Arizona’s public behavioral health care system, which serves some 150,000 mentally ill and vulnerable state residents, is wrestling with a number of urgent challenges. In addition to budget cuts resulting from the current economic crisis, and the demands of a 28-year-old class-action lawsuit, the system has been repeatedly criticized in several areas, including for inadequate staff, data, housing support, and crisis services. On July 22, a panel of professionals who play key roles in the system discussed these and other issues before some 300 behavioral health providers, supervisors, and policymakers at the annual Summer Institute hosted by Arizona State University’s Center for Applied Behavioral Health Policy. This paper provides an abbreviated report of that discussion, which was partially designed and moderated by ASU’s Morrison Institute for Public Policy.

Severe and widespread budget cuts in behavioral health and substance abuse services for lower-income Arizonans who don’t qualify for AHCCCS have already taken effect across the state. Even before these cuts were implemented, it was clear that the publicly-supported behavioral health system in our state was not adequately serving many Arizonans who needed mental health or substance use disorder treatment. This paper represents an effort by Arizona State University’s Centers for Applied Behavioral Health Policy and the Morrison Institute for Public Policy to promote and enrich Arizona’s public dialogue about these problems and potential solutions.

Arizona Ideas includes notions large and small, homegrown and borrowed, current and historical. From A-Z, every one -- whether originally born here or adapted from elsewhere-- contributes to the state’s competitive position. Arizona Ideas also explores the roots of Arizona’s tradition of self-criticism --some call it a sense of insecurity or inferiority in comparison to other places -- that often surfaces in discussions of public policy. This observation has provoked considerable debate, but few would deny that this perspective exists. It is time to debate this idiosyncrasy out in the open and find better ways of moving the state ahead.

States have always administered federal programs. But, states usually have had very little say in how they carried out programs. All states could generally do was follow the rules laid out by federal agencies. But now, devolution is giving states more power over programs. And, in general, Americans have said that they approve of the idea. A 1998 nationwide poll, funded by The W. K. Kellogg Foundation, showed that a majority of Americans perceive devolution to be a positive development for the country.

Arizonans have gained a reputation for their low opinion of government, despite -- or perhaps because of -- the major role played by all governmental levels in residents’ daily lives. This view was reflected in the responses to this segment of the survey, as panelists generally gave low ratings to the government services they were asked to judge. This was especially true of lower-income panelists. But the respondents’ low ratings might not always have been based upon personal experience: Few panelists said they had sought information from government or community agencies. This may be due to the increasing popularity of the Internet as a self-help source, but it could also mean that relatively few residents need the services or know they are available. In any case, more than half of those who did seek information said they were satisfied with the result. Panelists were not dismissive of all collective efforts at social betterment. They expressed high levels of agreement that good community-based programs can prevent many social problems, from drug and alcohol addiction to child abuse and juvenile delinquency. Asked how they themselves would distribute public funds for social problems, most respondents choose programs for children, affordable housing, and health insurance.