A few weeks after Mary Anne committed suicide, H. Clarke Romans reflected on her life.
"She had serious mental illness with bipolar disorder and clinical depression," said Romans, executive director of the advocacy group National Alliance on Mental Illness of Southern Arizona, from his tiny, cluttered office on 22nd Street.
Despite her illness, Mary Anne was able to get by—until a recent reduction in vocational-rehabilitation support left her with too little money.
"When she lost that funding," Romans said about the middle-aged woman, "she became depressed." He believes that led to her suicide.
"Mary Anne illustrates how many of these individuals (with serious mental illness) are struggling to cope with the ordinary variables of living while trying to manage their illness," Romans continued. "They've had very difficult life struggles. ... They're not hard to topple."
That is why Romans and many others involved with behavioral health are shocked by the funding cuts coming on July 1.
Thanks to Arizona's dire budgetary situation, the Arizona Department of Health Services (ADHS) will be slashing the state dollars it provides for services for people with serious mental illness from $90 million to $40 million—a 55 percent reduction.
The people impacted most will be the serious mentally ill who—often because of the money they receive from a Social Security check—earn too much to qualify for AHCCCS, Arizona's low-income medical-insurance program.
An estimated 3,500 Pima County residents are currently eligible for a range of assistance, including case management, therapy, support-group services and medications. However, after July 1, only generic prescriptions will be paid for. Those residents on AHCCCS will continue to receive all services.
This is the second budget cut to impact the mentally ill within the past few months. According to Romans, approximately 2,500 locals with a general mental-illness diagnosis who are not on AHCCCS recently saw their services chopped.
"These people have been put in a position to choose either to pay for the medications themselves and eat dog food, or go through the struggle to find some other cocktail of generic medications that will work for them," Romans said.
"If they go unstable (because of their lack of proper medication)," Romans said about the state budget cuts and the resulting ADHS decisions, "it's the luck of the draw. We, as a society, would rather pay for their hospitalization and run the risk that there won't be too many of those so we can save some money. If we lose a few to collateral damage through suicide, that's just the way it is."
Romans added: "I don't believe those making these funding decisions have come to terms with the consequences."
Dr. Laura Nelson, of the ADHS, called the planned budget cuts "sad" and "a big step backward."
Romans pointed out that newer drugs will be unavailable to those who are impacted, since generic versions of these newer drugs are not yet available. He said almost every seriously mentally ill person he knows takes at least one name-brand drug, and they are often expensive.
"This is a real crisis," said Neal Cash about the budget cuts in general. "They're being borne on the backs of the most vulnerable."
Cash, the CEO of the Community Partnership of Southern Arizona—which coordinates behavioral-health public funding in this part of the state—said his agency is taking what steps it can to reduce the negative impacts. But Cash and others see the budget cuts as pennywise and pound foolish. He predicted "unintended consequences" and said that hospital and jail costs will rise as a result. He also predicted an increase in homelessness among the severely mentally ill.
"We've built a pretty good behavioral-health system over the last 20 years," Cash said, "but there's been a slow erosion over the last few years."
Mindy Bernstein concurred, calling the cuts "devastating." Bernstein is the director of Our Place Clubhouse, which helps those with severe mental illness integrate into the community.
"You can give a pill to people," Bernstein remarked, "but if there is no one there to support them, a number of them will stop taking it and become ill, homeless or suicidal."
Bernstein said severely mentally ill people who wind up homeless are more likely to be victims of street crime.
This dark future is the brightest picture those involved can paint under the circumstances. The budget reductions will be even more draconian if Proposition 100 fails next week. Without the extra sales-tax funds from the proposition, ADHS would have to cut another $40 million. That, Nelson admitted, would probably mean the complete elimination of medications for non-AHCCCS recipients.
Looking out his office window, Romans discussed why he thought people ought to support the temporary sales-tax increase.
"They should want to help these people," Romans said, "because the success rate with best practices for mental illness is 72 percent, and that's higher than with most other illnesses. (The public) should care, because it will cost them more money while decreasing their quality of life."