Arizona Department of Health Services, Division of Behavioral Health Services and Arizona State Hospital Annual Report

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DIVISION OF
BEHAVIORAL HEALTH SERVIC6S
ANNUAL REPORT
FY 1985-1986
Bruce Babbitt
GOVERNOR, STATE OF ARIZONA
Boyd Dover, Acting Director
ARIZONA DEPARTMENT OF HEALTH SERVICES
. ,C:.:.. .~- ARIZONA DEPARTMENT OF HEALTH SERVICES
BRUCE BABBITT, Governor
BOYD DOVER, Acting Director
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December 11, 1986
The Honorable Bruce Babbitt
Governor, State of Arizona
1700 W. Washington
Phoenix, Arizona 85007
The Honorable Stan Turley
President of the Senate
1700 W. Washington
Phoenix, Arizona 85007
The Honorable James J. Sossaman
Speaker, House of Representatives
1700 W. Washington
Phoenix, Arizona 85007
The attached annual report reflects the activities of the components of the Division of
Behavioral Health Services during FY 1985-86. During that period, the State Hospital
(ASH), the Southern Arizona Mental Health Center (SAMHC) and the Office of
Community Behavioral Health Services (OCBHS) served 62,589 people. Total funding of
services was $74,798,587 ($14,907,277 in local match) and administrative cost was
$11,837,955, or 15.8 percent.
Despite these efforts, the level of need continues to grow.
o Arizona continues to be among the top ten states in the nation in various
indices of community disfunction: adult and adolescent suicide rates, divorce,
alcohol and drug abuse.
o An estimated 500 children throughout the state require intensive residential
and inpatient mental health treatment in the public sector. The state system
currently serves 31 children through contracted services and 19 adolescents
(average daily census) at ASH.
o There are an estimated 279,799 people in need of public sector mental health
services, not inclusive of chronic mentally ill individuals. The OCBHS and
SAMHC served a total of 26,664 individuals, or 10 percent of those in need.
o OCBHS and SAMHC served 6,376 individuals who were chronic mentally ill. It
is estimated that there are many more, as yet, unidentified throughout the
state. Some of these unidentified CMl's are in other systems, DES, DOC, and
some are not in systems at all but number among the homeless population.
The Department of Health Services is An Equal Opportunity Affirmative Action Employer.
State Health Building 1740 West Adams Street Phoenix . Arivn1p ~f;nn7
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DIVISION OF BEHAVIORAL HEALTH SERVICES
ANNUAL REPORT
Thomas E. Bittker, M.D.
Assistant Director
FY 1985-86
TABLE OF CXNI'fNI'S
Executive Surrnary •••••••.•••••••••••••••••••.••••••••••..•••••.••••.••••.••••.•• i
Introduction .................................................................... 1
Camn.inity Behavioral Health Se:r:v-ioes ..... ; ...................................... 1
Comparison of Total Comnunity Behavioral Health Clients ...................... 7
Comparison of State & Client Population by CountY ........................•... 8
Clients by County of Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Number & Percent of CMI Served by County of Residence ........................ 10
Canparison of CMI Services by Type of Service ................................ 11
Comparison of Alcohol and Drug Abuse Services by Type of Service .........•... 12
Comparison of Mental Health Services by Type of Services ..................... 13
Administrative Overhead by Fund Source ..•..................•..............•.. 14
Contracted Funds by Source & Program FY 85-86 ................................ 15
Admin. Overhead for CMI Program .............................•................ 16
Admin. Overhead for Alcohol Program ...............................•.......... 17
Admin. Overhead for Drug Abuse Program ......•....•........................... 18
Admin. Overhead for Mental Health Program ...................•..•............. 19
Southern Arizona M:mtal Health Center ................................•.......... 20
Comparison of Service & Clients by Program .........•.•................•.••... 25
Comparison of Percentage of CMis & Non-CMis •...•...... . .........•..........•. 26
Comparison & Percentage of Youth vs. Adult Clients ........•.•...•............ 26
Revenue, Expenditure, Administrative Costs FY 85-86 .......................... 27
.Arizona State Hospital ... · ................................. ....................... 2 8
Average Monthly Census by Type of Admission .................•................ 34
Length of Stay for Discharges ....•................•.....•..•..•...........•.. 3 5
Total Number & Percentage of Admissions by CountY ..........................•. 36
Admission Rates Per 100,000 Population by County .•...............••....•.... 37
Number & Percentage of Admissions by Diagnostic Reason .......................3 8
Number & Type of Discharges by County ............•....................•...... 3 9
Financial Surrnary FY 85-86 ................................................... 4 O
Administrative Cost FY 85-86 ................................................. 41
Future Concerns ......................••......•............................... 4 2
EXECUTIVE SUMMARY
During FY 85-86, there was no Division of Behavioral Health Services within the Arizona
Department of Health Services. The three service components, Community Behavioral
Health Services, Southern Arizona Mental Health Center and Arizona State Hospital,
operated as separate offices out of the Director's office. The Division has been
recreated to serve as the single state agency for behavioral health to provide
coordination, planning, administration and monitoring of all facets of the public
treatment system.
The Office of Community Behavioral Health Services (OCBHS) contracted with nine
regional administrative entities and three sovereign Indian nations to provide
comprehensive prevention and treatment programs for substance abuse, mental illness
and domestic violence. During FY 85-86, the community system served 58,575 people;
28,453 were treated for alcohol and drug abuse problems; 24,678 for mental health
problems; and 5,444 for chronic mental illness. The behavioral health system worked
with over 130 schools throughout the state in providing prevention programming.
Significant decreases from FY 84-85 to FY 85-86 occurred in the level of inpatient
services provided, 46 percent in CMI, 42 percent in mental health, 37 percent in alcohol
abuse and 65 percent in drug abuse. At the same time, the level of residential services
increased in each program by 19 percent, 30 percent, 7 percent and 8 percent,
respectively. Increases also occurred in outpatient services for all programs except drug
abuse, and partial care services decreased in all four programs. Total revenues for
subvention contracts were $33,529,910, and total expenditures were $33,329,057*.
Administrative costs for OCBHS were $567,693. Total funds expended on behavioral
health services by contractors, including ADHS and contractor funds, were $48,236,334.
*$200,853 difference due to insufficient service delivery.
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B9ExecSum
The ADHS share represented 62 perc ent. Of the total fund s, $9,666,606, or 20 perc ent,
was expended for administrative costs.
Southern Arizona Mental Health Center (SAMHC) is the only state operated treatment
r center providing specialized mental health services to residents of Pima County and
southern Arizona. Services provided include screening and evaluation, comprehensive
outpatient treatment programs for adults and children, partial care, residential
treatment and prevention programs. During FY 85-86, SAMHC provided services to
2,918 clients, including 2,325 adults and 593 children and their families. Of the adult
population served, 932 were chronically mentally ill, a 48 percent increase over the
numbers served in FY 84-85. The total number of clients increased by 11 % over FY 84-
85. Service levels in the day treatment and day activity programs increased over FY 84-
85 by 29 percent and 14 percent, respectively. All other service levels decreased during
FY 85-86. Total funding for SAMHC was $3,240,792, and expenditures were $3,114,190.
