMI is committed to the following solutions:
a person-centered culture (instead of a program-centered),
financial & other incentives, based on performance & outcomes, for providers to better serve this population;
more Lighthouse- like homes, i.e. community living properties with 24-hours per day and 7-days per week supportive staff inside these properties,
humane, well-regulated facilities for a secure residential treatment, involuntary as medically appropriate, for those who need more intensive care for a longer period of time to gain insight and continue their recovery in a less restrictive setting; and,
other possible solutions that include increasing capacity and oversight at the Arizona State Hospital.
I will continue to spend every Tuesday with my son who has a chronic mental illness because he is one of the fortunate few whose family has been able to obtain these appropriate and humane levels of treatment and support. Sadly, James Carr’s family will only be able to visit him in prison along with so many other people in this same situation. We must do better in order to prevent these needless tragedies and keep the general public safe.
Arizona State University Watts College of Public Service and Community Solutions and its Morrison Institute for Public Policy proposes a new approach to describing the costs associated with chronic mental illness. Rather than a top-down analysis that estimates the overall cost of CMI across the state, this analysis will utilize a bottom-up approach that will examine the costs associated with the individuals with a CMI as they move through Arizona's criminal, public benefit, and physical and behavioral health systems. This approach lends itself to a highly-graphic system map and/or flow charts that could be enhanced with animation for use in PowerPoint display. For this study's purposes, chronic mental illness will be defined as a subset of the population with serious mental illness that is unable to settle into a stable living arrangement. The symptoms and behaviors exhibited by people with CMI make it difficult for them to remain either in an independent household or group housing for an extended period. This instability leads to the frequent use of high-cost services from various medical, behavioral, and criminal justice resources. The total costs of CMI are challenging to calculate because they are spread over an extensive network of services, and the nature of CMI means that these services are repeatedly accessed. Recognizing that each individual will process through this system in a slightly different matter, we will take a bottom-up approach to estimate these costs, focusing on the values of an individual at each node of the system.
We will hold a meeting to reveal the study findings. Subscribe to our newsletter for notification.
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