Prescott 2050

Mental Health Report

Report of the Mental Health Visioning Committee

Mission 2
Vision Summary 2
Recommendations: Highlights and Challenges 3
Chart 1.  Recommendations and Vectors/Categories 4
Chart 2 Time Frames and Resources Required 6
Background:  Mental Health Services in Prescott Today 7
Overlap with Transportation, Housing, Seniors and Economic Development Concerns 8
Our Recommendations and Proposals: More Details 9
Recommendation A.  Create a Mental Health Resource Center 9
a. A Website 10
b. An information and referral phone service 11
c. A public space 11
Recommendation B:  Training for police 11
Recommendation C:  Attract more primary care physicians and ongoing education 12
Recommendation D:  Revive The WARM LINE 12
Recommendation E.  A Low-Fee Psychotherapy Clinic 13
Recommendation F. Campaign for Mental Health Power of Attorney forms 13
Recommendation G.  Fund West Yavapai Guidance Center Foundation 14
Recommendation H.  Develop Long Term Supervised Housing 15
Recommendation I.  Operate a Convenient and Affordable Transport System 15
Recommendation J:  Develop a Suicide Prevention Program 15
Recommendation K:  Develop a Crisis Triage and Detox Center 16
Gaps, Anomalies and Opportunities in Mental Health Service Delivery in Prescott and the Surrounding Area 16
Appendices 19
Appendix 1.  Committee Members 19
Appendix 2.  Thanks to Many for Information 19
Appendix 3:  Glossary and Acronyms 20
Appendix 4 : Information sheet on AZ211.org project 21
Appendix 5:  Charts Showing Services Available 22
Seriously Mentally Ill 23
Legal System Involved 26
Elderly 27
Elderly 28
Low to Moderate Income/ Indigent 29
Substance Abuse as Primary 31
Wellness 32
No Legal Involvement 35
Youth/Children 36
Able to Afford Services 38
Mental Health Issues with No Substance Abuse 39

Mission

• To develop the Prescott area as a community where local residents and professionals can access up-to-date information, support, referrals, and care for a range of mental health issues, from wellness to serious mental illness to addictions. 
• To promote awareness that there are many situations where a person needs mental health services but does not have a formally diagnosed mental illness. 
• To promote understanding and compassion for all persons with mental health issues, reducing social stigma and misinformation.
• Promotion and treatment for mental health should be on par with physical health whether acute, chronic, mild or life threatening.

Vision Summary

Our vision for Prescott is a community that
• Supports a continuum of services including education, prevention, and family support as well as direct treatment.
• Provides for coordination among the many diverse city-wide mental health resources, including private and public sector resources
• Gives citizens and mental health and health care providers the up-to-date information to identify the most appropriate services for the patients’ and families’ needs and how to access these services.
• Provides appropriate training to ensure police understanding and court diversion when mental health and addiction issue are significant.

Vectors illustrating the scope of the population to be served: 

Our Continuum Model of Mental Health-related Services includes:
• Prevention and education for wellness
• Early identification of a problem
• Appropriate referral and coordination of services
• Crisis/acute intervention
• Inpatient treatment and care
• Outpatient treatment and care
• Patient and family support

Recommendations: Highlights and Challenges

A. Create a Prescott Mental Health Resource Center, ideally as part of a Prescott Health Resource Center
B. Provide training for police, jail personnel, emergency room staff on how to identify and best assist citizens with serious mental illness
C. Attract more primary care physicians and CME for physicians
D. Revive the Warm Line with funding
E. Start a new Low-Fee Psychotherapy Clinic
F. Support a campaign: Mental Health Power of Attorney forms
G. Find donors for the West Yavapai Guidance Center Foundation
H. Develop Long Term Supervised Housing for the SMI Population
I. Operate a Convenient and Affordable Transport System
J. Develop a Suicide Prevention Program
K. Develop a Crisis Triage and Detox Center

We have identified more needs and gaps in service delivery than are addressed in the recommendations above, and the charts for each vector/category identify some of these unmet needs.  Time constraints have not allowed us to develop proposals to address all the unmet needs.  We hope that further work by this committee and additional volunteer members and new committees will develop more ideas for implementing the recommendations we have developed, as well as developing recommendations to meet the other unmet service needs identified in our charts.

Chart 1.  Recommendations and Vectors/Categories
Recommendation Serious mental illness Elderly Low Income/ Indigent Substce abuse is primary Wellness MH Issues, No Legal Issues Youth/ Children Able to Afford MH only, no SA
A. Mental Health Resource Center x x x x x x x x x
B. Training for police, etc. on serious mental illness x x x x x x x x x
C. Attract more primary care physicians and CME for physicians x x x x x x x x
D. Warm Line should be revived x x x x x x x x x
E. New Low-Fee Psychotherapy Clinic x x x x x x
F. Campaign: Mental Health Power of Attorney forms x x x x x x x x x
G.  Find donors for the West Yavapai Guidance Center Fdtn x x x x x x
H.  Develop Long Term Supervised Housing x x x x x x

