Amy Davis , Honorable Mention Award, 2005-2006
Young Steward of Public Policy
Honorable Mention 2005-2006
"Mental Illness Healthcare in the State of Arizona: Community Awareness"
By Amy Davis
Horizon High School
"Mental illness, according to the National Alliance for the Mentally Ill (NAMI), is any disorder to the brain that can "disrupt a person's thinking, feeling, moods, ability to relate to others and capacity for coping with the demands of life." Arizona's current system for providing treatment to citizens afflicted with mental illness is inadequate. This population, often subject to stigmas and disenfranchisement, deserves access to treatment for their illnesses on par with those suffering from traditional medical problems such as diabetes or heart disease.
The turmoil surrounding mental healthcare in Maricopa County began in 1981 with a class action suit filed on the behalf of mentally ill adults. The case, Arnold vs. Sarn, demanded equal and adequate treatment for every mentally ill individual within the state with an idealistic goal of providing 'community-based' healthcare. Although Arnold vs. Sarn attempted to set the precedent concerning who should be provided for within the state's healthcare system it has yet to be settled. The general goal stated by the case is unfortunately too broad for current Arizona policy makers to enforce effectively. While the case may have set the precedent, its execution is hindered by the public stigma associated with mental illness which limits the decision's effectiveness.
The current mental healthcare services of Maricopa County are in need of evaluation and revision. The projected objective is to maximize the impact of the limited number of resources available to the greatest number of patients. Within Maricopa County resides the largest proportion of the state's population, and among this population roughly 12,000 are classified as being severely mentally ill, or SMI. The mental healthcare system has undergone numerous relatively unsuccessful changes in an attempt to find the best way to serve the rapidly expanding population.
In 1989, the state began to focus on the issue and the ultimate solution to the mental healthcare dilemma. The creation of the RBHA system, Regional Behavioral Health Authority, allocated and controlled the necessary funds for the five districts of Arizona. Also, Maricopa County contracted Comcare, a nonprofit behavioral health service provider, to control the mental health system for the entire county. However, in 1997, Comcare declared bankruptcy protection with a $20 million dollar debt. At this point, the Arizona State Department of Health stepped in to provide care to low-income and indigent patients. With the collapse of Comcare, the healthcare system of Arizona was put on emergency status. Now, ValueOptions, a Virginia based for-profit contractor, is the primary contracted organization taking responsibility for the care of the seriously mentally ill citizens in Maricopa County. Unfortunately, the population of Maricopa County overwhelms the services that ValueOptions provides, and the program is subject to scrutiny and further criticism for its inefficiency.
With the movement to deinstitutionalize care across the nation, treatment for mentally ill persons lies within every community. Deinstitutionalization refers to the practice of removing residential care from hospitals and placing the displaced seriously mentally ill patients within the community, in effect necessitating the creation of community based healthcare for the severely mentally ill. The assumption of this is that it is more cost effective and humane to move in this direction. However, the unintended reality of this deinstitutionalization of mentally ill people is the increase of incarcerated mentally ill persons. Until the stigmas surrounding mental illness are addressed, deinstitutionalization cannot possibly provide sufficient care. The heart of the issue lies within the idea that a community based healthcare system cannot exist until the rest of the community is willing to embrace and aid those who are SMI.
While a mentally ill person will always face the challenges of his illness, improvement in care must start with a foundation of adequate social support, removal of stigmatization, and greater community awareness. Creating a larger social awareness of mental illness and allowing the full implementation of the spirit of the Americans with Disabilities Act to individuals with mental illness will move Arizona closer to what was originally outlined by Arnold vs. Sarn. Without a caring community foundation, no other structure can stand."