Our National Numbers
- 600,000 people living with chronic mental illness have been either prisoners or homeless in the U.S. in 2017
- Number of people living without homes has increased for the first time in seven years
- 25% of homeless population have a serious mental illness
- Mortality rate for people living on the streets is 4 to 9 times higher than general population
- People living with chronic mental illness are more likely to be arrested and cycle through criminal system
References:
Markowitz, F.E. (2006). Psychiatric hospital capacity, homelessness, and crime and arrest rates. Criminology, 44, 45– 72.
Roy L, et al. Criminal behavior and victimization among homeless individuals with severe mental illness: a systematic review 2014 Psychiatric Services. 65(6): 739-750.
Greenberg, G.A., & Rosenheck, R.A. (2008). Jail incarceration, homelessness, and mental health: a national study. Psychiatric Services, 2, 170—177.
hudexchange.info/resource/5639/2017-ahar-part-1-pit-estimates-of-homelessness-in-the-us/
The 1947 Freedom Train Inspiration
1885
The 13th Territorial Legislature met to appropriate $100,000 for the construction of the Territorial Insane Asylum at Phoenix, Arizona.
1887
The “Territorial Insane Asylum at Phoenix, Arizona” opened.
1911
After a fire the State Hospital was rebuilt in 1913 and named the “State Asylum for the Insane”.
1963
Arizona Community Mental Health Centers Act of 1963 passed. State plans for building comprehensive mental health centers.
1970
Restrictions were such that made it impossible to get in the State Hospital and easy to be released. Many patients who had been at the hospital for years were released in downtown Phoenix and the patient census dropped from almost 2,000 to 300 within a few months
During the height of the human rights movement, the Arizona Legislature passed Senate Bill 1057(A.R.S. 3655) which required that a patient must be dangerous to themselves or others in order to be confined to the State Hospital.
1981
ADHS and Arizona State Hospital were sued in a class action court case Arnold vs. Sarn. The decision which stated that “Arizona has failed to meet its moral and legal obligations to our state’s chronically mentally ill population”. The decision required a push toward community-based programs and services for discharged patients.
1986
Division of Behavioral Health is created at ADHS by statute.
1987
ADHS implements the first Behavioral Risk Factor Survey (BFRFSS)
1990
Concern about mental health became a federal issue, generating reports from the Surgeon General’s office and from high-ranking advocates. The Arizona State Hospital adopted Psychiatric Rehabilitation, a new model of patient care that encompasses all disciplines.
1992
New Arizona Behavioral Health System implemented – Regional Behavioral Health Authorities (RBHA’s) are started.
2012
Arizona Governor Jan Brewer, State health officers and plantiffs’ attorneys announced a two-year aggreement that included funding for recovery-oriented services including supported emplyment, living skills training, supported housing, case management, and expansion of orginazations run by and for people living with SMI
2014
A final agreement was reached in the Arnold v. Sarn case. The final settlement extends access to community based services and program agreed upon by the State and plaintiffs, including crisis services; supported employment and housing services; ACT; family and peer support; life skills training and respite care services. The State was required to adopt national quality standards outlined by SAMHSA, s well as annual quality service reviews conducted by an independent contractor
Arizona Mental Health Timeline Reference:
Arizona Department of Health Services, Historical Timeline
Maricopa's Mental Health Freedom Trails 
I really enjoyed learning about the history of mental illness and the homeless population from your blog. As of 2019, Arizona has an average of 10 thousand experiencing homelessness (United States Interagency Council on Homelessness (USICH), (2019). According to USICH, 910 are veterans, 745 are families, 587 are between the ages of 18-25, and 1,876 are individuals experiencing chronic homelessness (2019). Homelessness is a national issue that can include both sheltered and unsheltered homelessness. This means some stay in shelters for the nights, hotels, or stay with others while unsheltered is living and sleeping on the streets. The causes for homelessness are often complex and diverse. Homelessness can result from poverty, lack of social and family support, addiction, mental illness, and failed government policy (Turnbull, Muckle, & Masters, (2007). Although the homeless suffer from these hardships, they also experience some of the same problems as the housed population. Medical illnesses also affect the homeless. However, due to their social vulnerability and lack of access to healthcare, homeless people have a higher mortality rate (Klop et al., 2018). Possible solutions for ensuring the homeless have access to medical and social services should include government funding that allows for tailored care for this special population. For example, ideas to improve outcomes include medical providers in shelters and having specific providers that work on the streets to offer flu, pneumonia, and psychiatric medication might help improve overall medical and mental health outcomes for this population. This is a complex population that deserves the support and assistance from the community in which they strive to survive in.
References
Klop, H. T., Evenblij, K., Gootjes, J. R., De Veer, A. J., & Onwuteaka-Philipsen, B. D. (2018). Care avoidance among homeless people and access to care: an interview study among spiritual caregivers, street pastors, homeless outreach workers and formerly homeless people. BMC Public Health, 18(1). doi:10.1186/s12889-018-5989-1
Turnbull, J., Muckle, W., & Masters, C. (2007). Homelessness and health. Canadian Medical Association Journal, 177(9), 1065-1066. doi:10.1503/cmaj.071294
United States Interagency Council on Homelessness (USICH). (n.d.). Prevent homelessness. Retrieved February 23, 2020, from https://www.usich.gov
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https://mentalfreedomtrails.health.blog Dawn Augusta
Hi Dawn, my name is Joe Medlin I am in the psychiatric family mental health nurse practitioner program that Arizona State University as well.
My condolences go out to you for you brother. I also have a family member that utilizes the Maricopa mental health system his adolescent and adult life. For my family member the system broke down at medication/treatment compliance and we never got much farther in placement, ongoing treatment or long-term residential issues. I’ve also worked at County hospital now for 12 years, which was recently renamed as Valleywise hospital, before that I worked in various inpatient facilities. At Valleywise Hospital I do experience the “frequent flyer” or “rotating-door” patient. In my opinion, there are several places where the Maricopa county mental health system can breakdown. From my observation one key area of breakdown is when the patient discharges from the hospital to the residential facility, their own apartment, or back home with a family member to continue their court order treatment. It seems that checking up on the patient for treatment compliance via a case manager, family, friends or community neighbor is a weak point in the system. Then the patient comes into emergency psychiatric facilities via police, mobile crisis, or case manger after decompensating for several weeks or even months depending on the severity of their mental illness. It seems to me better monitoring could be put in place with people discharging from the hospital on the court order treatment. Another weak point I’ve noticed in the Maricopa County mental illness services is when patients come into emergency psychiatric services, via voluntary or by police; the patient does not meet criteria for a 72 Hour Court ordered evaluation hold. Furthermore, the patient refuses to sign in voluntary. The practitioner can tell the patient is hurting a great deal from their illness and in need of stabilization, though the practitioner is helpless.
I did go to the Maricopa County website in search of resources/help and was a bit disappointed to find the usual crisis lines, local psychiatric clinics; not to say these services are not needed and helpful, quite the contrary they are needed (Maricopa County, 2020). I believe addressing the two points above would make a significant improvement for the lives of many in the Maricopa county area.
Reference
Maricopa County. (2020). Resources. Retrieved February 7, 2020, from https://www.maricopa.gov/5065/Resources
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