Of that amount, $446,120, or 14 percent, was expended for administrative costs.
Arizona State Hospital (ASH), a state operated facility located in Phoenix, provides
inpatient psychiatric care and treatment for state residents who are suffering from
severe mental and emotional illnesses and disorders. Admissions to ASH increased by 44
percent from FY 83-84 and stabilized in FY 85-86 with a census of 492 at the end of the
year. Court-ordered commitments accounted for 80 percent of admissions in FY 85-86.
There was a significant increase in the median length of stay for patients, from 74 days
in FY 84-85 to 113 days in FY 85-86. This is a result of the growth in the number of
patients with severe illnesses and the number of court-ordered patients requiring longer
stays. Patients are assigned to a treatment program based on their needs and level of
functioning. Treatment methods include biological therapy (medications), psychotherapy,
environmental control, rehabilitation therapy and nursing services. Total funding for
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ASH was $23,448,063, and expenditures we re $23,448,063. Of that a mount, $1,157,536 ,
or 5 percent, was expended for administrative costs.
The Division of Behavioral Health was recreated by the passage of H.B. 2511 and is
,. responsible for planning, coordinating, administering, regulating and monitoring a
comprehensive system of behavioral health services. Future issues for the Division are
as follows:
Implementation of H.B. 2511.
Initiation of a strategic planning process.
Recruitment and maintenance of staff at ASH.
Continuation of renovation and improvements at ASH. -- ,
Development of secure inpatient psychiatric services for children.
Improvement of coordination among all agencies in the behavioral health
service delivery system.
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INTRODUCTION
The Division of Behavioral Health Services was abolished, by Arizona Department of Health
Services management in January 1984. After· gathering input from concerned pa_rties, a
behavioral health plan was developed by the Department, which reorganized behavioral health
within the Department and created geographic entities to administer the resources and the
service system for substance abuse, mental illness and domestic violence. The plan was
approved by Governor Babbitt and the legislature for implementation. Pt.iblic hearings were
held throughout the state to determine geographic boundaries, a request for proposals was
issued and administrative entities were selected and funded for start-up in January 1985.
Throughout this period of time and until H.B. 2511 became effective in August of 1986, there
was no Division of Behavioral Health Services. Community Behavioral Health Services,
Southern Arizona Mental Health Center and the Arizona State Hospital functioned as separate
offices within the Director's office. Community Behavioral Health was reduced from
approximately 23 staff to 5. The majority of admlnistra tion, monitoring and planning
responsibilities formerly performed at the state level were delegated to the new administrative
entitles. H.B. 2511 recreated a Division within the Health Department that would act as the
single state agency for behavioral health and recapture those essential functions. Since there
was no Division administration during FY 85-86, this report covers only the three service
components: Community Behavioral Health Services; Southern Arizona Mental Health Center;
and Arizona State Hospital.
Community Behavioral Health Services
0
The Office of Community Behavioral Health Services (OCBHS) contracts with nine regional
administrative entities and three sovereign Indian nations to provide a comprehensive program
of prevention and treatment for substance abuse, mental illness and domestic violence. In turn,
these entities contract with over one hundred public and private, not for profit corporations to
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provide direct client care to persons with chronic and acute mental disorders, abusing or
addicted to alcohol and/or pharmaceuticals or other substances and victims of domestic
violence. During FY 85-86, the behavioral health system served 58,575 people. Of these,
28,453 were treated for alcohol and/or drug dependency problems, 24,678 for menta'l health
problems and 5,444 for chronic mental illness.
A major goal of OCBHS is to care for people at a facility with a service which is cost effective,
clinically appropriate and offers the best opportunity for improvement in the individual's and
his/her family's life. Therefore, the system of care ranges from inpatient hospital care to the
flexible and independent setting of the outpatient office. Yet some clients require 24-hour
residences for short-term 0 -30 days) or long-term (30-365 days) treatment. These facilities
offer people the opportunity to restructure their lives in a secure, supervised environment
complemented with counseling, educational and employment-oriented activities. Many clients
are able to continue living at home qut still require intense individual and group counseling;
partial care programs (3 or more hours per day) provide such a therapeutic setting. Finally,
outpatient care is offered to individuals and their families who are able to function at home and
at work but need to meet on at least a weekly basis, for an hour or more, in order to work
together with clinicians for resolution to problems. All of these services are available
statewide to mental health, alcohol and drug abuse clients on a sliding fee scale. Clients unable
to pay any fee a re cared for at state expense.
Chronic mentally ill persons rank among the highest priorities of both the Division and OCBHS.
In addition to the range of services described above, other services especially designed for the
chronic mentally ill are provided. Case management is such a service. Case management
efforts continue to be expanded in order to ensure that once a client is identified, he will
receive the most appropriate care and support services. Another unique service for these
clients is Day Treatment. This is a five to six-hour program combining living skills, social,
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recreational and therapeutic activities which help to improve their quality of life. Key support
services which are being developed in concert with the Department of Economic Security are
supportive work programs. The goal of these programs is to assist people to become more self ­fulfilled
through learned or renewed employment skills, thus becoming more independent of tl)e
behavioral health care system. Legislative funding has enabled the Division to begin to
implement a more complete and effective system of care. Nevertheless, continued program
growth and development is needed and anticipated.
The Division and OCBHS have only begun to scratch the surface in meeting the needs of
children and adolescents who are severely emotionally disabled. Of the documented 500
children in need, only 31 are able to participate in the program because of limited funding.
Additionally, there are many more children still in need of care who are less severely disabled.
This issue has been raised as a major concern by the Division, the Department and community
groups.
Women and children who are the victims of continuing violent and abusive behavior in their
homes receive short-term (up to 30 days) care at various shelters throughout the state. These
programs are relatively new and severely underfunded. Yet more than 8,000 women and
children were cared for last year. Estimates as high as 20,000 in need appear realistic, and
demonstrate the gaps in care still existing in our state.
Prevention Activities
Despite the increasing demands to expand treatment services to large numbers of people in
need, the Division has continued its commitment to primary prevention activities. It is more
cost effective and beneficial to the state and community to prevent behavioral health problems
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than to provide treatment and prevention activities provide an entry for high risk populations
into early intervention services before a problem becomes disabling.
Of particular importance is the degree of coordination and involvement by community prograrps
in school districts throughout the state. The behavioral health system is working with over 130
schools throughout the state in prevention programming. This emphasis has developed over a
ten-year period and has created a rich environment for future interdepart_mental coordination
with the Department of Education.
Profile of the Clients Treated
Non-chronic mentally ill persons (24,678) made up 42 percent of the clients seen, while 36
percent (21,068) persons with alcoholism problems and 13 percent (7,385) persons abusing or
addicted to drugs were treated. There were modest increases over the previous year in the
numbers of alcoholism and drug abuse clients seen; +3.6 percent and +5.3 percent respectively.
Chronic Mentally 111
Chronic mentally i11 clients, 5,444 in community agencies, made up 9 percent of the total
clients treated. The number of community agency clients (5,444) appears to be less than the
number treated during FY 84-85, 6,027 . More accurate tracking of state funded clients
eliminated prior year inclusion of Maricopa County funded chronic mentally i11 clients.
