Mark’s Story

Dr. Tim Hampton
Commander
Phoenix Police Department
Commander Tim was a high school student and a regular in my youth ministry in the early 70s. He lost his son tragically last summer. Mark took his own life. Tim currently serves with me on Congressman Salmon’s Council on Faith-Based Neighborhood Partnerships, where our primary focus is addressing the mental health care crisis in Arizona.
On June 7, 2015 Mark ended his life. He was 30 years old. The horror of mental illness is never more real than when the medical examiner’s office removes your son’s remains from your home. The reality is never clearer than when your brother, brother-in-law and stepson remove blood soaked bedding, mattress, and carpet from your son’s room. Finality of death is never more acute than when you make arrangements at a funeral home to honor your son’s life. Pain is never more overwhelming when you realize your son is never coming home.
Mark suffered from severe bipolar disorder. It is difficult to describe his mental illness without using terms of hopelessness, helplessness, guilt, shame, self-loathing, severe depression, anger, and insignificance of life. For Mark, death was always an option, and he eventually chose death because he would rather die than continue in his tortured life. Mark did not give up; he was exhausted from fighting his bipolar disorder. Mark’s psychiatrist described bipolar disorder as living with postpartum depression every day of your life. The disease creates an exaggerated irrational distortion of internal feelings which intensely distort cognitive associations and beliefs often rendering the patient incapable of sustaining a functioning life.
The last words from my son:
I’m going to kill myself tonight. I’m sorry dad. Please don’t blame yourself for this. I just can’t take it anymore. Please forgive me. I love you dad with all my heart.
Challenges Associated to Mental Health Issues in Arizona:
During 2015 Mental Health America (MHA), formerly known as the National Mental Health Association published Parity or Disparity: The State of Mental Health in America. The association was founded in 1909 and continues to be a guiding light for mental health treatment in the United States. Contributors to the study include the Center for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ), Child and Adolescent Health Measurement Initiative (CAHMI), Strategic Policy Analyst Theresa Nguyen, and many other mental health experts. Their findings are summarized below.
Overall Ranking for Mental Health Care and Access in the United States Based on 15 Measures:
According to research, 42.5 million Americans (18.19%) suffer from mental illness, and Tufts University places the percentage of mental health subjects in the U.S. at 25%. MHA provides the listed statistical data concerning Arizona. Excluded from the study were the homeless who do not stay in shelters, active duty military personnel, and subjects in jails or prison.

• Arizona is rated 51 of 51 for overall care for mental illness.
• Arizona is rated 50th for states with the highest prevalence of mental illness and lowest rates of access to care for adults.
• Arizona is rated 46th for states with the highest prevalence of mental illness and lowest rates of access to care for youth.
• The population of mentally ill in Arizona faces significant barriers to recovery.
• More than 900,000 people in Arizona suffer from a form of any mental illness, which is 18.19% of the total population.
• More than 435,000 (9.09%) of the adult population in Arizona are dependent or abuse illegal drugs or alcohol.
• More than 193,000 (4%) of adults in Arizona had serious thoughts of suicide.
• More than 143,570 (10%) of children in Arizona are diagnosed with Emotional Behavioral Developmental Issues (EBD).
• More than 40,000 (7.5%) of Arizona youth are dependent or abuse illicit drugs or alcohol.
• Ten percent of Arizona youth have attempted suicide.
• Service providers for SMI patients in Maricopa County generally fall under the umbrella of AHCCCS and Magellan. Maricopa County served 20,257 patients with SMI, expending $11,232.52 per capita (Arizona Department of Health Services (ADHS) FY 2013 Annual Report).

The Treatment Advocacy Center published More Mentally Ill Persons are in Jails and Prisons than Hospitals: A Survey of the States in 2010, and the report provides significant detail concerning the criminalization of mental illness in America, the state of mental health treatment, and information regarding Arizona’s attempt to meet the needs of the Arizona population. The findings are provided below.

• In the United States there are now more than three times more seriously mentally ill persons in jails and prisons than in hospitals.
• Twenty-four percent of inmates in jails and prisons have a serious mental illness (SMI). In 1983, only 6.4% of the prison and jail population were SMI.
• Forty percent of individuals with serious mental illness have been in jail or prison at some time in their lives.
• In 1955 there was one psychiatric bed for every 300 Americans. In 2005 there was one psychiatric bed for every 3,000 Americans.
• Our current behavioral health model in the United States now parallels the conditions of the 1840s by putting large numbers of mentally ill persons back into jails and prisons.
• In Arizona and Nevada, there are 10 times more mentally ill persons in jail and prison than in hospitals. Arizona and Nevada are far behind the times in dealing with mental illness and their ranking is at 49 and 50 across the United States.
• Arizona allocates a significant amount of budget to meet the needs of the mentally ill, but continues to provide inadequate care, which is evidenced in Arizona’s 51 of 51 rating in the United States for overall care of the mentally ill.
• Recent inspection of the Arizona State Hospital (ASH) by Federal inspectors resulted in allegations of cover ups, sexual abuse, deaths, misconduct, mismanagement and little or no accountability.

