In 1980, a statute was passed in Maricopa County, Arizona to change its mental health care model from an institutional method to one based on community treatment. Considering that not even twenty years earlier the state had been conducting forced sterilizations on the mentally ill, this was a remarkable achievement. The state had been dire need of change, as its mental health institutions had devolved into shoddily built halfway homes (one in Phoenix had burned to the ground three times) that left residents more comfortable living on the streets. By 1981, it was clear that the state hadn't taken any of the legally required measures, and a class-action lawsuit, Arnold v. Sarn, was filed to force the state to follow up on its promises. Lawsuits are the most commonly proven method of affecting change in mental health code standards, as has been proven recently in the wake of the Riker's prison scandal.
"The original defense in the case was that the state didn't have the money", the Arnold, Phoenix-based lawyer Chick Arnold, told a local PBS recently. The judge in the lower court determined that this defense made no sense: "The state health department had one of two responsibilities: either to go try and get money to support its statutory responsibility, or lobby to change the statute." The state appealed this and in 1989, the Arizona Supreme Court agreed with the lower court in blunt terms. To quote its ruling, "Arizona has failed to meet its moral and legal obligations to our state's chronically mentally ill population".
In 1991, a basic blueprint was created to implement a host of services and since then, a series of judges have been keeping tabs on Arizona's mental health system, watching it expand into including a grievance system, Assertive Community Treatment (the mobile, multi-disciplinary form of treatment that has been proven to be just as, if not more, effective than institutionalization while offering far more civil liberties), supported housing, supported employment, and peer and family services. In 2010, many of these services were lost all over again as a result of state-wide cuts. This violated "every rule of public health care", said Dr. Jason Caplan, a psychiatrist at a local hospital.
In 2012, a proper framework was agreed for a full funding of Arnold requirements and this September, in 2014, the lawsuit was finally dismissed on a formal basis, with the county judiciary retaining jurisdiction to enforce the agreement for funding.
It's a jurisdiction that will certainly need it. In August, 50-year old Michelle Cusseaux was shot and killed by Arizona police. Cusseaux suffered from bipolar disorder, schizophrenia, and depression. When her mother had called to place her in in-patient services, police who weren't trained in dealing with the mentally ill showed up. They say she came at them with a hammer, but it has not been proven that deadly force was required. All sides agree that the police shouldn't have been there in place of trained professionals, and that on top of that that the Arizona police need better training with the mentally ill. Everyone expects funding for these things to come as a direct result of Arnold v. Sarn. If that will make a diffrence, it's hard to tell: "The Phoenix Police Department talks at us, but they don't listen to us", said Mary Lou Brncik, director of the Arizona Mental Health and Criminal Justice Coalition.
Arnold was a long slog of a class-action suit that was only able to affect change by peristently pointing out the failures of the state. As Arnold enters its next phase, implementation, it will be worth investigating if a thirty-three years is long enough to change not just funding, but the cultural bias against the mentally ill as well