Chronic mentally i11 clients reside predominantly (78.& percent) in the major urban areas of
Maricopa and Pima Counties, due to the location of the state hospital, the concentration of
state population, the availability of support services and boarding home type housing.
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For the past two years, there was an even mix of male and female clients; this year, the number
of males increased to 51.8 percent of the client population·, with female representation at 48.2
. .
percent. The largest age group remained in the 25-54-year old range (73.5 percent vs 70_.2
percent in FY 84-85), while the 55+ year old range decreased from the previous two years by 3.7
percent.
The pattern of marital status remained relatively unchanged, with the predominant number
(50.3 percent) of chronic mentally ill clients in single status. Ethnicity of clients is
representative of the state population with the exception of the over-representation of black
clients (7.7 percent), who constitute only 3 percent of the state's population.
Unfortunately, the chronic mentally ill clients continue to have the lowest economic status
among behavioral health clients with 68.6 percent earning less than $9,500 per year. Related to
this, 63.8 percent are unemployed or are receiving public assistance or social security.
Mental Health
The 24,678 clients seen during the year represent a 3.6 percent increase over the number of
clients seen the previous year; of these, 7,231, or 29.3 percent, were Children or adolescents
(below 18 years of age). Within the total increase, Maricopa County increased its
representation from 47 .2 percent of clients to 53.8 percent. All other demographic information
remained relatively unchanged. Clients are predominantly white, female, between the ages of
25 and 54 years old, single and have an income below $12,500 a year.
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Alcohol and Drug Abuse
There was a slight decrease of .5 percent in alcohol abuse clients (21,068) from the previous
year. However, drug abuse clients represented the largest increase of any client category, with
an increase of +5.3 percent, or 7,385, as contrasted with 7,016 in FY 84-85. · Children and
adolescents (below 18 years of age) comprised 8.1 percent (2,302) of the total of substance
abuse clients treated. Reflective of population distribution, the largest. concentrations of
clients were in Maricopa and Pima Counties, but rural areas continued to maintain their client
numbers in both programs. Unlike mental health programs, substance abuse programs continue
to be over-represented by males, a trend consistent with national data. Again, while whites are
the majority users of mental health facilities, minorities tend to be over-represented in
substance abuse programs, blacks (6 percent) and hispanics (21.6 percent) in . drug abuse
programs and native americans (22.4 percent) in alcohol abuse programs. Contrasted to alcohol
abuse and mental health programs, drug abuse clients are predominantly under 34 years of age,
rather typical of the abuse/addiction experience nationally. Alcohol abuse programs tend to
have a higher proportion of divorced people than mental health or drug abuse, but drug abuse
programs have the highest percentage of single clients. As expected, both drug abuse and
alcohol abuse programs have a greater percentage of clients below the $12,500 income range.
Substance abuse clients are less dependent upon their families, utilize public assistance and
entitlement programs less than mental health clients, but have about the same percentage of
employed individuals.
The following tables portray clients, services, revenues, expenditures and administrative costs
for the community behavioral health system.
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.. .
Fiscal Year
FY 83-84
FY 84-85
FY 85-86
Percent of
change between
84-85 &: 85-86
~ .
lFFICE CF CON..tUTY BEHAVIOOAL 1£ALTH SERVICES
Canparison of Total Camutity Behavioral Health Clients
Mental Heal.th
24,966
23,825
24,678
+3.6%
Alcohol Abuse
20,981
21,183
21,068
-0.5%
Drug Abuse
7,292
7,016
7,385
+5.3%
OU
4,491
6,027
5,444
*
Total
57,730
58,051
58,575
+0.9%
With the exception of the Chronic Mentally Ill Programs, the other disability services received only a Cost of Living
increase of 4% in FY 85-86. Hence, the increases in Mental Health and Drug Abuse Programs continue to demonstrate the
continued availability of services to people despite high case loads per therapist and the decreased buying power of
funding dollars. Programs still have not yet recovered from significant decreases in federal block grant funds
experienced in FY 84-85.
*The apparent decrease in chronic mentally ill Clients is attributed to more aggressive data analysis by the Division
in order to display clients served by Division managed federal and state funds. Specifically, clients funded and served
by Maricopa County directly are no longer included since the termination of the direct contract with the county and its
inclusion in the administrative responsibility of C0DAMA Services Inc. Additionally, as .in prior years, the 932 chronic
mentally ill clients served by the Southern Arizona Mental Health Center are not included in the community data, but are
displayed in a separate section.
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Apache
Cochise
Coconino
Gila
Graham
Greenlee
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma/LaPaz
Totals
«FFICE (F COIUUTY BEHAVICIW... tEALTH SERVICES
cot>ARISOO CF STATE POFU.ATICJ-.1 AN) a..IENT POFU.ATICJ-.1 BY a:l.NTY
FY 85-86
X s
1986 I of I Mental Alcohol
Population State CMI Health Abuse
56,400 1.6% 0.7% 1.8% 3.6%
96,300 2.9 1.7 2.8 1.8
86,000 2.7 1.5 3.7 7.4
38,100 1.2 0.7 2.1 1.8
23,300 0.7 0.4 0.5 0.4
8,700 0.3 0.2 0.1 0.1
1,800,000 56.8 55.3 53.8 36 .4
72,600 2.1 2.0 4.4 3.6
72,300 2.2 1.5 4.0 4.2
624,300 19 .7 23.5 8.7 9.8
100 ,100 3.2 4.0 7.0 4.1
27,100 0.7 0.8 1.0 0.4
88,000 2.7 2.8 6.0 4.0
104,500 3.2 1.5 2.2 2.2
3,197,700
DES Projected Census 1986
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~ .}
X
Drug
Abuse
1.7%
1.4
4.4
1.3
0.4
0.1
49.4
2.3
2.5
22.7
4.6
0.4
5.0
1.9
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IFFICE IF COM.NITY IEHAVIOOAL IEAL Tii SERVICES
Clients by CoUlty of Residence
tb\04!