Recommendation Serious mental illness Elderly Low Income/ Indigent Substce abuse is primary Wellness MH Issues, No Legal Issues Youth/ Children Able to Afford MH only, no SA

I.  Operate a Convenient and Affordable Transport System x x x x x x x x x
J. Develop a Suicide Prevention Program x x x x x x x x x
K.  New center for crisis/triage and detox x x x x x x x

Chart 2 Time Frames and Resources Required
Recommendation Time Frame What is Needed Who might help
A. Mental Health Resource Center by 2010, hopefully funding: location, staffing, technical help United Way and ??
B. Training for police, etc. on serious mental illness 2009 hopefully Funding Proposal submitted 11/08 Fred Trost of NAMI coordinated the proposal
C. Attract more primary care physicians and CME for physicians 2015 and beyond funding, planning, recruitment agencies? AHEC, City, YRMC
D. Warm Line should be revived ASAP Funding Proposal submitted 11/08 ?? Need funding ideas
E. New Low-Fee Psychotherapy Clinic by 2015 or before funding: location, staffing Foundations?  Prescott College
F. Campaign: Mental Health Power of Attorney forms by 2010 and every 5 years after Public Info campaign YRMC volunteers?
Recommendation Time Frame What is Needed Who might help
G.  Find donors for the West Yavapai Guidance Center Fdtn by 2015 or before Donors, money
H.  Develop Long Term Supervised Housing by 2015 or before funding: location, staffing need funding source
I.  Operate a Convenient and Affordable Transport System See transportation committee report

J. Develop a Suicide Prevention Program by 2020? funding: location, staffing need funding source, sponsor agency
K.  New center for crisis/triage/detox by 2020? funding: location, staffing need funding source

Note on Time Frames:  We have assumed that the mental health service systems will expand as population increases in Prescott and surrounding areas.  This is hopefully a realistic assumption in general.  Our recommendations address needs not primarily related to population size.

Background:  Mental Health Services in Prescott Today

In Prescott, mental health services are often difficult to find and use; information regarding what types of services and who provides them as well as what insurance or other methods of payment cannot be easily accessed.

Prescott actually has many types of mental health services and a relatively elaborate system for a community of our size, but more providers who offer services for persons with private insurance, Medicare and/or the ability to pay for moderately priced services are urgently needed.  In addition, we need easier access to information about which providers accept which insurances. 

Prescott also needs more public awareness and acceptance of mental health treatment as an essential part of our medical care.  Good mental health is an aspect of good health.  Too often a stigma is attached to accepting mental health services.

Prescott and the surrounding area have resources in our churches, families, volunteer services and social networks that help improve our mental health status and community well-being with modest or no funding.  For example,

• The AA website indicates that Prescott area has many AA meetings, over 100 on Mondays through Sundays that meet once a week, (an average of 14 AA meetings a day) including jail and juvenile detention meetings.
• NAMI, a peer support organization, has regular support meetings for the seriously mentally ill and their families every month.  Space for meetings is generously provided by Prescott United Methodist Church.
• The American Evangelical Lutheran Church offers marriage enrichment classes to over 100 couples per year at no charge.
• The TIP program sends non-professional, trained volunteers to victims of accidents, homes of the deceased, and other crises that come to the attention of the police.

Also, new technologies could help provide information when needed. 

• The state is just beginning to develop http://www.AZ211.org as a standardized address for finding mental health providers and services, but county-specific websites are not yet developed although this seems to be an idea with much potential.
• Granite Mountain Psychological Society’s website,
http://www.prescottmentalhealth.org, could be expanded to provide current, accurate information about providers’ availability, fees and types of payment accepted.  However, many logistical problems and some funding will be needed.
• A First Responder Smart Card Program has been developed.  It can be effectively implemented and expanded through new technology to help police identify mental health patients who have preregistered with the program.

Overlap with Transportation, Housing, Seniors and Economic Development Concerns

Mass transit, i.e., a bus system, and affordable housing, especially housing for seriously mentally ill and elderly citizens, as well as a wide range of employment opportunities are, of course, of great importance to the mental health visioning committee.  We have not elaborated on those needs in this report, but we support the efforts of 2050 Vision committees working on those concerns. 

A distressingly high percentage of the elderly suffer from depression in this city, as nationally, and we hope the city’s Commission on Aging will help address some of those issues when it is formed. 

A public transportation system is urgently needed for for work, housing and treatment for the Seriously Mentally Ill, those in Substance Abuse treatment, etc.

Our Recommendations and Proposals: More Details

Recommendation A.  Create a Mental Health Resource Center

Create a Prescott Mental Health Resource Center (MHRC)

It would seem likely that our proposed mental health resource center could be operated in cooperation with or as a subsidiary of UWIN. 

Also, our ideas for a mental health resource center should be coordinated with the AZ211 website effort.  Currently the Yavapai 2-1-1 Steering Committee is looking into working with GITA (Government Information and Technology Agency) to be trained on the Tapestry software system to create a stronger data base here in Yavapai County.  We encourage the city and United Way to support this effort.

