Why lawmakers may lift the 55-bed cap for Maricopa County residents at the Arizona State Hospital

The Arizona Senate has approved a bill that would lift the cap on the number of beds available to Maricopa County residents at the Arizona State Hospital.

That cap has been in place for more than a decade, after the state settled a long-running lawsuit, known as Arnold v. Sarn. The suit alleged the state was not providing adequate care for residents with serious mental illnesses.

Will Humble is the executive director of the Arizona Public Health Association. He was the head of the state health department who signed off on the settlement back in 2014.

Full conversation

MARK BRODIE: So tell me about your decision to sign this settlement in the first place that instituted this cap.

WILL HUMBLE: Yeah. So, as you know, the Arnold v. Sarn lawsuit was exactly like you described, that Arizona was doing a super bad job helping people with mental illness get treatment back in the '80s and '90s. And there was a stipulation agreement in 1995 that Gov. [Fife] Symington's team signed that that capped the number of treatment beds at the Arizona State Hospital civil unit at 55. And it stayed that way. Well, it's still that way.

... And then when we settled, when we did the settlement agreement under Gov. [Jan] Brewer in 2014, I signed the agreement that said, OK, we'll limit the number of treatment beds at the Arizona State Hospital for Maricopa County residents to just 55. I knew it was a bad idea, but the overall bigger settlement was really worth it, because we got performance measures in place and accountability in place for even future administrations around treatment for folks with serious mental illness. So, I agreed to the 55 cap. So, mea culpa there.

BRODIE: Yeah. But. So now you are supportive of the effort to lift the cap. Is it mostly a matter of there are more than 55 Maricopa County residents who could benefit from the services that they would get at the state hospital?

HUMBLE: Yeah. Way more. You know, Arizona, if you look nationally at the number of inpatient psychiatric treatment facilities, beds, you might say, Arizona is at the very bottom of the list. So we need a lot more treatment capacity and secure environments for people under court ordered treatment for serious mental illnesses, in my opinion. There's other people that disagree with me, ... but I ran the system. I know. And it's gotten a lot worse since I left. So. Yeah ... so that's the situation now.

BRODIE: How much of a dent would this put in? Do you have a sense of ... everybody who needs this kind of help won't be able to go there even if they lift the cap, right?

HUMBLE: Right, no. ... If you lift the Maricopa County cap, that would allow people who need, really need treatment in Maricopa County who are stuck at like Valleywise. And Valleywise does good work, but the secure environments that they have are really hospital type environment, like small hospital-type environments. Where at the Arizona State Hospital, it's a more therapeutic, or at least has the resources to be more therapeutic for people.

So it would allow the transfer of people from the Valleywise system into the Arizona State Hospital. But to your point, it doesn't solve the overarching problem, which is just the lack of capacity for this kind of treatment — and by the way, the discharge capacity. So if you have people at the civil unit with a serious mental illness who need to get discharged to another environment that's more secure, like a secure residential facility, we don't even have those.

So there's lots of problems in the system. This would provide some help.

Bret Jaspers/KJZZ

BRODIE: What would it take to make this workable? I assume that assuming, let's say the bill passes, the governor signs it. I assume you don't just snap your fingers, tomorrow the state hospital can let in a bunch more people from Maricopa County.

HUMBLE: Correct. Good point, good question. So, yeah, so what would. So by the way, at the Arizona State Hospital, the civil unit, that's the folks that we're talking about here, there are some, like some empty floors because of the 55 cap. So there's actual physical space to provide a lot more. A lot more.

I mean, dozens more treatment capacity for people with a psychiatric illness like this at the Arizona State Hospital. But they have to be staffed, so you'd have to fund it. The extra ...

BRODIE: And that staff is not there now.

HUMBLE: No, that staff's not there now. So you'd have to fund the ability for staff to come in and provide that kind of treatment. So it'd be like an eight-month sort of landing pad where you could get the state resources in place and increase the amount of capacity that's available for that kind of treatment out at ASH. And then by opening up those floors on Ironwood, that's the name of the building.

BRODIE: OK. Is there a danger that by lifting this cap it would violate the terms of the settlement that you signed?

HUMBLE: Well, so as you mentioned, I signed and Gov. Brewer signed the settlement agreement in 2014 and the 55 cap was in that. But if the state Legislature, and by the way, there's no 55 cap in state law, it's just a settlement agreement. So if the Legislature passes a bill that says, hey, you could go beyond 55 for Maricopa County residents then and even fund it, let's say, then, you know, the plaintiffs may, in the Arnold v. Sarn suit, go to the judge and say, hey, look, they violated the settlement agreement, your honor, and make them stop.

And that's the, so there would be probably some court appearance, but the state could say, hey, look, the Legislature passed this bill. That settlement agreement was 10 years ago when the population of Arizona was a lot less than it is today.

We need this treatment capacity. We're in accord with all of the other performance measures in the Arnold v. Sarn agreement. Your honor, we would like you to amend the stipulation agreement or settlement agreement.

BRODIE: Right. Well, so the original 55 was that. I'm curious why that was put in place. I know that all of that sort of predates your time at the health department, but I'm wondering, was there a thought that if you didn't put a cap on the number of residents of Maricopa County at ASH, that residents of other parts of the state wouldn't be able to get in?

HUMBLE: You know, I just don't know that part of it. I wasn't in the negotiation. I was doing food safety at the time. So I wasn't like, in the room where these things were discussed at the time. But in general, the plaintiff class, the people who sued the state were really concerned that people were being institutionalized too quickly.

And so this was a mechanism to, like, hardwire a cap on that because the lawsuit was about Maricopa County. So it just applied to Maricopa County people.

BRODIE: OK, so. Well, very quickly, before I let you go, this bill is gonna. As I mentioned, it cleared the Senate. It's going before a House committee next week. What's your level of optimism that it'll pass that committee?

HUMBLE: I think it'll pass the committee. I think there's a really good chance that it'll pass on the floor of the House and passed in the Senate with bipartisan support. Where I don't get a sense is where the governor is. Whether she'd sign it or not, I just. I don't know. I think she should if it gets to her desk, but I'm not the governor.

BRODIE: Right. OK. Fair enough.