Cot.nt y Mental Health Alcdlol Abuse On.g Abuse
83-84 84-85 85-86 83-84 84-85 85-86 83-84 ~ 85-86
Apache 492 2.0% 418 1.6% 444 1.8% 808 3 . 9% 850 4.0% 752 3.6% 109 1.5% 117 1.7% 123 1.7%
Cochise 746 3.0 716 3.0 691 2.8 281 1.3 443 2.1 378 1.8 73 1.0 78 1.1 105 1.4
Coconino 1,164 4.7 1,048 4.4 907 3.7 1,828 8.7 1,631 7.7 1,561 7.4 273 3.7 329 4.7 322 4.4
Gila 915 2.9 733 3.1 530 2.1 325 1.5 289 1.4 380 l.8 129 1.8 83 1.2 93 . 1.3
Graham 190 0.8 165 0.7 133 0.5 86 0.4 122 0.6 85 0 .4 11 0.2 19 0.2 28 0.4
Greenlee 49 0.2 50 0.2 37 0. l 34 0.2 29 0.1 22 0.1 5 0.1 10 0.1 6 0.1
Maricopa 11,124 44.6 11 ,270 47.2 13,262 53.8 9,510 45 .3 10,205 48 .2 7,671 36.4 3 , 584 49 . l 3,470 49.5 3,650 49 .4
Mohave 1, 231 4.9 1,169 5.0 1,098 4.4 681 3.2 852 4.0 749 3.6 159 2.2 183 2.6 169 2.3
Navajo 1,244 5.0 1,019 4.3 988 4.0 983 4.7 895 4.2 892 4.2 243 3.3 204 2.9 185 2.5
Pima 2,831 11.3 2,398 10.1 2,146 8.7 2,632 12.5 2,114 10.0 2,072 9.8 1,701 23.3 1,536 21.9 . 1,678 22 .7
Pinal 1,872 7.5 2,072 8.7 1,730 7.0 886 4.2 926 4.4 871 4.1 273 3.7 323 4.6 · 340 4.6
Santa Cruz 239 0.9 258 l. l 246 1.0 122 0.6 93 0.4 74 0.4 47 0.6 26 0.4 28 0.4
Yavapai 1,572 6.3 1,436 6.0 1,466 6.0 879 4.2 830 3.9 849 4.0 367 5.0 343 4.9 373 5.0
Yuma/La Paz 934 3.9 662 2.8 530 2.2 531 2.5 624 3.0 469 2.2 138 1.9 131 1.9 140 1.9
Out of State 232 0.9 223 0.9 248 1.0 892 4.3 1,068 5.0 1,087 5.2 121 1.7 101 1.4 83 1.1
Unknown/Transient 298 1.2 188 0.8 222 0.9 504 2.4 212 1.0 3,156 15.0 59 0.8 63 0.9 62. 0.8
Totals 24 ,966 100% 23,825 100% 24 ,678 100% 20,981 100% 21,183 100% 21,068 100% 7,292 100% 7,016 100% 7,385 100%
/BHSTABLE2
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Cfl"ICE CF ClMUUTY BEHAVIOOAL.. I-EAL.TH SERVICES
tunber and Percent of Clrronic Mentally Ill served by Camutlty Behavioral Health & SAM-£ by Comty of Residence
County FY 83 -84 FY 84-85 FY 85-86
Apache 38 0.8 42 0.7 44 0.7%
Cochise 76 1. 7 91 1.5 106 1. 7
Coconino 62 1.4 82 1.4 97 1.5
Gila 26 0.6 30 0.5 46 0.7
Graham 12 0.3 23 0.4 26 0.4
Greenlee 4 0.1 6 0.1 12 0.2
Maricopa 3,171 70.6 4,329 71.8 3,526 55.3
Mohave 68 1.5 127 2.1 129 2.0
Navajo 37 0.8 73 1.2 93 1.5
Pima 396 8.8 508 8.4 589 23.9
Pinal 131 2.9 225 3.7 250 3.9
Santa Cruz 38 0.8 37 0.6 48 0,8
Yavapai 128 2.8 165 2.8 181 2.8
Yuma/La Paz 141 3.1 87 1.4 97 1.5
Out of State 47 1.0 23 0.4 20 0.3
Unknown/Transient 116 0.6 179 3.0 180 2.8
SWTOTALS 4,491 100% 6,027 100% 5,444 100%
SAMHC 717 695 932
TOTALS 5,208 6,722 6,376*
*The decrease in total clients treated reflect s the exclusion on Maricopa County OHS clients not funded by state controlled funds.
Hence, the FY 85-86 total reflects t he actual number of state funded clients currently in the Community and SAMHC system.
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COMPARISON OF NUMBERS OF COMMUNITY BEHAVIORAL
CHRONIC MENTALLY ILL HEALTH SERVICES
BY
TYPE OFSERVICE
TYPE OF SERVICE
PROVIDED FY 83-84 FY 84-85 FY 85-86
OUTPATIENT HOURS 39,164 64,033 66,022
PARTIAL CARE DAYS 84,235 103,897 100,331
RESIDENTIAL DAYS 96,071 125,677 -1-49,079
INPATIENT DAYS 3,436 21194 1,181
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COMPARISON OF NUMBERS OF COMMUNITY BEHAVIORAL ALCOHOLISM
SERVICES
BY
TYPE OFSERVICE
TYPE OF SER VICE
PROVIDED FY 83-84 FY 84-85 FY 85-86
OUTPATIENT HOURS 118,427 132,288 158,348
PARTIAL CARE DAYS 4,508 3,502 3,196
RESIDENTIAL DAYS 180,769 182,241 195,679
INPATIENT DAYS 98 :78 49
NON-REGISTERED HOURS* 73,525 63,706 66,.366
Emergency Hours
"
20,705 11,919 16,592
Outreach Hours 12,655 14,266 13,802
Prevention Hot:rs 9,237 8,987 7,950
COMPARISON OF NUMBERS OF COMMUNITY BEHAVIORAL DRUG ABUSE
SERVICES
BY
TYPE OFSERVICE
TYPE OF SERVICE
PROVIDED FY 83-84 FY 84-85 FY 85-86
OUTPATIENT HOUttS 76,9j5 73,952 ~:":,,679
PARTIAL CARE DAYS 7,530 9,862 5,849
RESIDENTIAL DAYS 77,071 69,772 7.5,026
INPATIENT DAYS 425 349 122
NON-REGISTERED HOURS 49,941 32,905 38,699
Emergency Hours 1,920 1,477 1,530
Outreach Hours 3,682 12,1.52 1,470
Prevention Hours 49,941 11,981 22,436
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COMPARISON OF NUMBERS OF COMMUNITY BEHAVIORAL
MENTAL HEAL TH SERVICES
BY
TYPE OFSERVICE
TYPE OF SER VICE
PROVIDED FY 83-84 FY 84-85 FY 85-86
OUTPATIENT HOURS 213,966 185,882 223,346
PARTIAL CARE DAYS 22,102 18,008 17,0.56
RESIDENTIAL DAYS 35,545 29,490 · ·38,338
INPATIENT DAYS 9,290 2,540 1,480
NON-REGISTERED HOURS* 1051880 971278 84,963
Emergency Hours 13,158 10,259 10,490
Outreach Hours 7,492 6,003 .5,319
Prevention Hours
.,
241566 22,753 11,013
The decrease in services from FY 83-84 to FY 84-85 was a result of corrective
actions taken by the Department to realign Federal Block Grant Funds.
Additionally, services provided to the Chronic Mentally Ill through these funds
were transferred to the Chronic Mentally Ill category.
*Non-Registered hours reflect services provided to people not yet admitted into
the system (Emergency Crisis and Outreach), or to the general or at risk
populations not yet in need of behavioral health treatment services (prevention
activities).