Prescott currently has a large number of mental health resources, but successful access to these resources can be quite difficult because information on what these resources are, how to access these resources, and which resources are suited to whom is not consolidated in one place that is readily available to the public.  Even most health and mental health practitioners have at best only sketchy knowledge of the full range of mental health resources available in Prescott and how to access them.

The purpose of the Prescott Mental Health Resource Center (MHRC) is to make available to the public and referring practitioners up-to-date information on the mental health resources available in Prescott, how these resources can be effectively accessed, and for whom these resources are appropriate. 

We propose that the MHRC should exist in three forms

A website that has comprehensive, up-to-date, easy to understand information.
An information and referral phone service that draws upon the same material on the website for those who cannot easily access the internet.
A public space that informs Prescott residents about the website and the phone service and perhaps offers MHRC content as space permits.

The MHRC is an immediate community need, and the following describes a basic approach to implementing the MHRC with current structures already in place.

a. A Website
A Website that has comprehensive, up-to-date, easy to understand information.

Primary questions in implementing the MHRC website are:
A. Who will host the website?
B. How will comprehensive information be gathered and who will gather it?
C. Who will actually create the website pages?
D. How will the website be maintained and updated?

A.  Who will host the website?

The most cost effective and efficient approach is to add the website to a pre-existing site.  One possibility is to approach the United Way about this.  The United Way has a site at
http://www.unitedwayyavapai.org.  Another possible host is the Prescott area association for mental health professionals Granite Mountain Psychological Society (GMPS), which has a website at http://www.prescottmentalhealth.com and has a mission to promote “human welfare through professional and public education.”

B. How will comprehensive information be gathered and who will gather it?

The MHRC is of intrinsic value to all local mental health organizations and practitioners.  Everyone benefits when residents know how to successfully access the services they need.  A committee of representatives from local mental health groups and agencies could canvass local organizations with a uniform questionnaire that obtains the information necessary for implementing the MHRC.  As an additional benefit, a group such as this could become an information hub for the broader mental health community, serving the existing need for increased inter-agency, inter-practitioner awareness and communication.

C. Who will actually create the website pages?

That would depend on who ultimately agrees to host the pages.  The technical skill involved in creating the pages might require a paid consultant, although both UW and GMPS might see it within the scope of their community service to fund some or all of this.

D.  How will the website be maintained and updated.

The original group that canvasses local practitioners and organizations might be charged with re-canvassing at intervals and forwarding the information to the web host for updating.  Alternatively, or additionally, the website pages might be set up so that local organizations could update their own material on an as needed basis. 

It is too early to be certain whether the http://www.az211.org project will provide the information and web page hosting that we need.

b. An information and referral phone service
that draws upon the same material on the website for those who can not easily access the internet. Way already offers such a service for general community needs and thus would be a natural partner for MHRC.  Another natural partner, if it is revived and re-instituted, would be the local warm-line previously funded by NARBHA.  The person receiving calls would be able to turn to the website as a knowledge base for responding to inquiries.  Perhaps both would be ideal.

c. A public space
that informs Prescott residents about the website and the phone service and perhaps offers MHRC content as space permits.

An ideal location is a city building that sees significant traffic, such as the local Public Library.  The space required could be quite minimal, just enough to inform the public about the website and the information and referral service.  If space allowed, additional public education material might be made available.

Recommendation B:  Training for police

Training for police, jail personnel, emergency room staff
on how to identify and best assist citizens with serious mental illness

A proposal for funds for CIT training for police, developed in Memphis, has been submitted to NARBHA.  This kind of program serves the SMI consumer going into an episode, but it can also lessen the load on the West Yavapai Guidance Clinic by being able to screen out the drug overdose folks from the true SMI patients. AND, it is a distinct safety feature for the police as well.

From “Crisis Intervention Team Core Elements” at

“The Crisis Intervention Team (CIT) is an innovative first-responder model of police-based crisis intervention with community, health care, and advocacy partnerships. The CIT Model was first developed in Memphis and has spread throughout the country. It is known as the “Memphis Model.” CIT provides law enforcement-based crisis intervention training for assisting those individuals with a mental illness, and improves the safety of patrol officers, consumers, family members, and citizens within the community. CIT is a program that provides the foundation necessary to promote community and statewide solutions to assist individuals with a mental illness. The CIT Model reduces both stigma and the need for further involvement with the criminal justice system. CIT provides a forum for effective problem solving regarding the interaction between the criminal justice and mental health care system and creates the context for sustainable change.
Basic Goals:
• Improve Officer and Consumer Safety
• Redirect Individuals with Mental Illness from the Judicial System to the Health Care System”

Recommendation C:  Attract more primary care physicians and ongoing education

Attract more primary care physicians and provide ongoing education on psychiatric issues for physicians and other health care providers

Prescott needs a coordinated, strategic campaign to attract more primary care physicians to make referrals and offer early mental health treatment to the Prescott residents.  Although local primary care physicians, physician assistants, nurses, and associated personnel typically have some training in mental health issues, the need for further opportunities for continuing education in mental health is well known, and a serious challenge that might be remedied in the next few years if given further attention.  Also, new medications and guidelines for use of psychiatric medications change often.

