Arizona's Broken Mental Health System with Specificity
Existing Arizona laws can help prevent mass
shootings by persons with a severe mental illness, but only if they are followed
by the government agencies charged with carrying them out.
This guest editorial was published in the March 22, 2018,
issue of the
Arizona Capitol Times.
Tucson. Sandy Hook. San Bernardino. Orlando. Las
Vegas. And now Parkland. Since 2011, a new location is added to the
list of mass shootings every 64 days. After each mass shooting, the
public discussion inevitably turns to what factors may have
contributed to the mass murder – guns, cultural disintegration, the
perpetrators’ desire for fame and notoriety, mental illness – and
how such tragedies can be prevented.
In theory, the mental health system should offer
a meaningful, albeit partial, solution to preventing some of these
mass shootings. However, when the discussion turns to the mental
health system, the conversation inevitably ends in frustration with
the statement, “Well, the mental health system is broken.” That
phrase is commonly the last word on many discussions, because it
lacks the specificity necessary to take any action. This over-used
adage is where mental health conversations go to die. Yet, if we
want real changes, this cannot be so. To understand how the course
can be adjusted on bad and broken systems, we need to appreciate,
with specificity, how the system is broken.
To better understand the frustration with the
mental health system, it is first important to understand how it
could help. The laws of every state allow authorities to
involuntarily detain and evaluate mentally ill persons if they are a
danger to themselves or to others. Arizona law goes further by
allowing an individual to be detained for evaluation before they
become a danger. To do so, a person must meet the definition of
persistent or acute disability (PAD).
Arizona’s law was drafted to permit a person
afflicted with a severe mental illness to be picked up by law
enforcement when it can be shown that they:
would benefit from
do not understand the need for treatment, and
without treatment are likely to come to harm.
This law allows for
involuntary evaluation and treatment before imminent danger arises
out of the mental illness. It allows for involuntary evaluation and
treatment before the severely ill person endures a long period of
untreated psychosis. It allows for involuntary evaluation and
treatment before the person ends up in jail. It allows for
involuntary evaluation and treatment before the person hurts
themselves or others. For concrete and haunting examples, the
persistent or acute disability law would squarely fit the Parkland
shooter, Nikolas Cruz, and would have been appropriately applied to a
person like Jared Loughner.
Arizona law states that any responsible person
can begin the process for a PAD by filing an application at a
“screening agency.” The screening process includes interviews with
an applicant, a prospective patient, and a review of any pertinent
documentation submitted to the screening agency. The screening
process is required to be completed and a determination is to be
made within 48 hours as to whether the proposed patient should be
taken in for evaluation.
But here is where our system is broken, at least
as it exists in Maricopa County. Rather than completing the
screening process within 48 hours as the law requires, the system in
most cases does not respond for weeks. It is not uncommon for the
system to wait over 40 days to complete the screening process.
During these long weeks, the persistent or acute disability patient,
who is initially perceived to be non-dangerous, becomes dangerous.
Rather than obtaining the treatment they need, a PAD patient may
transition from simply being psychotic or depressed, to being
suicidal or a danger to others. Rather than being committed to a
hospital for treatment, they end up on the streets, or in jail,
which exacerbates the mental illness. In the case of Jared Loughner,
rather than receiving help, he became more ill, more psychotic,
bought ammunition at Walmart, and ended up shooting 18 people in a
Safeway parking lot.
Arizona has laws that could prevent such
shootings. However, the laws are not followed by the agencies
charged with executing them. Our system has the capacity to handle
these screenings within 48 hours but because of custom and long
misguided standards, it does not. The result is that people do not
get the treatment they need and they, and our communities are
harmed. Our Legislature, which drafted these laws, should not allow
them to go unfollowed. Public hearings should be held to address the
situation. The Maricopa County Board of Supervisors should not allow
this dangerous error to continue. It should use its jurisdiction
over the issue to demand the law is followed. If so, real change
could be made, and one specific area of our broken system could be