BHSTABLE 25
-13-
OFFICE OF COMMUNITY BEHAVIORAL HEALTH SERVICES
ADMINISTRATIVE OVERHEAD BY FUND SOURCE
FISCAL YEAR 1985-1986
State Approp. Adm. Blk Grant HRO-Federal
Personal Services $212,347 $173,854 $7,397
ERE 44,417 38,291 763
Travel-In State 459 9,472 0
Travel-Out of State 0 1,343 416
Other Operating 6,632 34,620 1,867
Prof. Outside Svcs. 0 34,490 0
Capital Equipment 0 1,325 0
TOTALS $263,855 $293,395 $10,443
-14-
BHS:B8AdmOver
TOTAL
$393,598
83,471
9,931
1,759
43,119
34,490
1,325
$567,693
'-
DIVISION OF BEHAVIORAL HEALTH SERVICES
OFFICE OF COMMUNITY BEHAVIORAL HEALTH
Contracted Funds by Source and Program
Fiscal Year 1985-86
-Fr-n-,,-~1- -S-o- -ur-ce Alcohol Drug Mental Health CMI TOTAL
S t.:i tc Apprn pri a tion $5,729,675 $3,587,768 $6,217,769 $7,359,278 $22,894,490
F Y0Ir /\ DAMI-IS Block Grant 30,539 23,392 129,470 8,100 191,501
F Y~°1 ADAMI-IS 13lock Grant 516,022 665,289 1,084,341 178,407 2,444,059
FY:.-;(; 1\ DA Ml-IS Block Grant 1,402,709 1,709,543 2,707,461 365,097 6,184,810
Pr.:)j,:;ct e d S tate Fines 200,000 200,000 0 0 400,000
Liquor Se rv ice Fees 45,000 0 0 0 45,000
l l urn:.n Re so urce Dev. Grant 0 0 105,150 0 105,150
Su b tot a l $7,923,945 $6,185,992 $10,244,191 $7,910,882 $32,265,010
lJOi1kS tic Violence She lter $0 $0 $485,000 $0 $t,t85,000
Sp,~c io.! Chi ldren's Ser-
·1 ice 0 0 779,900 0 779,000
$7,923,945 $6,185,992 $11,509,091 $7,910,882 $33,529,910
- 15-
B8ContFund
OFFICE OF COMMUNITY BEHAVIORAL HEALTH
ADMINISTRATIVE OVERHEAD AS REPORTED ON
FY 85-86 COST FINDING ANALYSIS
INCLUDES ADHS AND CONTRACTOR FUNDS
PROGRAM CATEGORY: CHRONIC MENTALLY ILL
Contractor* Total Cost Admin. Costs % Admin. ADHS Share % of Budget
ADAPT $1,465,821 $363,912 24.83% $811,829 55.38%
BHACA 621,949 88,999 14.31 % 473,690 76.16%
BHS 758,945 90,460 11.92% 377,836 49.78%
CCN 2,194,409 477,532 21.76% 1,380,387 62.90%
CODAMA 4,095,063 809,634 19.77% 3,017,015 73.67%
EAST VALLEY 468,005 102,070 21.81 % 257,885 55;10%
NACGC 991,152 157,344 15.87% 746,265 75.29%
SEABHS 268,989 62,486 23.23% 196,771 73.15%
PIMA CTY HEALTH 299,287 48,497 16.20% ~000 50.12%
TOTALS $10,864,333 $2,152,437 19.81 % $7,261,678 66.84%
*Does not include IMBHA entity, which was defunded in 1985.
BHS:B8CMI
-16-
·- .. ~
OFFICE OF COMMUNITY BEHAVIORAL HEAL TH
ADMINISTRATIVE OVERHEAD AS REPORTED ON
FY 85-86 COST FINDING ANALYSIS
INCLUDES ADHS AND CONTRACTOR FUNDS
PROGRAM CATEGORY: ALCOHOL ABUSE
Contractor* Total Cost Admin. Costs % Admin.
ADAPT $1,925,537 $431,573 22.41%
BHACA 495,059 75,126 15.18%
BHS 361,910 56,561 15.63%
CCN 1,015,541 228,954 22.55%
CODAMA 5,165,762 785,247 15.20%
EAST VALLEY 1,363,320 232,766 17.07%
NACGC 1,416,129 218,026 15.40%
SEABHS 598,862 162,026 27.06%
TOTALS $12,342,120 $2,190,279 17.75%
*Does not include IMBHA entity, which was defunded in 1985.
-17-
BHS:B8Alcohol
ADHS Share
$1,397,310
329,598
254,965
638,726
2,323,826
955,883
1,033,921
471,913
$7,406,142
.I
% of Bu~et
72.57%
66.58%
70.45%
62.90%
44.99%
70.11 %
73.01%
78.80%
60.01%
PROGRAM CATEGORY: DRUG ABUSE
Contractor* Total Cost
ADAPT $2,903 ,028
BHACA 239,2 18
BHS 85,607
CCN 1,402,712
CODAMA 3,642,674
EAST VALLEY 709,945
NACGC 432,487
SEABHS 164,342
TOTALS $9,580,013
OFFICE OF COMMUNITY BEHAVIORAL HEALTH
ADMINISTRATIVE OVERHEAD AS REPORTED ON
FY 85-86 COST FINDING ANALYSIS
INCLUDES ADHS AND CONTRACTOR FUNDS
Admin. Costs % Admin. ADHS Share
$679,4 14 23 .40% $1,790,301
36,310 15.18% 15 1,873
14,431 16.86% 59,855
330,269 23.55% 1,0 11 ,003
731 ,538 20.08% 2,235,569
120,050 16.91 % 253,133
123,822 28.63% 362,348
43,482 26.46% 110.438
$2,079,316 21.70% $5,974,516
*Does not include IMBHA entity, which was defunded in 1985.
- 18-
BHS:B&Drug
% of Budget
61.67%
63.49%
.69.92%
72.07%
61.37%
35:66%
83.78%
67.20%
62.36%
.,
,,
Adult Day Programs
The Adult Day Treatment Program provides partial care services to a chronically mentally ill
population on a five day a week, five hours a day basis. During FY 85-86, 5,211 partial care
days were provided to 88 clients.
The Adult Day Activity Program provides long-term social, recreational and behavioral learning
experiences for chronically mentally ill clients through a partial care group program. During
the past year, 199 clients received 7,887 hours of service.
Adult Ou tpa tien t Section
The Adult Outpatient Section provides individual, family, group and case management services
to individuals suffering from severe or long-standing psychiatric illness. Patients referred to
the Adult Outpatient Section include: Persons disabled because of chronic mental illness who
require care throughout their lives; persons suffering from serious psychiatric problems, which
may be life threatening because of danger to self or others, including some who are treated
under court order; and persons suffering from alcohol or drug abuse who also have a significant
psychiatric illness.
During FY 85-86, 11,604 hours of service were provided to 1,169 individuals. Approximately 600
clients were active at a time, 59 percent of whom were chronically mentally ill.
Halfway House Program
The Haitway House ?rognm pr'.J't:.des r=s:d en-:-.ia.1 t r'= a:;-n en t to a chronic::i.Hy mental ly ill
"! : -
population, through independent living skills training, socialization, recreation and support
activities, resource management, family therapy and education and aftercare follow-up.
The majority of clients admitted to the program are referred by inpatient units and oth~r
SAMHC programs. Clients discharged from the program were referred for follow-up psychiatric
care, with most clients being placed in their own apartments, returning to live with family and
friends or transferred to a less structured residential treatment setting.
During the past year, the Halfway House Program delivered 7,00 l residential days to an average
daily census of 20 clients. A total of 91 clients were treated during the year.