“Most services provided for emotional or substance use problems in the United States go to people with a 12-month diagnosis or other indicators of need. Patients who lack these indicators of need receive care largely outside the formal health care system.” From “Understanding Mental Health Treatment in Persons Without Mental Diagnoses,” Arch Gen Psychiatry. 2007;64(10):1196-1203.  Also “Notably, adequate follow-up care for depression was significantly related to reduction in odds of patient mortality at the 12-month follow-up. These findings suggest that quality of depression care may significantly affect patient outcomes, including mortality, and that further efforts to improve quality appear warranted.” From “Quality of Depression Care and Its Impact on Health Service Use and Mortality Among Veterans.” Psychiatr Serv 59:1399-1405, December 2008.

The Mayor reports that the City is working with YRMC (Yavapai Medical Regional Center, our hospital) to attract more primary care physicians to Prescott.  We are not sure what more can be done, but possible resources are available at http://www.azahec.org.  It seems that our region has been underserved by Area Health Education Centers, and we urge the Mayor and YMRC to pressure for more assistance in recruiting physicians, and encourage more CME on mental health issues.

Recommendation D:  Revive The WARM LINE

The Warm Line should be refunded, for referrals, talking, a friendly voice for anxious or depressed people.  When it was operating, the Warm Line handled about 300 calls per month.  Unfortunately, NAZCARE (Northern Arizona Consumers Advancing Recovery & Empowerment) has not been able to continue funding the Warm Line.  For about $65,000 the Warm Line could and should be revived.

Recommendation E.  A Low-Fee Psychotherapy Clinic

Although the City of Prescott has many resources for those in need of Mental Health Services, it lacks a Clinic that would provide low-fee psychotherapy or counseling for individual adults and children, as well as for families and groups. 

Currently, Mental Health Services are available for those with ACCHSS coverage, with private insurance, or with sufficient funds to afford psychotherapy or counseling with a private practitioner (private practice fees in Prescott range from $70 to $130 per session). 

However, there is a substantial echelon of citizens who fall between the sector whose services are supported by a third party, and the sector that can afford the services of a private practitioner. 

Prescott needs a low-fee Clinic that would provide psychotherapy and counseling services in the range of $25 to $50 per session.  The professional services at such a Clinic could appropriately be provided pro bono by clinical trainees under appropriate supervision (as is done in many Clinics across the country).  Prescott College’s graduate program in Mental Health Counseling has advanced graduate students who are in need of such a training opportunity.  What is currently lacking are the facilities and organization to bring such a beneficial clinical program into the City.

WYGC Foundation, if it has funds in the future, and other foundations with interests in Prescott, mental health, and experiential therapies may be sources for start up or operational funds.

Recommendation F. Campaign for Mental Health Power of Attorney forms

Campaign to Have Mental Health Power of Attorney forms signed by Prescott Residents

Prescott residents who have not completed the Mental Health Durable Power of Attorney forms, developed by the Office of Arizona Attorney General and updated August 27, 2007, should be encouraged to complete these forms and file them with family, attorneys, etc.  Residents who moved to Arizona from other states or have not completed/updated Living Wills or Durable Power of Attorney for Health Care forms often do not realize that Arizona has specific requirements for legal actions due to mental health conditions.  The YRMC hospital Office of Volunteer Services has these forms available at the hospital reception desk.  Also, increased use of Mental Health Durable Power of Attorney processes could help reduce the suicide rate by making legal and family intervention easier for people considered suicide risks.

Perhaps the hundreds of YRMC volunteers could be enlisted to mount a campaign to inform resident about the need for these forms, as well as help all willing residents to understand, complete and file these forms.

“One recent revelation with Health Care Power of Attorney documents is that they are not valid with respect to mental health facilities.  So, now we have a Mental Health Care Power of Attorney as well.  These are critical in the case of dementia or Alzheimer’s.  They are revocable as well.

If you are over the age of 18 and have mental capacity, you may designate another adult to act on your behalf with regard to making mental health care decisions if you are later unable to make them for yourself.  This designation is distinct from a durable health care power of attorney…

… The agent is authorized to make mental health care decisions when you cannot make them for yourself.  The document can place restrictions on this authority.  The authority may be revoked either by you or by court order.  Your agent may receive health information and related records in order to make appropriate decisions for you.  Your agent must act in accordance with the directive and in good faith.“
from “Mental Health Care Power of Attorney” by Camie Pickett at the website
http://aztrustlaw.typepad.com/ecpazlaw/2006/02/mental_health_c.html

Recommendation G.  Fund West Yavapai Guidance Center Foundation

Publicize the WYGC Foundation and Find Donors

The West Yavapai Guidance Clinic Foundation could be a mechanism to help those with no funds or insurance to pay for services, but the foundation is not funded to have community-wide impact.  The purpose of the Foundation is to support the mission of the West Yavapai Guidance Clinic by raising funds to make a critical difference in behavioral health outcomes within our community. To promote this objective the Foundation acts to increase the awareness of local behavioral health needs. Its vision is that behavioral health services are provided to anyone in our community who needs them.

