In part four of the special report OVERWHELMED, The Show explores potential solutions to the challenges faced by patients at the Arizona State Hospital, including those with autism.
This report begins at Maricopa County’s psychiatric hospital.
In this series, we've heard from patients at the Arizona State Hospital with autism who say they're not getting the appropriate accommodations.
We also heard from Summer Walter, who says her brother Darren Beach was an all-time low after his time at ASH.
He got worse. By the time he left ASH, over the course of that time — he ended up leaving Ash on over nine different psychiatric meds," she said.
Today, Darren is doing better, his sister says. He's out of jail and living at Valleywise, Maricopa County's psychiatric hospital, as he waits for a suitable community housing placement. Valleywise has been a game changer, Walters says, and that is because of Dr. Carol Olson.
Olson is the medical director for the hospital's psychiatric division. She sees patients who have been ordered by the courts to receive treatment and are waiting for available beds at the state hospital or elsewhere.
Sometimes a patient waits for months — or even years — because Valleywise is a hospital setting and not equipped for long-term living like ASH. Olson says that can be a negative. Imagine being stuck in a hospital room for months on end.
Unlike ASH officials and medical personnel, Olson agreed right away to an interview — as long as it wasn't about specific patients. A tour was a different matter.
Although promised, the interview was rushed. Microphones had to be turned off as reporters were escorted through heavy metal doors and pass a few empty rooms in the adolescent unit.
There's a white board on one wall with a daily schedule. Every minute is accounted for.
A call box-style phone hangs on a wall in front of the nurse's station encased in plexiglass.
Each living quarter holds a small cot, and one empty room at the end of the hall is reserved for timeouts.
The tour ends in Olson's office, where she competes with piles of paperwork and books to find a spot to sit and talk. She too does not have formal data, but Olson is seeing a significant percentage of patients with autism and serious mental illness. She and her staff do their best, she says, to provide accommodations.
The financial cost can be high.
"In almost all cases where the person has significant autism, we have a one-to-one staff member with them at all times," says Olson. "That's one of the reasons why a lot of hospitals don't want to take people with autism or other types of developmental disorders, because it requires extra staff."
There are easier, more affordable ways to help patients with autism, Olson says.
"And then obviously we can try to do things like weighted blankets or doing other types of kind of more sensory modalities for people," says Olson.
Apparently that is not so obvious to others. Two other patients in Matt Solan's unit at the state hospital spoke with KJZZ and asked that their names not be used because they fear for their safety.
"I've been here at the hospital seven years and haven't got treatment for my autism, PTSD, anything, any of that," says one patient. "When I was a kid as well, when I got too anxious, my mom would say, go take a warm bath, and it would calm me down immediately. That was a huge coping skill for me, and they took that away."
Another patient says his autism has become a common struggle at ASH.
"You know, I used to calm myself down by taking a bath, but now they've shut off the bathtubs," the patient says. "There's so much wrong with this place. If prison is hell, this is purgatory, I would say."
Matt Solan echoes the sentiments.
"I end up in the situation I'm at now with still no treatment and no faith that when I get out the exact same thing isn't going to happen the first week I'm out there," says Solan.
Holly Gieszl, Solan's attorney, says treatment plans are a joke — and no one at the hospital will take accountability for what is or is not happening.
"Everybody stands in a circle and points left," says Gieszl.
Patients are isolated for having an emotional outburst, Gieszl says, and that means therapy is withheld. To her, that makes no sense.
"You don't go to treatment. When you're restricted to the unit, you don't get to go to your group. If you throw your orange juice against the wall because you have intermittent explosive disorder, you just lost a month of treatment," she says. "Please, please ask: Why? Why is the Arizona State Hospital permitted to discipline people who are the most severely mentally ill, there because they are insane, and they discipline them by taking away treatment."
The path to reforming the system isn't clear, because pretty much everyone involved agrees that the law already requires ASH to provide accommodations for patients with autism.
Asim Dietrich is an attorney with Disability Rights Arizona, a nonprofit agency funded by the federal government, that represents people with disabilities.
"ASH is bound by both the Americans with Disabilities Act and the Arizonans with Disabilities Act to make sure that they provide the needed reasonable modifications for individuals with disabilities," says Dietrich. So yeah, if it's definitely it's something that's needed for a disability, there needs to be an individualized assessment to determine how to accommodate that disability."
Other Arizona laws specifically mandate that appropriate treatment be provided for patients at the state hospital — but that doesn't mean those laws are being enforced.
State lawmaker Catherine Miranda is concerned.
"To have autism and the psychotic disorder, like schizophrenia, together, I mean, they have to meet these patients where they're at, and that's not happening," Miranda says.
In a statement, ASH officials say that when warranted, accommodations are given to patients with autism, but without more detail on either end, it's hard to know what's really going on inside the hospital.
It could simply be that there's not enough funding available. According to a clinical improvement plan current ASH CEO Michael Sheldon released in 2023, the hospital doesn't have enough state funding to hire staff who are specifically trained to work with patients with autism. The same report concluded that ASH had more than 80 full-time staff vacancies and needs a total of 117 positions filled to meet its current obligations.
This is not a new challenge. In 2021, Sheldon's predecessor, Aaron Bowen, told lawmakers that Ash couldn't accommodate patients with autism.
"We do not have the ability to treat autistic spectrum disorders or developmental disabilities without the appropriately trained, niche staff who specialize in this type of treatment," Bowen says."It's it's very challenging for Ash to accept these types of patients into the state hospital and effectively treat them."