Northwest Clinic
The Northwest Clinic is a satellite facility serving adults and children who live in the northwest
area of Tucson and Pima County. The clinic provides individual, group and family therapy, case
management and chemotherapy on the site and coordinates with the main Center and other
clinics and agencies to provide additional services.
During the past fiscal year, there was a total of 364 registered adults and 14-1 children and their
families were seen at the Northwest Clinic. Adult services totaled 3,488 hours, and services to
children and their families totaled 1,553 hours. At any given point in time, CMI clients
represent approximately 39 percent of the adult treatment population.
Pre-Care Services
Pre-Care Services provides screening, evaluation, referral, crisis intervention and short-term
treatment. Pre-Care Services receives approximately 500 phone calls a week related to a
-22-
BHS:B9Annual
request for assistance. Intake appointments are scheduled for those individuals whose
treatment cannot be handled elsewhere either because of severity of illness or lack of financial
resources.
In FY 85-86, 1,060 clients were provided 3,824 hours of service. Approximately 32 percent of
the clients followed at any given point in time are chronically mentally ill.
Youth and Family Services
Youth and Family Services provides individual, family and group therapy to multi- cultural,
emotionally disturbed children who are at high risk of developing long-standing emotional
disorders. Most referrals come from the various school districts and the Department of
Economic Security; however, self-referrals are increasing. Staff were actively involved in
school district activities and parent education. During FY 85- 86, Youth and Family Services
provided 7,983 hours of service to 452 children and their families.
Clinical Services
The number of clinical staff totaled 56; 79 percent of the clinical staff has a professional,
masters or above degree. With a centerwide caseload of 2,918, the average number of clients
per FTE equaled 52.
Services at SAMHC have a strong psychiatric emphasis. During FY 85-86, 7,515 psychiatrist
hours were provided for direct service and program supervision and consultation. In addition,
3,131 of clinical and distributive pharmacy hours were provided. The pharmacy processed
18,025 prescriptions during FY 85-86, a 25 percent increase in prescriptions over the previous
year.
-23-
BHS:B9Annual
The following tables portray clients, services, revenues, expenditures and administrative costs
for SAMHC.
-24--
BHS:B9Annual
SOlITHERN ARIZONA MENTAL HEALTH CENTER
3-YEAR COMPARISON OF SERVICE AND CLIENTS BY PROGRAM
FY 83-84 FY 84-85
Day Treatment Days 5,190 4,047
Clients 72 49
Day Activity Hours 6,729 __ 6,893
Clients 131 .133
Outpatient Hours 13,845 13,833
Clients 871 854
Halfway House Residential Days 7,104 7,481
Clients 66 73
Northwest Unit Service Hours 7,622 6,886
Clients 548 498
Precare Service Hours 7,718 6,879
Clients 1,665 1,190
Youth and Family Service Hours 7,952 9,193
Clients 530 489
-25-
BHS:B9Annual
FY 85-86
5,211
88
7,887
199
11,604
1,169
7,001
91
5,001
505
3,824,
1,060
7,983
4,52
FY 83-84
FY 84-85
FY 85-86
FY 83-84
FY 84-85
FY 85-86
SOlITHERN ARIZONA MENTAL HEALTH CENTER
3-YEAR COMPARISON OF CMIS &: PERCENTAGE OF CLIENTS WHO ARE
. CMI VS. NON-CMI
CMI % CMI % NON-CMI
717 24 76
629 24 76
932 32 68
3-YEAR COMPARISON OF CHILDREN &: PERCENTAGE OF CLIENTS
WHO ARE YOUTH VS. ADULTS
Children % Youth % Adult
580 19 81
581 22 78
593 20 80
.,
SOUTHERN ARIZONA MENTAL HEALTH CENTER
REVENUE, EXPENDITURE, ADMINISTRATIVE COSTS
FY 198~86
Revenues:
State appropriation $3,190,261
Inter-agency contracts 32,082
Donations 6,131
All other 12,318
Total Funding $3,240,792
Total Expenditures $3,114,190
Admlnistra tive Costs $446,120
Percent Administrative Costs 14%
-27-
BHS:B9Annual
Arizona State Hospital
Arizona State Hospital (ASH), a state-operated facility lo\:ated in Phoenix, provides inpatient
psychiatric care and treatment for state residen.ts who are suffering from severe mental and . '
emotional illnesses and disorders. It is the mission of Arizona State Hospital to develop aod
enhance the strengths, abilities and interests of patients, enabling them to return to their
families and communities.
In FY 85-86, there was a stabilization in the patient census. The census was 498 at the
beginning of the year and was at 492 at the end of the year. In the two previous years, the
census grew from 342 to 493, an increase of 44.2 percent. That increase coincided with the
implementation of a more lenient commitment law in July of 1983 and subsequent liberalization
of the law again in August, 1985.
The statutory changes do seem to have contributed to the rise in the ASH census between FY
83-84 and FY 85-86, but perhaps not to the degree that many anticipated. Court-ordered
commitments accounted for 60 percent of total commitments in FY 82-83, 63 percent in FY 83-
84 and 80 percent in FY 85-86.
The Division of Behavioral Health Services has taken steps to ensure that involuntary
commitments to ASH are appropriate. A psychiatrist is under contract to review petitions for
court-ordered treatment under Title 36 and attend commitment hearings when intervention is
indicated. Intake procedures have been improved at ASH. Admissions are reviewed daily for
appropriateness of referrals.
Another factor that contributed to the increasing ASH census was the growth in the number of
patients whose i11nesses are so severe as to require long stays in the State Hospital. Also, court
actions are committing patients for longer stays. Many of the longer term patients are housed
in the Continued Care Program units. At the close of FY 83-84, 135 patients resided in these
units; by the end of FY 85-86, 172 patients resided in these units, an increase of 27 percent. A
possible result of the change in admission characteristics on the census was a rise in the median
length of stay 1•
1 The m,=dian l·en3;:h of s::ay is +J1e .::i ritn.:·w!tic ;-ni,::p1):.n 1: 1 or 50 per:::entile. The median length of
stay means that 50 pe rcent {one-half) o f the patiems ,vere discharged by this point in time.
--z.'.;.
An indepth continuing analysis of lengths of stay is being conducted by the hospital. An
examination of patients with lengths of stay greater than one year showed that 49 patients
accounted for the abnormally high lengths of stay. The 49 patients had a combined length of
stay of 58,063 days, or an average of 1,185 days o~ 3.2 years per patient. Including the length of
stay for these patients in the calculation incre·ases the hospital's overall average. As the~e
long-term patients are discharged and placed in community settings, they will continue to have
an impact in the overall length of stay.
Arizona State Hospital made significant progress during FY 85-86 to improve the quality of
patient care provided at the hospital. The emphasis placed on analysis, planning and
development resulted in the identification of key problem areas, as well as the plans to address
those issued identified. Program, Planning and Evaluation Services was created to immediately
begin work on developing a strong hospitalwide quality assurance system (QAS). The QAS
provides a comprehensive set of checks and balances for both clinical and support areas in the
hospital.
