Thousands of Arizona's most behavioral-health care for severely mentally ill lost a about 70,000 people in wide range of treatment and Maricopa County, has tracked services last year when the the rates of incarceration, state made deep budget cuts. hospitalization and other key Some of them are getting indicators for those with along, and others have serious mental illness who deteriorated. But how they lost services last July. are doing as a whole is Magellan's analysis shows an uncertain. increase in the incarceration To help close a billion- rate and a decrease in dollar budget gap, state psychiatric hospitalization lawmakers and Gov. Jan Brewer during the first year of cuts. eliminated all but generic The rates don't account for drugs and crisis services, the declining numbers of effective July 2010, for 12, seriously mentally ill people 000 people diagnosed with on their rolls. serious mental illnesses who Magellan Arizona CEO Richard don't qualify for Medicaid. Clarke acknowledged that Here's what was lost in hundreds of people have mental-health care dropped out of sight. But State health officials say among the nearly 6,000 in the the public mental-health county who continue to check system and the people it in at area clinics and serves have weathered the receive mediation, he said, cuts without significant most appear to be managing. incident, largely because of "The system is doing an a beefed-up crisis-response extremely valiant job of system. People may be on the keeping individuals from brink before they get help, deteriorating," Clarke said. officials say, but most "We're making the best of a appear to be getting it. bad situation." But many of those directly 'In really bad shape' Those affected, and the people who who treat the mentally ill care for them, say the loss say the cuts have hurt people. of services has caused harm They point to growing numbers to people, including hundreds of people with mental illness who have become incarcerated, showing up in emergency rooms, hospitalized due to psychotic psychiatric hospitals and breakdowns or fallen through jails. the tattered safety net and Patients have suffered from disappeared. adverse reactions to generic "This violates every rule of drugs and quit taking them or public health care," said Dr. spiraled into paranoia and Jason Caplan, a psychiatrist psychosis when the generic at St. Joseph's Hospital and drugs didn't work. Some have Medical Center, where resumed abusing alcohol or emergency-room psychiatric drugs. consultations have spiked by "The most tragic thing for me, 40 percent since last spring. as a professional, are the "It may improve the state's folks who had been previously bottom line in the short term, stable," Caplan said. "The " Caplan said. "In the long symptoms that had previously term, this is going to raise been treated emerge. They the price of health care for begin hallucinating. They everybody." become paranoid. They become A lack of comprehensive data manic." makes it difficult to measure In the past, Caplan could the true impact of the cuts, call a clinic and find a case which saved $50 million in manager to advise him on the fiscal 2011. patient's medical history, The state does not keep track including medications. Now, of how many of the seriously he said, for a growing number mentally ill who lost of patients, there is no one services in July 2010 have to call. been homeless, jailed or Dr. Chris Carson, who runs treated in psychiatric the Valley's only walk-in hospitals. Nor do health urgent psychiatric-care officials know why thousands center, said the medication of people no longer are switch has caused trouble for accepting any state services patients, who have and are unaccounted for. experienced everything from Based on the few items the weight gain and drowsiness to state tracks, including full-blown psychosis. complaints about services, "I just believe that it was spending by service providers, wrong to take a person off a mortality and calls to crisis medicine they've been stable hotlines, state on for years and then watch administrators say patients, them deteriorate," Carson for the most part, have said. adapted. Business at Carson's Urgent "There has been no concerning Psychiatric Care Center has trend there," said Dr. Laura increased steadily - growth Nelson, an assistant director that mental-health advocates for the Arizona Department of believe is directly tied to Health Services who oversees the budget cuts. The facility the state's behavioral-health provides emergency crisis system. "The system is not stabilization and is one of experiencing a crisis as a two urgent psychiatric result of this." centers in the Valley. The budget cuts Last year, "We see people who are in a Brewer and state lawmakers great deal of distress cut funding for adults because they lost those diagnosed with serious mental services," said Carson, CEO illnesses, such as of Connections AZ. "There are schizophrenia and bipolar not huge numbers of them, but disorder, to help bridge the they are in really bad shape." fiscal 2011 budget deficit. Data is lacking Magellan has The decision affected people tracked rates of whose income, often from incarceration, Social Security disability hospitalization and other checks, put them just over data for this population the federal poverty level of during the past year, but it $10,890 a year and made them doesn't paint a complete ineligible for the Arizona picture. It's unclear what Health Care Cost Containment happened to people who have