Please explore my newest post- Dashboard Indicators Light & Sirens

Grand Central Station

Consider me your train conductor on this journey in exploring the navigation of Maricopa County’s Mental Health Systems.

Dawn Augusta is a Innovation Leadership Doctor of Nursing Practice scholar at Arizona State University. Her project aim is to improve the mental health navigation system in the community she was raised and loves-Phoenix, Arizona. This blog aims to shine a light on the navigation of our mental health system in Maricopa County.  In the light shining hope this DNP scholar seeks to explore and respond to gaps identified in the process of discovery.  The aim is for a greater social dividend, a truly cohesive system to emerge by way of leveraging multi-sector collaborations.

Freedom Trail Inspired

Freedom is perpetual- for those of us having the luxury, to choose daily, to be free from what oppresses the mind; let us ring liberty’s bell as a clarion beacon to raise and train an army of mental health freedom fighters

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Background Stories: Coal & Diamonds

Mental illness impacts ripple outward from a singular persons’ lived experience to families, communities, and society as a whole. Mental illness in America is often cloaked as other public issues such as homelessness, crime, and poverty.

Part of my lineage can be traced to a resilient people who survived captivity as American slaves. Another part of my lineage is tied to a silent oppression woven throughout all human lineage stories. One that crosses borders of geography, race, social class and gender deeply plaguing humanity.  The oppression of the mind.

I have watched family members and strangers alike struggle navigating their own mental health care like train cars on windy, circular tracks. One all too common stop in our circular system is the inpatient psychiatric stabilization station.  Where a cluster of people coming from a multitude of paths who have traveled countless miles on their life journey navigating their individual circular tracks arrive in the chaos and uncertainty of their temporary stop at “Grand Central Station”.  Eventually, one by one, the trains leave the station stable enough to bravely navigate back on their railways.

Observing the system in Maricopa County, and speaking to front line mental health service workers, police and fire first responders’ one thing seems apparent, the trains eventually circle back.  Back to Grand Central Station- inpatient, again. In need of psychiatric stabilization, again.

My big brother Robbie has been navigating the circular track all of his adult life.  Some first responders know him as the guy who sprayed his entire naked body with metallic silver paint and locked himself in the bathroom of a federal post office in an effort to hide away from the world. Other first responders met him the day they showed up to help my family after all the phone cords were pulled out of the walls of our home and wouldn’t allow us to leave the house for fear we would be “captured”.

 I know him as the loving protector who used to walk me to school carrying a massive “ghetto blaster” on his shoulders so we would look really cool and so that “no one would ever mess with his little sister”.  He was always gentle and playful letting his siblings try their best to tie him up with tangled basket of grandpa’s old neck ties and like Houdini, he would entertain with his magical methods of escaping any hold. He was a creative and inventive young man.  I remember he made a wooden skim board in high school shop class. Then, when flood irrigation waters would transform our front yard into our very own desert ocean oasis Robbie would sprint across driveways leaving wet footprints on scorched concrete. Dropping his skim board just beyond the berm and surf. Making waves that rippled across the water causing all the floating grapefruit and pecans in the water to bob.

The ripple effects of my brother’s navigation journey in the effort to attain and maintain mental wellness reaches every member of my family in various ways.  The emotional spectrum of family experiences range from compassion to frustration to pure avoidance. His circular journey impacts local systems of health care, public safety systems and supportive social systems. 

His circular journey is unique and simultaneously typical of the predictable pattern that people living with a mental health diagnosis and their families often experience.

From a systems design perspective there are gaps between the stops in the navigation pathway that make the connections from inpatient to community care feel like a massive leap.  It turns out that people (much like trains) don’t tend to leap tracks very well. Likewise people living with mental illness are not well equipped to jump to the next navigation point, instead there is a tendency to circle.

Because I care about the well-being of all the big brother’s like my Robbie living in our community I aim to direct my energies as a doctor of nursing practice scholar to work on this “gap in the tracks” social resiliency issue.               

Mind Health Arizona: I believe that people and practitioners engaged in thoughtful community design can serve as synergistic partners in reimagining our American health and safety landscape.  It is my life mission is to enhance the health and wellness of families through intentional, participatory community design.      

Building Momentum

Arizona Mental Health Background: Mental health providers, social service agencies, first responders, law enforcement, jail, court system and probation department each provide service for persons with severe mental illness, yet the entire system is diversely fragmented. People experience inefficient care coordination evidenced by gaps and burdensome redundancy. Arizona has more than 100 mental-health-professional shortage areas, which means the federal government officially has declared there are not enough providers to treat the population. Only 40.3% of adults with mental illness in Arizona receive any form of treatment from either the public system or private providers. The remaining 59.7% receive no mental health treatment [1]. According to Mental Health America 2020 rankings, Arizona is ranked 36 for providing access to adult mental health services [2]. This underprepared, overburdened Arizona healthcare workforce leaves a lingering unmet need, like missing train tracks in the journey, further exacerbating the mental health crisis in our community. Current approaches to planning access and treatment rarely take into account patients’ capacity to cope with the workload of accessing and maintaining care.

Patients who have treatment workload that exceeds their capacity are more prone to nonadherence to medical treatments, leading to worsening outcomes overall. Again, people much like trains are not well equipped to jump tracks. And hence the circular experience. Navigation is the work individuals must do to form the railway ties that connect multiple disconnected services and providers together to create a functioning personal micro-service system[3]. Should the work of navigation be performed by the person experiencing the missing links in the tracks? It is like asking one person to drive the train, refuel the train, repair worn parts, and lay new tracks leading to unknown destinations all while in current motion. It is a great deal to ask of any person, let alone one whom has been diagnosed with illness. But many Americans were raised on the spirited overcoming repeating train story mantra, “I think I can, I think I can”.

I think it’s time to rethink some new navigation methods.

What do you think?

References:

[1] Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

[2] Mental Health America. (2020) Access to care ranking 2020. Retrieved from https://www.mhanational.org/issues/ranking-states

[3] Gui, X., Chen, Y., & Pine, K.H. (2018). Navigating the Healthcare Service “Black Box”: Individual Competence and Fragmented System. Proceedings of the ACM on Human-Computer Interaction (CSCW 2018 second cycle), 2.

1. 

   Great post, I work in behavioral health and I see it everyday. Patient’s constantly report the barriers that they face…

2. 

   I really appreciate your systems perspective on publicly funded mental health services in Arizona. As an Arizona newcomer, I often…

3. 

   With the class action suit Arnold v. Sarn initially filed in 1981, the court’s decision determined that the Maricopa County…

4. 

   I really enjoyed learning about the history of mental illness and the homeless population from your blog. As of 2019,…

5. 

   https://mentalfreedomtrails.health.blog Dawn Augusta Hi Dawn, my name is Joe Medlin I am in the psychiatric family mental health nurse practitioner…

Dashboard Indicators…Lights & Sirens

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

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