Other foundations have been and continue to benefit the mental health of Prescott residents, but the WYGC is uniquely focused on the provision of mental health services to people who cannot pay for needed treatment because of lack of insurance or restrictions of insurance coverage.  The WYGC could assist family foundations interested in supporting similar goals, for example.

Recommendation H.  Develop Long Term Supervised Housing

Develop Long Term Supervised Housing for the
SMI Population and Other Disabled Adults

In Prescott we have some short term supervised housing and some long term unsupervised housing for the SMI population, but we do not have the long term supervised housing that is available in some other cities and towns.  There are families, including many retired people, in this community who are taking care of their mentally ill adult children, parents, siblings and other relatives at home.  This works out well until the caregiving family members die or are no longer capable of providing this care.  At that point, the disabled adult must find a new place to live.  Because many of these disabled adults/SMI adults are not capable of living on their own without having someone present to advise them and check on them, they could become ill or slip into homelessness if living independently.  What they need is a place to live where there is someone present who is hired part-time to supervise the residents.  This supervisor can make sure that they are eating properly, are properly clothed, are getting their meds and taking them, are handling their disability payments and banking properly, and are getting to their appointments and/or jobs. 

Recommendation I.  Operate a Convenient and Affordable Transport System

Operate a Convenient and Affordable Transport System that is Accessible for All and has Stops at WYGC, DPS, Vocational Rehab, Social Security, YRMC, the VA, YC Community Health Services, the methadone clinic and other medical, mental health, income assistance and social service agencies

People with multiple DUIs and many of those with substance abuse problems are often forbidden to drive, and so must use public transportation.  Also, many mentally ill citizens either don’t have cars or are not well enough to drive them in stressful conditions.  There are many reasons to support public transit in Prescott, but our committee would like to draw attention to these special needs that are now being recognized by many citizens and groups in Prescott.  For example, at a recent AAUW Public Policy meeting, as the meeting’s guest speaker, David Quinn discussed the city’s transportation issues and acknowledged the need to plan to meet the special needs of some citizens.

Recommendation J:  Develop a Suicide Prevention Program

Determine how urgently and what type of a Suicide Prevention program is needed and whether it would best be developed at a city or county level.  We did not have time to develop an assessment or specific proposal.

Economic depressions and recessions generally increase suicide rates. Recent anecdotal evidence suggests that suicide is an increasingly serious problem in our city, we have not directed specific recommendations toward this issue.  However, public awareness of West Yavapai Guidance Clinic’s suicide hotline (928-445-7730) and Turning Point’s Youth Crisis hotline (928-778-7900) could be increased through our proposed Prescott Mental Health Resource Center.  Also, increased use of Mental Health Durable Power of Attorney processes might help reduce the suicide rate by making family intervention easier for people considered suicide risks.

Recommendation K:  Develop a Crisis Triage and Detox Center

It would likely be less costly overall and much more effective to have a crisis/triage/detox center that would divert many people from costly emergency room episodes at YRMC.  Currently, YRMC has neither inpatient psychiatric nor specialized detox services.  Windhaven, through YRMC, is expected to be full, at capacity, often, and an additional detox facility would help.  Windhaven is also the only nearby facility that offers inpatient care for SMI patients in acute episodes.

Gaps, Anomalies and Opportunities in Mental Health Service Delivery in Prescott and the Surrounding Area

The following situations led us to conclude that a mental health resource center is our most urgent need.  The web of mental health services is complex and difficult for agencies, service providers, and patients to explore –much less stay informed about.  There are serious and sometimes surprising gaps, anomalies and opportunities in the arena of mental health concerns in Prescott.  For example,

West Yavapai Guidance Clinic’s Green Tree Wellness Center has therapists that don’t have full schedules, and they take a wide range of insurances.  (The psychiatrists in that program, however, are booked way out.)

The newly staffed United Way Information Network (UWIN) referral phone line does not provide detailed information about many of our mental health providers but has information about social service agencies.  UWIN has made an important contribution to our community, especially by contacting teachers.  Now more needs of children are being identified and teachers provide UWIN’s phone number, 928-443-5321, to families.  However, we have no local residential treatment center or hospital options for kids with acute episodes of mental illness.  We have no public transportation system to get youth to mental health services.  We have very limited affordable mental health services for families with limited incomes.  And we have no resource center to help families find the right therapist for their situation.

We have few affordable outpatient mental health services for low to moderate income residents or the indigent.  We note, however, that Community Health Services, providing primary medical care for the uninsured and underinsured at the facilities on Commerce Drive in Prescott and on Windsong in PV, has found that in their medical care setting, few low income/indigent patients sign up and/or show up for mental health services, even with low or no copays.

Prescott College is nationally recognized for its training of Mental Health Counselors, graduating about 30 students with license-eligible Master’s degrees each year – the College’s largest department.  More counseling internship opportunities are needed.  Student interns, closely supervised, could be key to a financially viable mental health clinic offering low fee therapy services, if the start-up funds for a clinic were available.

