Arizona Mental Health

In Maricopa County, Arizona, most defendants who are found not competent and not restorable (NCNR) are admitted involuntarily to an acute-care inpatient hospital. Many of these patients would most likely not have met the State's usual admission criteria for acute inpatient care had they not been evaluated in relation to a criminal offense. Is this group treated differently from their peers who are not involved in the criminal justice system? We examined records for 293 NCNR admissions, retrospectively, to assess their admission status and the outcomes of their commitment...

BACKGROUND: Mental health issues are a rapidly increasing problem in the US. Little is known about mental health and healthcare among Arizona's Hispanic population. METHODS: We assess differences in mental health service need, mental health diagnoses, and illicit drug use among 7,578 White and Hispanic participants in the 2010 Arizona Health Survey. RESULTS: Prevalence of mild, moderate, or severe psychological distress was negatively associated with SES among both Whites and Hispanics...

We used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change...

Most immigrant detainees held in U.S. Immigration and Customs Enforcement (ICE) facilities do not have legal representation, because immigration proceedings are a matter of civil, not criminal, law. In 2005, Mr. Franco, an immigrant from Mexico with an IQ between 35 and 55, was found incompetent to stand trial, but was not appointed an attorney for his immigration proceedings. This failure led to a class action lawsuit, known as the Franco litigation, and in April 2013, a federal judge ordered the U. S. government to provide legal representation for immigrant detainees in California, Arizona, and Washington who are incompetent to represent themselves due to a mental disorder or defect...

It is increasingly argued that social and economic inequities poorly affect overall health. One of the means through which these inequities are translated to the body is via negative emotions, which carry known psychological and physiological responses. This paper examines migration-related psychosocial stressors impacting first-generation Mexican immigrants in southern Arizona, and reports on the primary emotional experiences immigrants associate with these stressors. Data were drawn from a qualitative, ethnographic study conducted over the course of 14 months during 2013-2014 with first-generation Mexican immigrants (N = 40) residing in Tucson Arizona and service providers working directly in the immigrant community (N = 32)...

OBJECTIVES: Victims of domestic violence presenting for health care are frequently referred to medical specialists, but little is known about domestic violence screening among specialists. The aim of this study was to evaluate attitudes and behaviors concerning domestic violence of all physicians in Arizona. METHODS: A cross-sectional survey of 2244 physicians from 13 medical specialties describes domestic violence screening practices, attitudes, and behaviors of practicing physicians in Arizona...

BACKGROUND: Persons appearing in trauma centers have a higher prevalence of unhealthy alcohol use than the general population. Screening and brief intervention (SBI) is designed to moderate drinking levels and avoid costly future readmissions, but few studies have examined the impact of SBI on hospital readmissions and health care costs in a trauma population. RESEARCH DESIGN: This study uses comparative interrupted time-series and the Arizona State Inpatient Database to estimate the effect of the American College of Surgeons Committee on Trauma SBI mandate on the probability of readmission and cost per readmission in Arizona trauma centers...

The aim of this study was to examine if family system dynamics (e.g., parent mental health, marriage quality, conflict, and cohesion) that have often been overlooked when studying Latino families play a more important role in predicting adolescent internalizing symptoms than acculturation processes. Data comes from the Latino Acculturation and Health Project, a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona (Smokowski & Bacallao, 2006, 2010). Researchers conducted in-depth, community-based interviews with 258 Latino adolescents and 258 of their parents in metropolitan, small-town, and rural areas...

Over six years, 4317 teleconsultations were scheduled in the Arizona Telemedicine Program. A total of 402 scheduled teleconsultations (9.3%) did not take place. A review showed that 254 were cancelled but eventually took place (5.9%), while 148 never took place (3.4%). The cost of a teleconsultation to the service provider was, at minimum, 228 US dollars. Telepsychiatry accounted for all the missed consultations that eventually took place, and 92% of these were from three of the six sites referring telepsychiatry patients...