Another accomplishment was the finalization of a plan to develop specialized treatment
programs to serve patients with similar identified needs. The objective of this plan is to
coordinate services among several patient units that are under the direction of a psychiatrist
who is responsible for the quality of the program under his direction. Other accomplishments
included revision of the Medical Staff Bylaws to re-emphasize the role of the physicians at the
hospital; development of quality circle groups to foster communication, morale and problem­solving
by employees; modernization of the data information system; and centralization of
personnel functions.
Physical Plant
Major improvements in the physical plant at ASH included fencing, fire sprinkler systems,
remodeling and installation of new equipment. Work is under way to prepare an additional unit
for patient use, which is scheduled to open in January, 1987.
Patient Demographics
The demographic composition of ASH admissions has been stable between FY 84-85 and FY 85-
86. Roughly one-third of the admissions were between 19 and 29 years of age, one-quarter
between 29-39 and 40-64, respectively, and one-tenth under 19. The over 65 population declined
-29-
BHS:B9Annual
..
2.
3.
improving attention span and task attendance and improving level of frustration
tolerance. Occupational therapy also assists inpatients who have sufficiently
recovered to develop skiUs that may be marke~ed after discharge by improving and
maintaining sense of self-worth ancj increased responsibility for self, thereby
increasing likelihood of better outpatient adjustment;
Recreation therapy to enhance social interaction, discharge excess energy through
physical activities and to reduce tedium of hospitalization;
Physical therapy to treat physical problems of chronic patients suffering spasticity,
joint immobility and breakdown of superficial tissue. Physical therapy also functions
to improve strength and to increase the mobility of_ patients; and
lj.. Speech, Language and Hearing Therapy to improve the communicative skills of
patients through assessment of ability to receive and transmit spoken messages and
the implementation of remedial programming.
Nursing Services
Twenty-four hour implementation of interdisciplinary treatment plans and provision of patient
supervision, medical and psychiatric nursing care, supportive and therapeutic interventions and
therapeutic milieu.
The following tables portray admissions, discharges, revenues, expenditures and administrative
costs for ASH.
-33-
BHS:B9Annual
ARIZONA ST A TE HOSPITAL
Average Monthly Census, Admissions and Discharges
By Type of Admission
,_ Avg.
Mthly Total 1st Re-Admis- lnvol. Total
Census Admiss. Admiss. sions Commit. Dischgs*
FY 1985-86
July 484 34 18 16 30 61
August 465 45 19 26 36 54
September 470 52 24 28 43 48
October 466 52 18 34 35 43
November 4·84 48 24 24 36 35
December 496 60 29 31 50 43
January 504 45 27 18 39 48
February 506 47 29 18 40 35
March 518 54 27 27 41 53
April 518 57 35 22 51 53
May 500 53 26 27 42 73
June 492 51 12. 26 41 58
TOTAL 492 598 301 297 484 604
*Total Discharges are all exits including deaths.
-34-
BHS:B 9 Annual
ARIZONA ST ATE HOSPITAL
LENGTH OF STAY FOR DISCHARGES*
FY 1983-84, FY 1984-85, FY 1985-86
FY 1983-84 FY 1984-85 FY 1985-86
DAYS IN HOSPITAL NUMBER % NUMBER % NUMBER %
Under 7 Days 80 14 45 7 13 2
7-13 Days 49 8 27 4 21 4
14-20 Days 55 9 31 5 15 3
21-30 Days 42 7 50 8 -. 31 5
31-60 Days 121 21 128 20 87 15
61-90 Days 59 10 85 13 94 16
91-180 Days 93 16 149 23 136 24
181-365 Days 51 9 80 12 100 18
1-5 Years 31 5 41 6 65 11
5+ Years 7 1 12 2 12 2
TOTAL 588 100% 648 100% 574 100%
MEAN: 146 Days 166 Days 231 Days
MEDIAN: 48 Days 74 Days 113 Days
*Discharges do not include deaths, but do include all other exits.
-35-
BHS:B9Annual
ARIZONA ST A TE HOSPITAL
TOTAL NUMBER AND PERCENTAGE OF ADMISSIONS B·Y COUNTY
FY 198.5-86; FY 1984-85; AND FY 1983-84
+ FY 1983-84 FY 1984-85 FY 198~86
COUNTY* NUMBER % NUMBER 96 NUMBER 96
Maricopa 472 65 412 57 373 63
Pima 63 9 77 11 62 10
Apache 3 0 5 l 2 0
Cochise 11 1 13 2 2 0
Coconino 12 2 15 2 16 3
Gila 31 4 16 2 11 2
Graham 15 2 14 2 5 1
Greenlee 0 0 0 0 2 0
La Paz 0 0 0 0 0 0
Mohave 8 1 8 1 6 . 1
Navajo 13 2 19 3 14 2
Pinal 41 6 53 7 31 5
Santa Cruz 2 0 5 1 1 0
Yavapai 26 3 33 5 30 5
Yuma 34 5 47 6 34 6
Out-of-State/Unknown 0 0 9 2
TOTAL 731 10096 717 10096 598 100%
*County of Admission
-36-
BHS:B9Annual
ARIZONA ST ATE HOSPITAL
ADMISSION RATES PER 100,000 POPULATION BY COUNTY
FY 1982-83; FY 1983-84; 1984-85; AND FY 1985-86
COUNTY FY 1982-83 FY 1983-8.4 FY 1984-85 FY 1985-86
Maricopa 18.2 27.0 22.8 20.0
Pima 9.8 10.2 12.3 9.6
Apache 6.2 4.6 9.7 3.5
Cochise 12.6 11.6 14 .o 2.0
Coconino 17.3 13.0 17.8 18.1
Gila 71.1 78.7 44.1 28.9
Graham 32.7 61.2 60.3 21.3
Greenlee 8.0 0 0 24.l
La Paz 0 0 0 0
Mohave 14.7 13.1 12.0 7.8
Navajo 20.7 16.8 26.5 18.9
Pinal 28.l 41.1 52.2 30.5
Santa Cruz 12.1 8.1 21.4 3.5
Yavapai 24.1 33.0 39.5 35.8
Yuma 34.8 39.4 54.0 36.8
STATEWIDE RATE l7e6 23.3 22.6 l8el
-37-
BHS:B9Annual
ARIZONA ST A TE HOSPITAL
NUMBER AND PERCENT OF ADMISSIONS
BY DIAGNOSTIC REASON IN
FY 1984-85 AND FY 1985:-86
DIAGNOSTIC GROUPING
Schizophrenic Disorders
Affective Psychoses
Paranoid States
Other Psychoses
Neurotic Disorders
Senile and Presenile Organic Psychotic
Conditions
Alcoholic Psychoses
Other Organic Mental Disorders
Drug Related Disorders
Personality Disorders
Adjustment Reactions
Disturbance of Conduct
Mental Illness/Mental Retardation
Alcohol Abuse
Other
TOTAL
BHS:B9Annual
FY 1985-86
Number %
228 38
201 34
5 l
6 1
14 2
19 3
6 1
60 10
11 2
8 1
18 3
5 l
1 .1
0 0
16 2.9
598 10096
-38-
FY 1984-35
Number %
304 42
202 28
4 1
11 2
0 0
38 5
2 0
58 . 8
8 1
16 2
17 3
18 3
8 1
· 8 l
23 3
717 10096
...
