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Arizona's mental health system did not fail

March 1, 2011
by Dennis Grantham, Editor-in-Chief
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State's mental health director answers critics, details response to Tucson tragedy

We've seen and heard it all before: An awful tragedy, a spike in national interest, and an onrush of interpretations-some quite convincing, others quite emotional, others tied to interest groups, and still others that are self-serving, ratings nonsense. Days later come the national opinion polls, like the one a month after the Tucson shootings that reported “55 percent of Americans believe the mental health system is to blame.”

This special section takes another look at the Tucson tragedy-asking leaders in the field to share their perspectives on what can be learned and what the future holds for mental health. In the following pages, Arizona's mental health system responds to the media's intense criticism, national professionals reflect on lessons we should learn, and an expert explains the legal aspects of intervening on college campuses.

Our hope is that the perspectives that follow provide some guidance on how to interpret these tragic events-and helps focus our industry's attention on what we can do to improve, rather than where to place blame.

Lately, Arizona has taken more than its share of criticism from around the country on a range of issues-its stance on immigration, its rough political discourse, its relaxed attitude about handguns. So it wasn't surprising, in the wake of the shootings, that the state's mental health system has been intensely criticized.

Psychiatrist Laura Nelson, Deputy Director, Arizona Department of Health Services, Department of Behavioral Health Services, heads the state's mental health efforts and, therefore, has taken the brunt of much criticism.

While “saddened to see the negative articles coming out about Arizona's system,” Nelson says that she, with her colleagues, has been so immersed in meeting community needs that it was difficult to respond to the media attacks.

Initial response

“Essentially, I'm very proud of the response that took place in Arizona, particularly in Pima County [Tucson's location].” In the immediate aftermath of the tragedy, “crisis teams were mobilized to reach out to the schools, the local businesses, and anyone who was reeling from the tragedy.”

Laura nelson, md, deputy director, arizona department of health services, division of behavioral health (dbhs)
Laura Nelson, MD, Deputy Director, Arizona Department of Health Services, Division of Behavioral Health (DBHS)

And, despite recent state cutbacks in mental health funding due to a fiscal crisis, Nelson says that “We had the capacity, on the ground in Pima County, to meet local needs. We didn't need to bring in any resources from elsewhere in the state-or from out of state.”

And, she adds, it wasn't for lack of offers: “We were getting calls several times a day from SAMHSA asking ‘What do you need? How can we help?’ and my response was, ‘I think we have it covered.’ So, from that perspective, it was invigorating to know that we had the capacity to respond to that kind of local community need.

“We also have a 1-800 line, established through Magellan in Maricopa County, that has been available for the rest of the state because, frankly, parents and other community members statewide felt the effects of the tragedy and had all kinds of questions and concerns. That line has been handling hundreds of calls.”

In response to heated rhetoric in the media, Nelson says that she asked the state's regional behavioral health providers to reach out to enrolled members.

“Many were upset to see the kind of terminology that was being thrown around by, really, everyone,” she says, adding that “Terms like ‘madman,’ ‘deranged,’ and ‘psycho’ hit hard among our members because it reinforces that sense of social isolation and discrimination that we work hard to overcome.”

“We have to let people know-beyond the behavioral health community-that this is a public health issue.”

-Laura Nelson, MD

Avoiding the knee-jerk reaction

While critics were quick to blame Jared Loughner's bloody, Jan. 8 assault on factors ranging from lax gun laws and angry political discourse to a poor mental health system, the thoughts of behavioral health leaders nationwide-and in Arizona- quickly coalesced around a different factor, sure to be one of many that will emerge as the facts of the case become clear: Despite the many around him who saw, or were frightened by Loughner's disturbing behavior, none put all the pieces together. None convinced or compelled him to seek treatment.

Or, as National Council CEO Linda Rosenberg observes, “The system didn't fail. He never got to it.”

To address a broad lack of knowledge about mental illness, Nelson says that communities across the state support a very strong Mental Health First Aid program. The program, initially developed in Australia and offered in the United States through the National Council, provides a week-long “train the trainers” course to certify MHFA instructors, and a 12-hour course to certify interested citizens.

“We're working with regional behavioral health authorities-Community Partnership of Southern Arizona (Tucson) and Magellan (Phoenix, Maricopa County)-to bring in Mental Health First Aid ‘train the trainer’ programs through April, Nelson explains.

The goal is to certify 30 trainers and deploy them throughout the state-at community colleges, high schools, local YMCAs, state-based organizations, and other groups-“to infuse the concepts of Mental Health First Aid” to the general public. She notes that the mental health first aid effort “is not unlike what we already do with first aid like CPR and the Heimlich maneuver.”