System, the state's Medicaid disappeared from the system. program. From June 2010 to June 2011, As a result, more than 12,000 the number of seriously adults lost state funding for mentally ill people being brand-name medication, case treated with state funds who management, therapy, housing, are ineligible for Medicaid transportation, dropped by 15 percent, or hospitalization and other slightly more than 2,000 benefits. people, to 11,156. The state forced them to In Maricopa County, nearly 1, switch to cheaper, generic 600 fewer people were psychoactive medications, receiving services, for a 21 stripped them of the case percent decrease, according managers they routinely to state data. turned to for guidance, took They could have moved out of away their bus passes, ended state or completed treatment. their counseling sessions and Mental-health advocates fear uprooted hundreds from their the declining numbers signal homes. that a growing number of This group continues to people have pulled away, receive state coverage for potentially becoming more of psychiatric assessments, a danger to themselves than monthly medication check-ups to others. and associated laboratory and "We have so little nursing costs. information about what's Brewer, a longtime advocate happening to these people. for the mentally ill, said at They're like missing in the time that the decision to action," said Michael cut funding for this Franczak, a longtime state population was gut-wrenching. behavioral-health Mental-health experts say administrator, now chief it's difficult to overstate operations officer with the the importance of case Marc Center in Mesa. managers, therapy and other Franczak and others who work support services for someone with the mentally ill say with a serious mental illness. research shows people who "We have many years of don't receive support experience that demonstrates services, beyond medication, quite clearly that if you are more likely to suffer don't provide that kind of from repeat hospitalizations structure, they will simply and homelessness or wind up fall between the cracks," in jail. said Dr. Paul S. Appelbaum, a "These people did not go away, Columbia University " he said. "They went into psychiatry professor and past higher levels of care in president of the American terms of cost." Psychiatric Association. Maricopa County's Desert Putting out fires State Vista Behavioral Health health officials and mental- Center, a 125-bed psychiatric health providers acknowledge hospital in Mesa, has seen that some people have stopped the number of people coming to their assigned involuntarily admitted for health clinics and may not be court-ordered evaluations receiving any treatment. increase by more than 50 Lawmakers earmarked an percent in the past year. additional $16 million to During July, 286 people were enhance the state's crisis- admitted to the psychiatric response system in hopes of hospital, compared with 188 hanging on to as many as in July 2010. possible. Judges order psychiatric A statewide network of evaluations for people deemed hotlines and mobile teams a danger to themselves or answers urgent calls for help, others, or who are considered while a "warmline" fields "persistently and acutely less pressing problems, such disabled." as a conflict with a roommate But CEO Gene Cavallo said he or finding a free meal. doesn't know how much of that Typically, a two-person growth is from the group that counseling team will be lost benefits. dispatched to meet callers The number of inmates in the and defuse the most serious Maricopa County jail system situations. About 60 teams a who have received state- day are dispatched in funded services for serious Maricopa and Pima counties. mental illness has increased "The system as a whole did by about 20 percent over the what we could to put out the past year, to an estimated fires," said Suzanne Rabideau, 375 people on any given day. whose Crisis Network The numbers are up this year contracts with the state to even as the number of inmates provide telephone and in- has declined. person crisis-response in Dr. Dawn Noggle, mental- Maricopa and Pima counties. health director for the "It's just that people's county's Correctional Health lives had to deteriorate Services, said she can't before we could respond." determine how many of these The number of calls to mental- inmates lost state services. health crisis hotlines across It's possible that her staff, Arizona was 26.3 percent which has grown, may now be higher in May 2011 than in better equipped to identify July 2010. the mentally ill and that Nelson said the higher call could explain the increase. volume and the fact that the Mental-health advocates say vast majority of calls are the full impact of the budget handled solely over the phone cuts on Arizonans with without dispatching a mobile serious mental illness has team indicates that the yet to be seen. crisis network is meeting the "What we've been saying is needs of those who lost it's going to be a slow train services. People are reaching wreck," said Ann Rider, out and getting help. executive director of "If you're not able to solve Recovery Empowerment Network, the call on the phone, that which include five support would suggest the acuity is centers in metro Phoenix. much higher," Nelson said. "People don't deteriorate Magellan Health Services of overnight. They deteriorate Arizona, a for-profit state over time." contractor that oversees
Tags: critics, cuts, disagreeing, health, impact, Mental, state