ARIZONA STATE HOSPITAL
NUMBER OF DISCHARGES BY COUNTY AND TYPE OF DISCHARGE
FY 198.5-86
CONDITIONAL 'IP/OP* COMP~·ETE UNAUHORIZED
DISCH. TRMT DISCH ABSENCE DEATH** TOTAL
Maricopa 41 115 206 7 30 399
Pima 5 6 34 1 0 46
Apache 0 0 1 0 0 1
Cochise 0 2 0 0 -0 2
Coconino 2 3 16 0 O· 21
Gila 3 1 8 0 0 12
Graham 0 0 7 0 0 7
Greenlee 0 0 0 0 0 0
La Paz 0 1 2 0 0 3
Mohave 0 0 8 0 0 8
Navajo 1 0 7 1 0 9
Pinal 8 l 17 l 0 27
Santa Cruz 0 0 1 l 0 1
Yavapai 2 7 14 0 0 23
Yuma 8 3 6 0 0 17
Out-of-State 0 0 28 0 0 28
Unknown 0 0 0 0 0 _Q
TOTAL 70 139 3.5.5 10 30 604
* Inpatient/ Outpatient T re a tmen t.
** The average number of deaths at Arizona State Hospital over the past four years is 25 deaths
per year.
-39-
BHS:B9Annual
,.,
ARIZONA STATE HOSPITAL
FINANCIAL SUMMARY
FY 198.5-86
Funding Sources (General Operations):
State General Fund Appropriations (net)
Personal Services and Related Benefits
Operating Expenses
Rental Income
Endowment Earnings
Patient Benefit Fund
Donations
Total Funding
Expenditures:
Personal Services and Related Benefits
Professional and Outside Services*
Travel (Instate)
Travel (Out-of-State)
Food
Other Operating
Capital Equipment
Total Cost of Operations
Collections (Deposited to the General Fund):
Medicare
Family, Guardian or Patient
Insurance
Counties - Rule 11
Social Security, VA, or Railroad Retirement
Military Service Connected Neuropsychiatric
Total
Daily Costs by Treatment Unit:
Admissions and Evaluation
Behavioral Management
Adolescent Treatment
Psycho-Social Rehabilitation
Continued Care
Transitional Living
Average
*Contract Physicians, Nursing Registries, Outside Hospitalization Costs
-40-
BHS:B9Annual
$18,276,461
4,392,474
644,236
34,596
99,300
996
· $23,448,063
$18,300,227
2,013,443
31,551
3,524
741,191
2,284,497
73,630
$23,448,063
$1,601,954
603,967
302,368
145,842
229,000
30,175
$2,913,306
$201.00
152.00
241 .00
131.00
122.00
183.00
146.00
TOTAL FUNDING
$23,448,063
•'
BHS:B9Annual
ARIZONA ST A TE HOS PIT AL
ADMINISTRATIVE COST
FY 1985-86
ADMINISTRATIVE COST
$1,157,536
- l/ i-
% ADMIN.
5%
.,
Future Concerns
.
The Division of Behavioral Health Services was _recreated by the passage of H.B. 2511 and is
responsible for planning, administering, regulating and monitoring a comprehensive system of
services for drug and alcohol abuse, mental illness and domestic violence. This is accomplished
by the various offices of the Division as follows:
Assistant Director's Office
Office of Support Services
Office of Program Planning, Evaluation and Research
Office of Community Behavioral Health Services
Southern Arizona Mental Health Center
Arizona State Hospital
,, The goal of the Division is to reduce the incidence, prevalence and degree of disability of
behavioral health disorders in the State of Arizona through the provision of a continuum of
... ,
•. l
.,
behavioral heal th services.
Future issues for the Division are as follows:
1. Per H.B. 2511, implement standard data collection, client assessment, client tracking
and financial and audit practices throughout the continuum of care, including
Community Behavioral Health, Southern Arizona Mental Health Center and Arizona
State Hospital. This will allow for review and comparison of client and cost
information throughout the system.
2. Implement the behavioral health management information system utilizing standard
reporting formats. This system will incorporate information from the existing ASH
Patient Accounting and Clinical Enquiry (PACE) System.
-42-
BHS:B9Annual
..
3. Implement five pilot programs for chronically mentally ill clients in Maricopa, Pima
and Yuma Counties.
4. Implement a strategic planning proce~s that will result in a functional plan with
short- and long-term goals, objectives and timelines. The process will include input
from all in te rested groups and individuals throughout the state.
5. Develop a plan to recruit and maintain staff, particularly nursing staff, at ASH.
6. Continue renovation and improvements in the physical plant at ASH to provide safe
and healthy conditions for patients. Due to the age of equipment ·and facilities and
the numbers of the current and projected population, major construction must take
place as demonstrated in the attached schedule of recommendations for ASH.
(Attachment l)
7. Develop a program of secure inpatient psychiatric services for children.
8. Improve coordination among the regional entities, counties and ASH to enhance
~1 continuity of client care.
.. \
9. Develop mutually beneficial relationships with Arizona universities in areas of
training, internships and research.
,,
.,.,
RECOMMENDATIONS FOR REMODELING/
CONSTRUCTION PROJECTS
Attachment l
Projects to be conducted by the Engineering Department:
1. Power Plant
• Retrofitting existing boilers with efficient burners.
• Rebuilding or replacing boilers.
• Heating and air conditioning pumps modification and pump installation.
• Installation of circulating water pump and rearranging piping.
• Funds requested for FY 1987-1988.
2. Birch Building
• Replace refrigeration compressors.
e Remove old compressors and install new high efficient units.
• Funds requested for FY 1987-1988.
3. Kachina Building
•
•
•
Air conditioning system remodeling •
Installation of new air conditioning system and removal of old units •
Funds requested for FY 1987-88 •
4. Hermosa Building
• Exterior repairs of roof and walls.
• Interior remodeling of major efforts; ceiling replacement, wall partition
modification.
• Electrical distribution system upgrading and lighting improvement.
5. Transitional Living Cottages
• Replace refrigeration.
6. Challa Building
• Implement plans to improve the safety of the building in the event of fire.
• Project should be completed in FY 1986-1987.
7. Roof Repairing
8.
• AU buildings will require minor and major roof repairs within the next two to
three years. This can be done inhouse.
Building Exterior Maintenance and Repairs
• AU buildings will require major exterior repairs within the next two years, such
as painting and masonry repairs.
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BHS:B9Annual
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•,
,-'
9. Building Interior Maintenance and Repairs
• Many of the buildings are well over 25 to 30 years old and require ceiling
replacements.
• Electrical distribution upgrading •. ·
• Plumbing renovation, including toilet and shower improvements on patieAt
wards.
• Painting, building insulation, thermal window installation and replacemen t of
evaporative coolers.
10. Grounds Maintenance and Repairs
• The hospital grounds need constant attention. Some of the areas require
improvements such as proper landscaping, removing and installing trees and
plants.
• Road maintenance and repairs.
• Irrigation line replacement.
• Sprinkler system installation.
" Maintenance and repairs.
11. • Fire alarm system replacement.
12. • Demolition of two buildings which are not in use and are in very poor
condition. Restoration of these buildings is not considered feasible.
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BHS:B9Annual
( I
T