But additional funding won't change the fact that there's little transparency or accountability when it comes to the Arizona State Hospital. One reason so many serious matters remain unresolved, advocates say, is because independent oversight committees have no power.
IOCs, as they are known, are mandated by state law and operated by the Department of Administration as a way of monitoring the state hospital as well as the state's Division of Developmental Disabilities. Citizen members of the ASH IOC review redacted internal reports, ask questions and listen to patient concerns. But beyond reporting their findings, IOC members can do nothing.
Autism advocate Cynthia Macluskie has many years of experience sitting on an IOC.
"We have the power to ask questions and we ask and we ask. And we push and we push. But we don't have the power to make them do anything," Macluskie says. "They can hear it. They can give advice. It doesn't mean the system has to follow it. We don't have any real power."
The most recent annual report for the ASH IOC, dated October 2024, details a range of concerns, including a lack of immediate medical attention at night and on weekends; that the Phoenix Fire Department was not responding to calls as there was confusion over whether the ASH Forensic Unit is a prison or a hospital; and allegations by patients of retribution when they complained to the IOC and elsewhere.
The report also noted that "loud day rooms and bright lights have caused discomfort, especially for patients with autism spectrum disorder."
IOC members also reported concerns that staff were acting inappropriately.
"We substantiated claims that two employees were very aggressive and acted in a manner that escalated situations" the report reads.
Four committee members reviewed the videotapes of the incident. The employee was put on administrative leave while investigating the incident, but later returned to work on the unit. The employee involved in the incident was part of the treatment staff, sitting directly next to the patient in a staffing. The two staff had been reported to the IOC previously as intimidating to the patient.
The IOC's annual report also notes concern from patients over the fact that the state agency that operates the Arizona State Hospital is also charged with monitoring the hospital's performance and holding it accountable.
It's not just patients who are unhappy with that. Advocates came close to getting that law changed in 2024, but ultimately failed.
"DHS imposes financial penalties against Arizona State Hospital, but basically imposing financial penalties against their own department," says Asim Dietrich. "So that's unlikely to occur. And then the other thing is to either terminate or suspend a license. And again, that's unlikely to occur because ASH is only Facility for most of the patients who reside there and basically ASH is the last resort."
Will Humble has also championed the effort to keep the state hospital from, in effect, monitoring itself. He headed the Arizona Department of Health Services from 2009 to 2015 and is now executive director of the Arizona Public Health Association.
"A lot of the decisions that state agencies make are based on self-preservation and administrative ease rather than what's best for the state," says Humble.
The state Department of Health Services is responsible for overseeing all kinds of medical facilities in the state, including hospitals. The department posts results from the last three years of inspections, including penalties.
Over this time period, state inspectors noted that ASH failed to secure bathrooms, leading to the possibility that a patient could use a faucet as a tie-off point in a suicide attempt. It was also noted that the hospital failed to ensure a patient's bedroom was safe by having areas in which a patient could cut themselves.
Inspectors also noted that staffing numbers were continually under the required levels and that staff were not properly trained in policies regarding seclusion and restraint of patients.
Another citation noted that 5 out of 5 seclusion or restraint rooms "contained mirrors made of plexiglas that had sharp edges mounted on the interior wall of the rooms." The top of the mirrors, which were within reach of patients in all five rooms, had sharp edges that were not beveled. When touching the edges of the mirror in the first restraint seclusion room observed, one surveyor was cut on the hand by the mirror.
It was also observed that the fire alarm pole station was obscured and that monthly sprinkler systems inspections had not taken place. Frayed power cords were being used.
Over this three-year time period, ASH received two enforcement actions — one for the forensic unit, the other for civil. Each was fined $500.
On a practical level, Humble says he understands why accommodations like those Matt Solan is requesting aren't always made available.
"What can happen is administrators, medical directors and staff start to become more and more restrictive over time, because if you give someone a privilege — noise-canceling headphones, as an example — and something bad happens with that, then you're gonna be say, 'Why in the world was this person given ... headphones and they took out the battery and ate the battery.' And you'll get in trouble for having given them the headphones," Humble says.
That is not the right direction, Humble says. He holds Gov. Katie Hobbs responsible for ASH's shortcomings.
"It's really key for the governor, the executive, to hold those agencies accountable to say, 'Wait a minute, you're not here to make your job easy. You're here to meet the needs of the patients in Arizona,'" says Humble.
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Autistic patients at the Arizona State Hospital say they are not receiving accommodations and it’s making them worse. -
Autistic patients at the Arizona State Hospital say they are not receiving accommodations and it's making them worse. KJZZ's The Show partnered with Arizona artist Theo Grace Quest to create a zine based on a monthslong project exploring conditions inside the hospital. -
In part two of the special report OVERWHELMED, The Show reports on the complexities for people diagnosed with both autism and serious mental illness. -
In part one of the special report OVERWHELMED, meet Matt Solan, who has autism and has been in the Arizona State Hospital for almost five years. He says he's out of coping tools and barely surviving. -
In part three of the special report OVERWHELMED, KJZZ’s The Show sit down with the sister of a man diagnosed with both schizophrenia and autism who was recently a patient at the Arizona State Hospital. -
In part four of the OVERWLEHMED series, explore potential solutions to the challenges faced by patients at the Arizona State Hospital — including those with autism.