The Prescott College Counseling program is distinctive for its emphasis on experiential awareness as the source of health and healing.  Students have the option of specializing in Expressive Arts Therapy, Equine Assisted Mental Health, Somatic Psychology and Bodymind Therapy, or Ecopsychology/Ecotherapy and Wilderness-based Psychotherapy.  Prescott College is proud to be a national leader in these fields of specialization.  Prescott College’s training program for mental health professionals has colloquia that are open to the public as well as to professionals.  However, few citizens take advantage of the special colloquia opportunities or coursework, and local service providers are not well informed about the opportunities to refer to these special services.

WYGC has a new Psychiatric Hospital, Windhaven that was recently accredited and opened in PV, with a 16-bed facility.  However, we still lack “step down” services, especially supervised housing.  Typically, after an episode of severe problems, a SMI (seriously mentally ill) patient spends 3 days to 3 weeks in the PHF and is released – but often he/she can’t go home, or worse, has no “home”, so is released to the streets and we have another homeless SMI.

The Granite Mountain Psychology Society (GMPS) has widened its membership beyond psychologists in private practice, and now includes psychotherapy practitioners at the VA and other agencies.  It has a new website, and is providing speakers to the Prescott Adult Center on mental health-related topics.  However, we do not have many ways for would-be patients/clients to find the GMPS website that lists therapists’ types of practice, availability, and insurance/payment terms, http://www.prescottmentalhealth.com.

Appendices

1. Committee Members
2. Thanks to Many for Information
3. Information on AZ211.org Project
4. Charts and Notes on Service Vectors/Categories

Appendix 1.  Committee Members

Core members (names and relevant affiliations)

Barnaby Barratt, Chair of Counseling Psychology at Prescott College, psychotherapist in private practice, GMPS member
Nancy Burns, GMPS member and psychologist in private practice
Laura Norman, West Yavapai Guidance Clinic, Director of Development and Communications
RoJean Madsen, Prescott Free Clinic, Inc. board member
Barbara Swain, GMPS member and psychologist in private practice
Fred Trost, NAMI President
Bonnie Waterer, NAMI-Vice President and board member of Yavapai Guidance Clinic

Other members and those who attended meetings

Ann Sult, Prescott School District
Virginia Rodriguez, Yavapai County Health Dept.
George Jaeger

Appendix 2.  Thanks to Many for Information

We are well aware of the shortcomings of our information collection to date.  The responsibility for omissions, inaccuracies and misimpressions are ours, and we welcome clarification.  Please provide revised or additional information to
or call RoJean at 928-445-1927.

Kendra L Bourgart, for information on the Tri-City Partnership for Special Families and Children and the First Responder Smart Card Program
Dick Studdard, retired L.A. policeman
Mayor Wilson for assistance with the proposal for CIT funding
Don Shaffer, United Way board
Peggy Nies, Clinical Director, Community Health Services, and Director, Prescott Free Clinic
Several Prescott police persons, including Sgt Barbara Davies
Robert Resendes, Medical Director, Yavapai County Health Department

Appendix 3:  Glossary and Acronyms

ACCHSS: Arizona’s Medicaid program, Medical assistance based on income

AHEC: Area Health Education Center

APS: Adult Protective Services

CME: Continuing Medical Education

CIT: Crisis Intervention Training

CPS:  Child Protective Services

GMPS: Granite Mountain Psychological Society

MATForce: Methamphetamine Task Force

NAMI: National Alliance on Mental Illness

NARBHA: Northern Arizona Regional Behavioral Health Authority

NAZCARE: Northern Arizona Consumers Advancing Recovery & Empowerment

PAWS: Prescott Area Winter Shelter for Women and Children

PHP:

SMI:  “serious mental illnesses”: schizophrenia, bipolar disorder, etc.

UWIN: United Way Info Network, a resource center and phone line provided referrals to social service agencies

WYGC:  West Yavapai Guidance Clinic

YRMC:  Yavapai Regional Medical Center, the hospital

Appendix 4 : Information sheet on AZ211.org project
YAVAPAI COUNTY INFORMATION AND REFERRAL

In summer 2007, over 90 organizations participated in Community Conversations across Yavapai County including representatives from nonprofit organizations, Department of Economic Security, the courts, business and general public.  As a result of the Community Conversations, the number one need identified was a local, centralized, comprehensive information and referral data base.  An Action Team, comprised of members from Arizona’s Children Association, Catholic Charities, Community Legal Services, and Parenting Arizona was formed to identify and implement a solution for this need. 

The Action Team has proposed to develop a local, centralized information and referral (I & R) data base that will interface with the Arizona 2-1-1 system.  The system would be accessed through an Internet site that houses a comprehensive database of public and private programs, social service providers, charity organizations, volunteer opportunities and emergency response and homeland security resources.  When linked with the efforts of the State’s public safety and public health communities, a complex network of public and private sector service providers offer a continuum of service and care to individuals and communities.  In Yavapai County, individual sectors have been developing systems to participate in this effort.  The Action Team proposes that each of these sectors combine their efforts to achieve a comprehensive I & R system.

United Way of Yavapai County (UW) and the Government Information Technology Administration (GITA), which provides IT oversight for AZ 2-1-1, are working together with the Action Team. We have received letters of support from more than 15 agencies in both East and West Yavapai County.  United Way has an existing I & R data base, (United Way Information Network;UWIN), that has been streamlined to list local service agencies, decreasing the number of listings for services across the state and individual listings within a single service agency. 