Centers for Disease Control and Prevention (CDC)

• In the United States suicide is the tenth leading cause of death for all ages in 2013; seventh leading cause of death for males, and 14th leading cause of death of females.
• There were 41,149 suicides in 2013.
• Suicide occurs at more than twice the rate as homicide in the United States.
• 77.2% of suicides occur when the subject is impaired by alcohol (33.4%), antidepressants (23.8%), and opiates (20.0%). Mental health and substance abuse are linked as causal factors for suicide.
• Suicide results in an estimated $51 billion in combined medical and work loss costs annually – annual prison costs in the United States is $70 – $80 billion.
• In 2013, 494,169 people were treated in emergency rooms for non-fatal, self-inflicted injuries resulting in an estimated $10.4 billion in combined medical and work loss costs.

Suicide – Leading Cause of Death by Age Group

• Ages 10 – 14 Third leading cause of death
• Ages 15 – 34 Second leading cause of death
• Ages 35 – 44 Fourth leading cause of death
• Ages 45 – 54 Fifth leading cause of death
• Ages 55 – 64 Eighth leading cause of death

Findings
Arizona continues to fail the residents of Arizona in providing adequate care for the mentally ill; a continual assessment since the 1960s. In 2015, Arizona ranked 51 of 51 in the United States for overall care for mental illness (MHA, 2015). In 2014 the State of Arizona settled a class action lawsuit for failure to provide adequate services for the SMI; a case originating from 1983. Interestingly, Arizona is at the top of the list for allocation of monies toward mental health care, but continues to miss the mark in providing adequate treatment for the SMI population. We spend more money without improving the system. Either Arizona is unable to locate the right personnel having the expertise to fix the problem, or cannot induce radical change at the policy and structural level to enhance evidenced-based treatment programs. Either way, the results remain constant; unacceptable.
Proposed Solutions
Much of the material provided below originates from the work of Deborah Geesling, founder of MOMI of AZ (Mothers of Seriously Mentally Ill), and President of P82 Project Restoration, Inc. Proposed solutions to enhance mental health treatment in Arizona are provided below.
Background

• A gap exists in the Arizona mental health system to meet the needs of the seriously mentally ill (SMI) – the 4% most likely to be incarcerated, homeless, indigent, and least likely to be welcomed into community programs.
• We acknowledge that Arizona is attempting to improve mental health care to less severe mental health patients through “Recovery Model” methods, the SMI population is pretty much left to defend for themselves.
• Possible solutions to attend the needs of the SMI

Support the Expansion of Residential Group Homes with 24-hour Supervision

• Current state model leans toward a “Recovery Model” that requires people to manage their own care leaving the most vulnerable (SMI) to fall through the cracks.
• SMI patients require constant supervision, do not recover quickly, and generally cannot live independently.
• Influence from the Olmstead Decision has caused the state to move too quickly in moving the SMI to independent housing without considering the patients’ needs and capabilities to survive.

Explore the Creation of “Charter Homes”

• This concept explores the possibility of creating innovative partnerships between charity, non-profits, and the state.
• The creation of Charter Homes would also foster alternative options of evidence-based care for families and patients who cannot afford high quality private residential institutions.

Create a Parent/Caregiver Bill of Rights

• Parents and caregivers must be involved in communication and treatment discussions during initial intake and creation of treatment plans. Obviously, the patient must consent, but the treatment outcomes could be greatly enhanced from valuable information the parent or caregiver may provide.
• Require physicians to make a reasonable effort to gather relevant information from the family of admitted patients. Physicians may be unaware of substance abuse, past medications, behaviors, and episodes of the patient because the patient does not reveal the information.

Provide Greater Scrutiny and Evaluation of Patients Involuntarily admitted to Hospitals before Discharge

• Patients admitted involuntarily have been adjudicated as a ‘danger to self or others.’ These patients are high risk.
• Improve evaluation and treatment plans prior to discharge, and document the findings and strategies. If the patient has failed to meet Court Ordered Treatment, document and forward to the case manager or Adult Probation Officer. The state often orders treatment, but fails to provide the funds to pay for treatment. Finally, many patients are discharged before they are stabilized.

Gap between Hospital Discharge and Community Care

• The hospital’s responsibility for the patient ends at discharge and the community program’s responsibility does not start until intake. Many patients do not make it from discharge to intake.
• Create mobile teams that ensure the patient transitions from hospital discharge to community care intake.