How To Get Affordable State Sponsored Therapy in Arizona

Few mental health providers outside of those in the public sector are able to immediately serve people in crisis. This usually makes public mental health services the best option for anyone who is having a mental health crisis and needs help right away. The people who answer crisis lines can offer caring attention and support as they help people determine the best response to a crisis, whether it’s inpatient treatment or an appointment with a counselor.

In most cases, community mental health programs serve as alternative providers for people who lack the means to access services in the private sector. In Arizona, public mental health services are restricted to only those people whose income qualifies them for Medicaid or who have severe mental illness. However, the range of diagnoses and functional problems that meet the definition of SMI in Arizona is somewhat broad.

According to Mental Health America, Arizona ranks 42 out of 51 states (including the District of Columbia) for access to mental health care. According to SAMHSA, only 40 percent of people in Arizona with mental health conditions get treatment for them. While these rankings and statistics reflect the impact of Arizona’s funding cuts for mental health services in the past decade, they also show some improvement since the state was ranked second-worst in America for access to mental health care in 2015. The resolution of Arnold v. Sarn in 2014 means that Arizona will continue working to improve and expand its mental health system.

If you have a severe mental health condition or think you may be eligible for Medicaid, you should call your local RBHA or TRBHA for more information. You should also utilize the state’s crisis response system if you are in crisis. If you are not eligible for T/RBHA services and are not in crisis, you can search for free or low-cost counselors on  OpenCounseling.com or try affordable online counseling at BetterHelp (a sponsor). The help you need may be closer than you think.

Most of Arizona’s mental health funding comes from Medicaid. Arizona accepted Medicaid expansion under a waiver that allows anyone with income of up to 138 percent of the federal poverty level to qualify. However, state policy requires people who are not disabled to work or volunteer 80 hours a month to continue receiving Medicaid. Representatives of the Arizona Health Care Cost Containment System (AHCCCS), its Medicaid program, encourage people who may be eligible for Medicaid to apply for coverage to access these resources.

To qualify for non-Medicaid public mental health services in Arizona, a person must have a serious mental illness (SMI). Like other states, Arizona defines a serious mental illness as a mental health condition that impairs a person’s ability to function in everyday life. Functional impairments can range from poor nutrition and hygiene to difficulty maintaining employment. Arizona designates a relatively wide range of diagnoses as SMI. Qualifying diagnoses include:

• Schizophrenia and other psychotic disorders
• Anorexia, bulimia, and other eating disorders
• Borderline, narcissistic, avoidant, and other personality disorders
• Bipolar disorder, major depressive disorder, and other mood disorders
• Panic disorder, generalized anxiety disorder, social anxiety, and other anxiety disorders

This means that despite public perceptions of what “serious mental illness” means, people don’t necessarily have to have a history of suicide attempts, psychotic episodes, or hospitalization to qualify. For example, a person who has lost jobs because of depression may also be eligible for SMI services. To find out whether you meet SMI criteria, you can call the statewide SMI Determination Line at (855) 832-2866. All people who seek non-Medicaid public mental health services in Arizona must be evaluated first.

Arizona administers public mental health services through a network of Regional Behavioral Health Authorities (RBHAs) and Tribal Regional Behavioral Health Authorities (TRBHAs). When these organizations were established in Arizona in 1992, the state designated six RBHAs and four TRBHAs, and they were all public and not-for-profit. Now there are three RBHAs and four TRBHAs and some are run by private for-profit companies.

Each RBHA or TRBHA is responsible for managing a network of providers for Medicaid and non-Medicaid public mental health services, operating a regional mental health crisis line, and helping people access the public mental health system. To find out more about public mental health services in your area, you should call the RBHA assigned to your county or tribal nation. Crisis lines often function as both information and crisis lines, so consider calling one for help if you need mental health services right away.

In the 1960s, Americans started thinking differently about how to treat mental health conditions. New laws required state and local governments to establish community mental health programs as alternatives to institutionalization for people with serious mental illness. The hope was that these programs would provide the resources people needed to manage their symptoms at home.

Many states’ public mental health programs trace their origins back to this period, and Arizona is no exception. The state enacted its own community mental health law in 1963, the same year the federal Community Mental Health Act was passed by the Kennedy administration. These laws authorized the construction of community mental health programs but left it up to each county to decide whether to participate.

While some community programs were founded in Arizona in the 1970s, the state did not set up an organized public mental health system until after it established its Division of Behavioral Health in 1986. That same year, a local judge found the state to be in violation of laws requiring it to maintain a comprehensive community mental health system. The class action lawsuit that led to this ruling,  Arnold v. Sarn, was upheld by the Supreme Court in 1989. Following this ruling, Arizona intensified its effort to build a cohesive mental health system.

The 2008 national recession triggered a budget crisis in Arizona that has lasted over a decade. The state’s financial struggle has had a negative impact on its public programs. During this period, state officials have made severe cuts to mental health funding and significant changes to the public mental health system. A “Joint Stipulation to Stay Litigation During Fiscal Budget Crisis” was signed in 2012, effectively ending any active attempts to hold the state accountable to the Arnold v. Sarn ruling. By 2010, Arizona had cut its budget for non-Medicaid behavioral health services by a staggering  47 percent. Since then, there have been more cuts, Arizona’s public system has been partially privatized, and many community mental health providers have closed.

Still, not all hope is lost. Even though Arnold v. Sarn was dismissed in 2014, the final settlement agreement requires the state to expand community mental health services, much like the original 1986 ruling did. Arizona continues to provide public mental health services through its Medicaid program as well as its Regional Behavioral Health Authorities, which use state and federal funding to serve people with serious mental illness who don’t have Medicaid or other insurance or who need services not covered by insurance.