As collaboration continues, the Action Team plans to assist United Way in securing funding to update the software used to house the data base, and for personnel costs to manage the I & R system.  GITA has agreed to provide training and technical support in gathering and storing data such that the transfer of information from UWIN to AZ 2-1-1 is as seamless as possible. 

To maximize the efficient collection of information for the data base, Memorandums of Understanding will be sought with local organizations already maintaining internal data bases.  Organizations will agree to initially provide information in a format compatible with AZ 2-1-1 taxonomy, and then pass on management of the system and the data to United Way.  The availability of a single website will allow these organizations and agencies delivering services to focus on their service mission, rather than expending funds on raising their community profile and staffing their own referral lines. When employees access appropriate services more quickly, there should be quicker resolution of problems and quicker return to work. As a result, employers will experience a healthier and more productive workforce with reduced absenteeism. 

Appendix 5:  Charts Showing Services Available
to Each Service Vector/Category

We find that the web of mental health services is complex, even for those who work within it every day.  We did not use service “populations” because these categories led us to confusion when trying to describe services.  Our Vectors/Categories roughly reflect sources of funding, to some extent.

We hope that our work to date could serve as the basis for a website and much of the information within our proposed new Mental Health Information Center (see Recommendation A).

Note that these charts show only some of our efforts to date at compiling notes to accompany each of the service Vector/Category charts and is clearly a work in progress.  Also note that Appendix 4 provides a partial key to acronyms and program names and abbreviations.

Color Key for Charts: 
White, it is in place
Gold, we lack it

Seriously Mentally Ill

Seriously Mentally Ill:  Notes

National Alliance on Mental Illness.  NAMI of Yavapai County doesn’t have just one address.  The groups may meet in different places.  The mailing address is PO Box 11962, Prescott 86304-1962.  The president is Fred Trost.  National Alliance on Mental Illness.  NAMI of Yavapai County doesn’t have just one address.  The groups may meet in different places.  The mailing address is PO Box 11962, Prescott 86304-1962.  The president is Fred Trost.  vice-president is Bonnie Waterer.  Other board officers are Laura Hutchison (Treasurer) and Judy Russell (Secretary).  Fred’s phone number is (928) 541-7790.  Mine is (928) 717-2937.  NAMI offers a Family Support Group meeting on the 2nd Thursday of the month at 6:00 PM.  It is held in Mary’s Parlor at the Prescott United Methodist Church, 505 W. Gurley, Prescott 86301.  NAMI Connection/CARE, a peer support group, meets on the 2nd Friday of the month at 6:00 PM.  The location is the same for this meeting.  NAMI also sponsors Family to Family classes and Peer to Peer classes on a regular basis.  All of these groups are led by trained facilitators.

NAMI members have also done some “Rise Above Stigma” talks around town to service organizations or church groups.  These focus on their personal experiences with mental health issues. Vice-president,Bonnie Waterer.  Other board officers are Laura Hutchison (Treasurer) and Judy Russell (Secretary).  Fred’s phone number is (928) 541-7790.  Mine is (928) 717-2937.  NAMI offers a Family Support Group meeting on the 2nd Thursday of the month at 6:00 PM.  It is held in Mary’s Parlor at the Prescott United Methodist Church, 505 W. Gurley, Prescott 86301.  NAMI Connection/CARE, a peer support group, meets on the 2nd Friday of the month at 6:00 PM.  The location is the same for this meeting.  NAMI also sponsors Family to Family classes and Peer to Peer classes on a regular basis.  All of these groups are led by trained facilitators.

NAMI members have also done some “Rise Above Stigma” talks around town to service organizations or church groups.  These focus on their personal experiences with mental health issues.

CURRENT STATUS: What is available now

Family Support Group meetings by NAMI Yavapai Co.
Peer-to-Peer Classes sponsored by NAMI Yavapai Co.
Mental health information at http://www.nami.org and http://www.namiaz.org
Case management and psychiatric care at WYGC
Suicide Intervention Hotline sponsored by WYGC
Short term supervised housing sponsored by WYGC
Transitional and long-term unsupervised housing sponsored by WYGC
New inpatient Windhaven Psychiatric Hospital in Prescott Valley
Financial assistance to pay for psychiatric help and medicines
New Hope Drop-in Center sponsored by NAZCARE
Some apartments for SMI clients built by NAZCARE
Some mental health care at Northern Arizona Veterans’ Hospital
Crisis intervention at YRMC ERs


Quixote’s Garage drop in center
Treatment by members of Granite Mountain Psychological Society
Social Service help (Open Door, Catholic Charities, Salvation Army)
United Way Information Network

Additional inpatient mental (psychiatric) beds, respite/acute episode care, as well as supervised low cost housing for the seriously mentally ill.  We have no inpatient mental health services in Prescott. 

YRMC absorbs the costs of unfunded inpatient and ER mental health patients

Have psychological services for vets at the V.A.  (Do we have many Iraqi war veterans returning in need of mental health services?
Does the V.A. provide services for families of military overseas?)

