Gina Amoroso recalls her 20s as a total blur of heroin and methamphetamine addiction.
“I was completely gone,” Amoroso said. “I had no reality of time, what day it was, it just kind of all blended in together.”
She became homeless, sleeping in storage units or on the street.
“Doing drugs and riding my bike with a whole bunch of knives in my backpack and doing the whole psychosis thing — thinking the government was out to get me — I thought that was normal, I didn’t think I was being a danger or threat to other people,” Amoroso said.
Her parents, desperate to intervene, filed a petition with the Maricopa County Superior Court asking for Amoroso to receive court-ordered mental health evaluation and treatment.
Amoroso ended up in a program at Valleywise Health. She didn’t want to be there, but now says it was an important step on her path to recovery.
When an adult is in crisis and loved ones seek a court-ordered mental health evaluation for them, Valleywise is the only health system in Maricopa County that provides that service. When Maricopa County on Wednesday sends out ballots for this year’s all-mail election, one question before voters will be whether to increase property taxes to support Valleywise Health.
Proponents of Proposition 409 say the general obligation bond would be a critical investment to expand access to behavioral health treatment in the Valley.
“We often take care of the sickest of the sick in terms of their mental illness,” said Dr. Michael White, who is chief clinical officer for Valleywise Health.
And as a publicly funded safety net hospital, White said, Valleywise does not turn any patients away.
“If they show up and present to one of our facilities, we are going to facilitate their health care, whether they can pay for those services or not,” White said.
The Valleywise Health system comprises more than a dozen facilities across Maricopa County, including the Diane & Bruce Halle Arizona Burn Center, emergency rooms, community health centers and behavioral health centers.
The $898 million in funding that Valleywise is seeking through Prop. 409 would go toward improving hospital emergency services, training new doctors and making upgrades at some of Valleywise Health’s neighborhood clinics.
But White said the most urgent reason the funding is needed is to improve the behavioral health center on the Valleywise downtown campus. The building is nearly 50 years old, and mental health patients there are sometimes crowded four to a room.
About a quarter of the Prop. 409 funding would go toward replacing the aging behavioral health center with a modernized facility that would have double the capacity of the current building.
If the building is not replaced, White worries about how Valleywise would handle Maricopa County’s growing demand for mental health evaluations and treatment for adults in crisis.
“They may be having to sit in the emergency department because we do not have a bed to admit them to to be able to undergo that process,” White said. “That bogs down the entire system.”
Valleywise last sought bond approval from voters in 2014. That proposition passed with 63% of the vote and paid for $935 million in renovations for the main Valleywise hospital building.
Even after all of that construction, Valleywise reports its inpatient demand has surpassed projections, especially for behavioral health, White said. The system sees about 10,000 behavioral health patients annually, many of whom face wait lists before receiving treatment.
In a report this month from the organization Mental Health America, Arizona ranks among the states with the highest prevalence of mental illness and among the states with the lowest capacity for treatment.
“The barn’s on fire when it comes to behavioral health, and it has been for a long time,” said Will Humble, executive director of the Arizona Public Health Association. “Especially those needing court-ordered treatment, we just simply don’t have anywhere near the capacity that we need.”
Humble said Prop. 409 won’t solve the shortage of behavioral health services in the Valley. But he said without this investment, families will face even longer waits to find help for loved ones in crisis. That, he said, could contribute to even faster growth of Maricopa County’s homeless population.
“A big reason that we have a homeless problem — not the only reason, but a big chunk of it — is the fact that we just simply do not have enough treatment capacity for people with psychiatric disorders,” Humble said.
Humble is among more than 80 Arizonans who submitted letters of support for 409 in the voter pamphlet. The list also includes prominent Arizona Republicans like former Govs. Doug Ducey and Jan Brewer alongside Democrats like U.S. Sens. Ruben Gallego and Mark Kelly.
So far, there is no organized opposition to Prop. 409.
“But that doesn’t mean any election is easy,” said Stacy Pearson, a longtime Arizona political strategist.
This is an off-year election. So Pearson said drumming up enthusiasm and just getting voters to mail in their ballots will be the biggest challenge for the Prop. 409 campaign.
“It’s hard to get people to vote right now, especially on something as pedestrian as building another health care facility," Pearson said.
And there is a cost for Prop. 409.
If the proposition is approved, Valleywise Health will get $898 million upfront from investors. Maricopa County taxpayers will pay that back over the next 30 years. With interest, voters will pay nearly $1.4 billion.
Homeowners in Maricopa County would pay 11 cents for every $100 of net assessed limited property value on their homes. The assessed limited property value is the value assigned by the Maricopa County Assessor, and is typically much lower than the full market value that homes sell for.
The average Maricopa County homeowner would pay about $29 more in property taxes per year, according to backers of Prop. 409. The campaign offers an online calculator for homeowners to estimate their individual cost.
Pearson said these types of bond questions can sometimes be complicated for voters to understand, and they don’t always pass.
“Folks get confused and they vote ‘no.’ It happens on all sorts of issues,” Pearson said.
But Pearson expects a lot of voters in Maricopa County probably do understand the benefits of investing in mental health services.
“People that are driving down Phoenix streets right now, the need for additional mental health care beds is acute, we all see it every day in our community,” Pearson said. “So I think those are the folks that are going to turn out and vote ‘yes.’”
Amoroso knows firsthand the value of a behavioral health safety net system.
It took a few years after her court-ordered treatment at Valleywise before she finally got sober. But today she’s healthy and housed. She’s a mother of four and has a job that she loves — she works as a peer-support specialist in a behavioral health program at Valleywise.
“I’ve seen so much growth from so many members,” Amoroso said. “We’re talking hundreds that have come through our program super sick, not even able to talk or make eye contact, bond with other people, to holding a full-time job, living on their own, driving, going to school, graduating.”
The programs work, she said. She just hopes to see them expand.
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