When asked to reflect on the changes that have occurred in local mental-health services in the six months since the Jan. 8 shooting spree, H. Clarke Romans and Neil Cash point out both positives and negatives.
"The state Legislature marched forward with budget cuts," observes Romans, who heads the Southern Arizona chapter of the National Alliance on Mental Illness. "I think they're oblivious to the (mental-health) community."
Before the latest cuts, the state's mental-health system was already in dire straits. A 2009 national report concluded: "Arizona's public mental-health system provides services to only 18 percent of adults who live with serious mental illness."
In the coming year, Romans sees this deplorable situation "continuing to be grim and a little worse." He holds out some hope for 2014, because that's when the Affordable Care Act—aka "Obamacare"—is slated to take full effect.
"It contains positive things for people with mental illnesses," Romans says of the controversial law. He warns that if it is dismantled, the results will be "really, really awful for those people. We'll return to 1950-like conditions, and many people (with mental illness) won't be able to get any services."
Romans said that for a while after the shootings, an unfounded fear of people with mental illness seemed to escalate in Tucson. However, he believes those fears have since subsided.
Cash, the president and CEO of the Community Partnership of Southern Arizona (CPSA), which coordinates behavioral-health funding, also lists the state budget cuts as a negative. These cuts, he says, have resulted in decreased services for thousands of people in Pima County with mental-health problems.
"Fewer people will be eligible for clinical care," Cash says, "so we're trying to develop a crisis-service network."
On the other hand, both men agree there have been some positive changes since Jan. 8. Romans highlights the Schorr family-sponsored symposium held at the UA in April. "They did a great community service," Romans says.
Romans also points to post-Jan. 8 press coverage of mental-health issues and support groups like his as a plus.
As another positive, Cash cites the training of dozens of instructors and hundreds of individuals to see and understand the early signs of mental illness, so they will be able to intervene. "It's similar to the CPR model," Cash says of this ongoing popular program called Mental Health First Aid Training.
A substantial positive step is the scheduled mid-August opening of the Behavior Health Pavilion (BHP) and Crisis Response Center (CRC) on the Kino health-care campus along Ajo Way.
The $48 million BHP and $18 million CRC were built with bond funds approved by Pima County voters. Intended to expand and upgrade services at the adjacent hospital, the two new facilities "will offer a 'one-stop' easily accessible center committed to meeting the medical and behavioral health-care needs of the community," according to the county.
The three-story BHP is a psychiatric inpatient hospital. It will contain 48 beds in two secure units, along with room for an additional 48 beds. It will also have eight specially designed rooms in its emergency department, and will include a courtroom in which a Superior Court judge can preside over evaluation and involuntary-commitment hearings.
Patricia Harrison-Monroe, chief of behavioral health services for University Physicians Healthcare on the Kino campus, writes in an e-mail about the BHP: "Once a patient is assessed, he or she can access inpatient services on the second floor, transfer to the geriatric psychiatric unit at the main hospital, be referred to the CRC, or linked to a community provider upon discharge."
The two-story CRC will contain screening and stabilization rooms for adults and children with mental illness, whether they are insured or not, as well as space for their waiting families. "The emphasis is on stabilizing the mental-health crisis," writes Anna Mary Mackey, spokeswoman for Community Partnership of Southern Arizona, in an e-mail.
The CRC also includes a 24-hour crisis call center, and 15 beds for patient stays up to five days. This space, Romans says, will allow "a lot of resolution without hospitalization."
Romans' organization will have a presence in the CRC and he says of the new facility: "It will be a clearinghouse we didn't have before." He's especially hopeful that law-enforcement officers will take advantage of it.
"They will be able to put people in a therapeutic setting instead of jail," he says.
The advantages of doing that are obvious. Today, when responding to the more than 12,000 annual calls involving an individual experiencing a crisis, police officers have two time-consuming choices: take the individual to a hospital emergency room, or take them to jail.
Because of the triage process it will utilize, the CRC is slated to keep a police officer involved for 30 minutes or less. That's an important consideration, given the huge numbers of people with mental-health problems now populating the Pima County jail. According to a draft county report released in April, "approximately 50 percent of individuals detained at the (Pima County jail) are currently or have been enrolled in the public behavioral-health system." Even though that percentage includes issues other than mental illnesses, it still indicates the scale of the problem.
Cash's organization will operate the CRC. As for the overall impact of the new facilities, Cash says: "They should be incredible. I believe when we get the bugs worked out, they'll be one of the best in the country."