Need organized assistance for SMI peoples’ applications for disability status

Legal System Involved

Elderly

Low to Moderate Income/ Indigent

Indigent/Moderate to Low Income:  Notes

Quixote’s Garage is a drop-in center, providing an address and phone number for messages for anyone.  Members of Sacred Heart Catholic Church provide much of the support for Quixote’s Garage.

PAWS is the Prescott Area Winter Shelter for women and children.  Like many shelters, persons with obvious severe mental illness cannot be accommodated.

For ACCHSS patients: Have NACOG case managers
Have the Bridge Program at (County) Community Health Services clinic that helps patients apply for funding for medication based on financial need
Psychiatric consults and prescriptions are by referral, as are limited low-fee mental health counseling services are available through Yavapai Community Health Services
NACOG provides vouchers for transportation based on financial need; up to two vouchers per month
Have psychological services for vets at V.A.  (Do we have many Iraqi war veterans returning in need of mental health services?
Does the V.A. provide services for families of military overseas?

Substance Abuse is Primary:  Notes

NAZCARE (Northern Arizona Consumers Advancing Recovery & Empowerment) is headed by CEO Roberta Howard.  The address for their local drop-in center in Prescott (New Hope Center) is 599 White Spar Road, Prescott 86303.  The phone
number for NAZCARE is (928) 442-9205.

Additional residential treatment beds for adults with substance abuse disorders are needed; an identified need through the MATForce process and other community planning sessions

We need a center for triage services with detox capabilities

Substance Abuse as Primary

Wellness

Wellness:  Notes

YRMC’s Family Resource Center:  has some funding from NARBHA for prevention.

For Prescott, we DO have a functioning system of referral via the UWIN (United Way Info Network), 443-5321, and the website is http://www.unitedwayyavapai.org.  Their physical brochure racks are located at the Step One Center on Windsong Drive in PV. Their physical brochure racks are located at the Step One Center on Windsong Drive in PV.

Police have officers trained in suicide prevention

Crisis/hotline/suicide line 24/7 through WYGC: 445-7730

Turning Point’s Youth Crisis hotline (928-778-7900)

Prescott College’s training program for mental health professionals has colloquia that are open to the public as well as to professionals;

Warm Line is no longer funded
Have BIG KIDS’ BOOK that provides information about available social services
Have services through churches but no central source of information about them
Have 12 steps programs
Have some public school counselors, counseling services at YC, Prescott College, Embry Riddle

Do WalMart and Walgreens low cost Rx programs cover mental health meds?
Need publicity for new MH providers’ web site http://www.prescottmentalhealth.org
Need more transportation to services
More awareness of interfaith counseling service

Legal Involvement:  Notes
Police have officers trained in suicide prevention
Police / Jail may deny necessary medications
West Yavapai Guidance Clinic does informal training with some police forces but not currently for Prescott
No court-appointed mental health advocates Police training in MH
Need bilingual public education and services??

No Legal Involvement

Youth/Children

Children/Youth :  Notes

Prescott needs more training for school personnel.  NAMI has done a little of this, but a more comprehensive program is needed. 

We need to train school counselors, nurses, and teachers to be able to identify mental illnesses
when they observe them in the schools so we can get help to children early. 

Turning Point provides transitional and longer-term shelter for youth.
Turning Point’s Youth Crisis hotline (928-778-7900)

Have Big Brothers/Big Sisters

ABLE TO AFFORD TREATMENT/SERVICES:  Notes

YRMC’s Family Resource Center: has some prevention services (with funding from NARBHA )

Crisis/hotline/suicide line 24/7 through WYGC: 445-7730
Turning Point’s Youth Crisis hotline (928-778-7900)

New mental health parity legislation… we don’t know what it will mean for most of the insured population yet
Have many private substance abuse treatment services here

http://www.prescottmentalhealth.org provides info about private practitioners

Anyone can sign up for the County’s drug discount program

Need more practitioners, especially psychiatrists, who accept insurance plans, Medicare, Medicare plans and Supplements

Able to Afford Services


Mental Health Issues with No Substance Abuse
Mental Health Issues with No Substance Abuse:  Notes

Additional inpatient mental (psychiatric) beds, respite/acute episode care, as well as supervised low cost housing for the seriously mentally ill.  We have no inpatient mental health services in Prescott. 

YRMC absorbs the costs of unfunded inpatient and ER mental health patients

Currently: Emergency Title 36 Services are provided out of the Cottonwood-based Mingus center

NAZCARE’s Warm Line is no longer funded

Have Stepping Stones for victims of domestic violence, shelters for men, Prescott Area Winter Shelter (PAWS) for women and children but these shelters do not accept people with acute, obvious mental illness

Need more awareness of NAMI, NAZCare, and WYGC’s crisis, prevention and treatment services such as its Suicide-Domestic Violence-Child Abuse-Elder Abuse hotline

WYGC has a 24/7 suicide/crisis line.  Currently the hotline is not integrated into other agencies’ phone services

Anyone can sign up for the County’s drug discount program