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Thursday / September 28.

Stateline Takes a Deep Dive Into the ‘Arizona Model’ for Crisis Care

'Arizona Model' for Crisis Care

Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at​

Last week, we published an article on one essential piece of the Arizona crisis continuum: mobile crisis teams. Erica Chestnut-Ramirez, Regional Vice President of EMPACT Suicide Prevention Center at La Frontera Arizona, told us how she and other partners work together regularly to ensure that all the moving parts of the system work well together. “We are one piece of the crisis care continuum and collaborate with the call center, other providers, subacute facilities, and law enforcement to ensure that we work seamlessly together to provide people the best care possible, which is what they deserve.” This comprehensive system of crisis services, called the ‘Arizona Crisis Now model’ or the ‘Arizona model’ for crisis care, has gained nationwide attention, and other states are taking notice and working to replicate the model.

Christine Vestal, a staff writer for Stateline, took a deep dive comparing what people in behavioral health crises in Maricopa County, Arizona, experience compared to the rest of the United States. The article, which ran on on Friday, follows the experience of a 27-year-old man who arrives by police drop off to RI International’s Peoria Crisis Recovery Center. Two officers do a warm handoff with the center’s staff, walking in through a designated police and EMS drop off entrance. Within three minutes, the officers are out the door and back on the street. The man in crisis tells a counselor at the center that “the government was out to get him, he felt threatened, and someone was constantly photographing him.” He says that his neighbors called the police because he was being loud. Vestal notes that elsewhere in the United States, he would have been taken to the emergency room or jail, both likely resulting in days without adequate treatment. 

Developing the crisis care continuum in Arizona was slow going at first, but six years ago, momentum increased rapidly because of buy-in from key players like Tom Betlach, the state’s Medicaid director at the time, and Nick Margiotta, who was the Crisis Intervention Team program coordinator for the Phoenix police department. The result was that Medicaid developed reimbursement codes, federal and state funding was earmarked, laws and medical rules were changed, and crisis centers developed strong partnerships with law enforcement. The latter part has been so noteworthy that people from around the United States come to Arizona to witness how it works. Margiotta told us in June that Phoenix officers weren’t going to drop off people experiencing a behavioral health crisis if it resulted in them having to wait around for hours, which they had experienced over and over again. He told Vestal that he informed state officials that if they wanted drop-offs to work, crisis services (both mobile and centers) had to serve everyone regardless if they were “angry, drunk, disruptive, voluntary, or involuntary.”

Defaulting to the emergency room and inpatient hospitalization for behavioral health crises is expensive. With Arizona pioneering a different way, what states are also noticing is that fostering a robust crisis continuum is cost-saving and provides better outcomes for patients. Brian Hepburn, M.D., executive director of the National Association of State Mental Health Program Directors, says that states across the United States are increasingly investing in crisis care, but funding remains a challenge. Michael Hogan, Ph.D., told Vestal that psychiatric crisis care “is a patchwork quilt…with virtually no federal funding and no federal standards.” 

Yet, change may be coming with 988 on the horizon, a three-digit number for mental health and suicide crisis, and Alex Azar, secretary for the U.S. Department of Health and Human Services, stated in December the agency’s commitment to increase federal funding. Azar also highlighted a new Medicaid model called Integrated Care for Kids, which is designed to provide coordinated care and a full set of crisis services for children. Also promising is President Trump’s fiscal year 2021 budget for HHS that provides $758 million for the Community Mental Health Services Block Grant. A $35 million increase that would support a new 5 percent set aside in all states and territories “to build crisis systems that can quickly deliver high-quality services to meet the needs of individuals in mental health crisis.” 


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