Violence among those diagnosed with schizophrenia has been reported but is not a diagnostic component of the disorder. The position of the courts regarding fulfillment of the requisite intent to commit violent acts has not been extensively reported. This article discusses the impact of a diagnosis of schizophrenia in an individual and how the pharmacist can help integrate information into the health care system. The recent Supreme Court case of Clark versus Arizona and the older case of Patterson versus Cockrell are discussed with respect to the concept of intent (to commit the act) and the implications this has on an individual in the midst of a psychotic episode...

In Clark v. Arizona, the U.S. Supreme Court was faced with two main questions: Does Arizona's insanity defense statute, with its abridged M'Naughten standard, violate the Fourteenth Amendment? And does Arizona case law, with its complete prohibition on the use of mental disease or defect evidence to combat required mens rea elements of a crime, violate due process? In a six-three decision, the Court answered both of these questions in the negative.

Three recent U.S. Supreme Court antitrust rulings that influence the health-care delivery system are examined. Historically four defenses protected the health-care system from antitrust law. They are the learned-profession exemption, the fact that health-care systems have little effect on interstate commerce, the state-action defense, and the business-of-insurance exemption under the McCarran-Ferguson Act. These defenses and Supreme Court cases that have weakened or eliminated them are described. The cases are Arizona v...

This column describes a recent Supreme Court case, Clark v. Arizona, in which an adolescent who had schizophrenia was convicted of first-degree murder of a police officer who he believed was a hostile space alien. The Arizona courts had rejected his insanity defense as well as a second defense that he lacked the required intent to commit the crime (mens rea) because his delusions interfered with his knowing that the victim was a police officer. The Court ultimately declined to overturn Arizona's rules regarding the insanity defense and mens rea...

Since the recent shootings in Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut, there has been an ever-increasing state and national debate regarding gun control. All 3 shootings involved an alleged shooter who attended college, and in hindsight, evidence of a mental illness was potentially present in these individuals while in school. What appears to be different about the current round of debate is that both pro-gun control and anti-gun control advocates are focusing on mentally ill individuals, early detection of mental illness during school years, and the interactions of such individuals with physicians and the mental health system as a way to solve gun violence...

Scottsdale (AZ) Health System and the City of Scottsdale Fire Department are teaming up to treat patients at the right level of care and avoid unnecessary trips to the emergency department and hospitalizations. In the model, a paramedic from the fire department and an advanced practice nurse from the hospital will take calls to 911 that the medical triage staff determines are low-level complaints that do not require a trip to the emergency department. The nurse-paramedic team will also make follow-up visits to discharged patients who may be at risk for readmissions...

Within the last few years several lawsuits have significantly increased both the procedural and the substantive rights of mental patients; among them are Lessard v. Schmidt, in which the court held that persons facing involuntary civil commitment are entiltled to dueprocess safeguards, and Wyatt v. Stickney and Donaldson v. O'Connor, concerned with the right ot adequate treatment. The author draws on the problems of implementing the landmark decree of Miranda v. Arizona, guaranteeing the rights of criminal suspects, in discussing the difficulties of translating rights promulgated in the courts into reality...

In the aftermath of a successful class-action suit on behalf of seriously mentally ill patients, the Arizona legislature set into law five pilot projects to test a proposed system of care based on clinical teams, prepaid funding, and independent evaluations. The author, who drafted the proposal for the new system, discusses the system's principles and how the system's components will function under them. He then discusses some of the system's strengths and the difficulties it may encounter.

This article examines the history of behavioral health program evaluation efforts in the state of Arizona during the years 1974-1982. Program Evaluation in Arizona has been carried out in an environment where planning, monitoring, contracting, appropriations, and evaluation have been inter-related--sometimes loosely, sometimes closely. Here we trace the year-by-year evolution of the evaluation system and its connections with the other parts of the environment. This history illustrates the gradual development of an evaluation system in an organizational context, including the sidetracks and setbacks ...

No abstract text is available yet for this article.

The authors describe a prepaid mental health program affiliated with a Phoenix-based health maintenance organization. Challenged by the need to limit financial risk and by high outpatient utilization rates, this prepaid health plan, developed a policy of service delivery which could both satisfy patient and consultee demands and conserve costs. Staff philosophies, services, administrative characteristics and client population are described. Key concepts in the delivery of service are outlined. The authors conclude by reviewing some of the ethical and financial dilemmas confronting the prepaid mental health professional...