In November, Maricopa County voters will be asked to weigh in on Prop. 409, a bond initiative that would raise $898 million to build a new behavioral health hospital in the Valley. It would add 200 beds for people with serious mental illness and expand services and training at Valleywise Health, the county’s only safety net hospital.
The county says the cost shakes out to $29 per homeowner.
The effort comes as the Trump administration has changed the conversation around mental illness, issuing an executive order that broadens civil commitment laws to allow more people with mental illness to be locked up involuntarily.
To learn what this move would mean, The Show sat down with Dr. Carol Olson, chair of the Department of Psychiatry at Valleywise Health.
Full conversation
LAUREN GILGER: I want to begin with the problem that you’re trying to solve here. The touch point I think that most people have for serious mental illness in the community is seeing someone who’s experiencing homelessness, who clearly needs help and is out on the street, clearly not getting that help.
What does serious mental illness look like in our community? Has it gotten worse in recent years?
CAROL OLSON: I’m not sure that serious mental illness has gotten worse in recent years, but it is a fact that there are individuals with serious mental illness who don’t recognize that they are ill. Certain illnesses like schizophrenia, for example, part of the illness is that the person doesn’t have insight into having a mental illness and to the serious effects it’s having on their ability to function.
And some of those people will end up homeless and obviously appearing disturbed in the community. Occasionally those people are an actual danger to themselves or other people. And to the extent that they don’t recognize themselves as having a problem, there is a process under Arizona law — that’s not new, that’s existed for a very long time — which would allow them to be hospitalized even if they don’t see the need for it.
In Maricopa County, Valleywise Health System is unique in serving that population because we are the only hospitals that do court-ordered psychiatric evaluations. There’s many hospitals that are willing to take someone in for treatment who recognize the fact that they need treatment, but Valleywise is the only three hospitals in Maricopa County that take individuals where the court has ordered that person to have an evaluation because they’re having very serious symptoms.
GILGER: Right. So how significant, Dr. Olson, would 200 more beds be in the community right now? You’re talking about largely this population of people with court ordered treatment and giving them a place to go.
OLSON: Yeah. So currently, Valleywise has a total of 392 licensed psychiatric hospital beds. And this would be adding, we would be replacing our oldest facility that currently is located in central Phoenix, currently has 93 beds. And we would be replacing it with a facility of over 200 beds. That would create a significant difference.
As of this morning, I had over 40 individuals waiting for admission to the hospital who needed this type of emergency involuntary evaluation. And every single day I’m struggling to find a bed to put that patient in so that that person is not just remaining out in the community with no treatment.
GILGER: This comes, as I mentioned, as there’s a lot of concern in the behavioral health world about this new executive order from the Trump administration that basically aims to make it easier to get people into that court-ordered treatment. Institutionalization is a word you’re hearing a lot right now. Are some folks worried about building more of those institutions?
OLSON: I think that there’s a misconception about what is needed. Most individuals with serious mental illness who are severely ill and need an involuntary evaluation do not need long-term hospitalization. The average length of stay within Valleywise for those patients is about three weeks. The average length of stay for a voluntary patient in the community is about seven days.
So it is a longer length of stay, but it is not a long time. It’s not locking somebody up in the hospital for months or years. But we do need hospitals like Valleywise, that are willing to keep the more severely ill people long enough until they get better and can return to the community and function and be with their families.
So that’s what we’re asking the voters to do. Nobody likes to pay taxes, but in this case, it’s really, truly necessary. It’s really a core function of what’s needed in society to have a hospital for those individuals to go.
GILGER: Why now? Maricopa County voters will probably remember approving another major bond to build the big new Valleywise hospital that you’ll see if you’re kind of driving down the 202 on 24th Street and Roosevelt there, which was not that long ago.
OLSON: That was over 10 years ago, actually, the bond was approved. And at that time, in addition to that new hospital, which replaced a hospital that was over 50 years old, we also bought and remodeled Maryvale hospital on the west side, which is now our largest psychiatric hospital of our three, is located in Maryvale.
So this new funding is to pay for new because the population has grown, and as I said, we have a waiting list every day. We need more psychiatric beds. Yeah. So that’s the purpose of it.
GILGER: That’s the purpose. There are attempts to alleviate a very complicated problem here. This is a tough thing to even attempt to solve, which I know you know well, and you’ve been in this world for a long time.
So I wonder lastly here, Dr. Olson, in a perfect world, what would you think would really help? Like if you had a magic wand, what would you ask for? What would you do?
OLSON: I think that there need to be enough beds for individuals who are or are the more on the more severe end of the spectrum, including people who have complicated medical conditions in addition to their psychiatric problem, because there there are many hospitals that are willing to serve the less complicated patients, but the more severely ill patients or those who need a longer length of stay have very, very few places to go.
In addition, once they get out of the hospital, some people need to be in a more secured setting, because they’re very ill and they need to have people there 24 hours a day. So there need to be sufficient places for them to go to once they’re ready to be out of a hospital but still need quite a lot of supports.
Arizona as a whole actually has fairly good access, under our AHCCCS Medicaid program, has a fairly good continuum of services for people with mental illness. But it’s that piece of the population with the more severe illness and the more complicated problems that we need to have more facilities for.
GILGER: Is 200-something more beds enough? Is this a drop in the bucket?
OLSON: Well, I guess what I would say is right now it is enough. Arizona has a growing population. I can’t say that that would be true forever. And obviously, hospital beds are not the only solution. There’s other pieces as well.
But 200 beds, we would not have the waiting list we have right today of people waiting for court-ordered evaluation with 200 more beds.
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