Raising Phoenix: Mind Games

Amy SilvermanJuly 6, 2023
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Illustration by Jess Suttner
Illustration by Jess Suttner

Mired in a mental-health crisis with no easy answers, should we start considering difficult ones?

Several years ago, one of my writing students showed up to class with an essay that I have thought about almost every day since.

She described driving down the street – a street she takes all the time, not far from her house, on an otherwise unremarkable day – and seeing a person standing on the side of the road. That can be rare in Phoenix, where we are our cars, so my student took note and saw that this individual was filthy, shoeless, dressed in rags, pushing a shopping cart, ranting.

How can we just drive by these people? she asked in her essay. How is this OK?  

It’s not. And yet in the decade or so that’s passed since that writing workshop, the number of people living on the streets here has exploded. We know from years of research that at least a third are mentally ill. Beyond that, I’m not going to give you statistics. In fact, I think statistics are part of the problem. Numbers are easier to dismiss than people.

Instead, why don’t you take a moment to think about someone you’ve driven by recently – answering voices the rest of us can’t hear, juggling earthly possessions, sleeping off the high from a street drug in lieu of the heavy-duty psychotropics that make them feel like shit if they’re lucky enough to get help.

Since I read that essay, a multi-block homeless encampment appeared in Downtown Phoenix. Another popped up around the scrub in the then-dry Salt River, just west of Tempe Town Lake. Both communities were dismantled (sometimes more than once) earlier this year. But that didn’t rid the city of the unsheltered. I see them in the park, behind Circle K, walking down my street.

Honestly, I can’t imagine how anyone will ever fix this. Once we all became OK with walking or driving past people in unimaginable pain, it was over. How do you ever turn that around?

Here’s the thing. Even if we all decided tomorrow that we could no longer look away, if we declared as a society that it’s time to take care of our most vulnerable, we still have no idea as how to make it happen. Not in a humane manner, anyway. 

The state of Arizona directs a lot of money at care for people with serious mental illness. Too often it feels like a plug-your-nose-close-your-eyes-toss-some-cash-out-the-window-of-the-moving-car approach more than any kind of thoughtful, assertive method designed to truly change anything or help anyone. 

In fact, there’s a phrase for what happens here: “Treat, street, repeat.” For many of the people you drive past, life is a revolving door of being committed to a psych ward for a few days, medicated and sent back out there. 

Those closest to this population – most notably, some families of people with serious mental illness – are begging for that to change. Often, they argue for longer treatment stints in locked facilities. 

This raises very serious questions about civil rights. But before you judge, try sitting in the living room of a sweet, retired businessman and listening to him sob because his adult son’s imagined demons instruct him to run into traffic. And worse. 

These family members have the physical and emotional scars to show they are not able to care for their loved ones alone. They need help. Politics makes that pretty much impossible. There’s a complicated tangle of intake facilities, clinics and psychiatric hospitals meant to assess conditions and offer treatment. There’s jail and prison, because our corrections facilities double as mental-health wards. 

And then there’s the last resort, the Arizona State Hospital. As a rule, we don’t institutionalize people in the United States anymore. It’s considered inhumane. Decades ago, a court settlement set a cap of 55 on the number of Maricopa County residents who can be civilly committed to ASH. (Meaning they did not commit a crime that landed them there.)

Family members like the man whose son runs into traffic want desperately to increase that number, to bring more people with serious mental illness to ASH for intensive, longer-term treatment than they’ve been getting. 

In theory, that’s not a bad idea. It won’t save everyone, but could make a huge difference for some, particularly if we stop thinking of ASH as a place to simply warehouse people. 

But first, someone needs to clean up Arizona’s state hospital. And I don’t see that happening any time soon, if ever. 

I wonder how many Metro Phoenix residents even know there’s a mental institution sitting on 90-odd acres on the northeast corner of 24th and Van Buren streets. Thick bougainvillea bushes distract from the unusually high fences. 

The state hospital is charged with providing therapeutic treatment to the very sickest people with mental illness, including those who are civilly committed and others who have committed crimes and been sent there by the courts. ASH is supposed to get psychotic episodes under control, tamp down manic behavior and help patients take back their lives.

I’ve covered ASH off and on for years, including pretty much all of 2021, and I still have no idea what goes on in that place on a day-to-day basis. I have sources who share bits and pieces, never for attribution. Employees are terrified of retribution, I can tell you that much.

The last (and only) time my request for a tour of ASH was granted was 30 years ago, in 1993. I remember being taken to the outdoor space where patients exercised. There was chain link over the top of the enclosure, like a cage. I haven’t forgotten that, and I will always remember the state hospital patients I’ve written about since.

There’s Isaac Contreras, who was left in isolation for months, retaliation for filing complaints. And Matthew Solan, who begged for years for access to his therapy dog, a Pomeranian named Foxy. Solan waited so long that Foxy died last year before he could see her. Now he’s got a GoFundMe to raise money to have Foxy cloned.

And then there are the people who are no longer with us, like Philip Ronan, who stuck a pair of scissors into his neck in an ASH bathroom during an art workshop in 2021. He died.

So did Mark Chavez, who shoved an entire burrito down his own throat, also in 2021, as his one-on-one aide looked on.

Patients are often locked in restraints, I’m told (and I’ve seen some of the internal reports). There are frequent assaults of ASH personnel and patient-on-patient attacks.

Is any of this avoidable? I mean, to be fair, this is a really tough (probably the toughest) population to treat. I get that. But we’ll likely never know what goes on behind that high fence.

That is a big problem. Perhaps an even bigger problem? The Arizona State Hospital is in charge of policing itself.

You read that right. Oversight for ASH is provided by the Arizona Department of Health Services, which operates the state hospital. Legislation introduced this year would have moved oversight of ASH to an independent review board appointed by the governor. It never made it out of the legislature, but I’m told that one was dead on arrival from the beginning over concerns that the wrong governor would appoint the wrong people.

Point taken. But really, is there no other solution? No other way to make sure the Arizona State Hospital isn’t shrouded in secrecy along with bougainvillea?

There’s talk of putting ASH under AHCCCS, the state’s Medicaid agency, of writing new rules or laws requiring ASH to provide more information. There’s always the possibility of a class action lawsuit. The bottom line: No one should breathe a word about increasing the number of patients at ASH till the place is cleaned up. 

And then – if you can do it right – do it. Fill the buildings that are standing empty, open the grounds to non-dangerous patients and give them enriching activities. Treat these patients like human beings. Find guardians who really care about those who don’t have family. Hire doctors who know what they are doing and have clinical experience working with people with serious mental illness. 

It would be a nice move by a governor with a background in social work. Be the state that blew up its state hospital and started seeing these people as people. Make the northeast corner of 24th and Van Buren streets a model for the world. 

Why not try? 

I realize most of you are reading this and thinking, “What a pipe dream! What a ridiculous, bleeding-heart liberal.”

That’s fine. I’ll take the labels. How can you not feel that way after driving past so much pain?