Tucson shooting draws attention to Arizona's mental health laws, funding

By Philip Rucker
Washington Post Staff Writer
Thursday, January 20, 2011; 8:26 PM

TUCSON - The shooting rampage here that killed six and injured a congresswoman and 12 others has sparked a potentially fractious debate among Arizona lawmakers over two intertwined issues: state laws governing gun purchases and legislators' efforts to change mental health laws.

But even as legislators prepare bills on the state's mental health system, Arizona - like other states across the country - finds itself in a massive budget crisis. In Arizona's case, the budget problems could result in drastic cuts to existing programs helping the mentally ill.

Under the budget proposal presented by Gov. Jan Brewer (R) last week, the state would effectively cut health care for roughly 280,000 low-income Arizonans currently under the state's Medicaid program, including an estimated 5,200 who are mentally disabled. Brewer is preserving $10.3 million for those affected to purchase generic prescription drugs, but they would lose all other care.

In the looming debate over mental health, Brewer is a central figure. Throughout her career, she has advocated for behavioral health services; her adult son, Ron, has long suffered from a mental illness and has been living in a state institution. He was diagnosed with schizophrenia and was found not guilty by reason of insanity in a sexual assault and kidnapping case 20 years ago.

'Perfect storm'

With Arizona facing a $1.1 billion shortfall in the next fiscal year, Brewer proposed dropping some of the indigent from state rolls - a move she described as critical to balancing the budget.

In the wake of the Jan. 8 shooting outside a Tucson supermarket - before which alleged gunman Jared L. Loughner showed signs of mental instability, authorities and friends say - advocates and some political leaders say the budget cuts would result in mentally fragile people being turned away for help and potentially becoming a threat to society.

"It's a perfect storm here in Arizona," said state Rep. Matt Heinz (D), a Tucson doctor and friend of U.S. Rep. Gabrielle Giffords (D), who was injured in the attack.

"Services are being slashed and burned," he said. "Potentially in the next few months we'll be releasing thousands of folks from their relative stability. Our community resources are strapped beyond belief. And the state, which you'd think would be the safety net, we've lit the net on fire."

Heinz and state Sen. Paula Aboud (D), who replaced Giffords when she left the state Senate for Congress, said they plan to introduce legislation that would allow any school, business or other entity that sees a person exhibit erratic behavior to report that person to authorities. The state then would flag that person in the gun registry and require the person to pass a mental health evaluation before being able to purchase a weapon.

While Loughner's teachers and classmates at Pima Community College grew increasingly concerned about his behavior, officials said that none asked authorities that he be involuntarily evaluated for mental illness and potentially committed to psychiatric treatment.

"The schools had some concern, but he could buy a gun without a mental health evaluation," Aboud said. "Somewhere in there is a loophole. . . . If they're seeing that somebody's exhibiting some form of mental issues that are a threat to other people, then there needs to be some encouragement to report them to authorities, that those names be put on the gun registry list and they get flagged and a gun isn't automatically sold to that person without further checking."

Aboud acknowledged that her bill would face a steep climb in Phoenix, where both chambers of the legislature are controlled by Republican supermajorities. Arizona has some of the nation's most permissive gun laws, and legislative leaders said they would continue fighting to protect the constitutional right to bear arms.

"I'm not sure if we can protect the public any better with stronger laws without tipping the balance of constitutional protected privacy and individual rights," said state Sen. Nancy Barto (R), who chairs the Senate health committee. "In a free society, you're running the risk of deranged people doing very horrible things to other people."

Law on the books

Experts say Arizona has some of the most expansive mental health laws in the nation. Any person here can petition the court for a mandatory psychiatric evaluation for somebody else solely because that person appears to be mentally ill and may not know it.

In Loughner's case, college officials could have done this but did not. A college spokeswoman declined to comment on the matter this week.

The college has said Loughner was suspended after five disruptions in classrooms and libraries and after the discovery of a YouTube video Loughner posted claiming the college was illegal under the U.S. Constitution. In October, the college told Loughner that he could return to campus only if he resolved his violations and obtained clearance from a mental health professional that he would not present a danger to himself or others.

But officials said there is no record of Loughner having been evaluated.

"We deal with red flags every day," Pima County Sheriff Clarence Dupnik said. But, he said, "we don't do a good job of helping the mentally ill."

Heinz said Loughner was "a known quantity" but there was no way for the state's gun screening process to identify that. "The red flags" sent officers from the Pima Community College system to Loughner's house, but the information "did not go to the state database that we use to screen for gun sales," Heinz said. "If we pass that kind of legislation, I think it would prevent more Loughners."

Laura Nelson, deputy director for behavioral health services at the Arizona Department of Health Services, said the problem is an educational one. She said her agency should have done more to promote the involuntary commitment process with citizens.

State Rep. John Kavanagh (R) said the state has "the procedures and tools, but it's not being used effectively. I would assume the blame would be at all levels of government. Perhaps we did too much assuming. Maybe everybody assumed that if we passed the law and gave the authority, everybody in the chain would know what to do."

Charles Arnold, a longtime mental-health advocate here, said Arizona's laws are are strong enough to identify people like Loughner before they descend into violence.

"The vision of the statutes has been undermined by the philosophy of government," he said. "Our problems are not our statutes. It's this very conservative philosophy here that decides that the best government is no government."

The National Alliance on Mental Illness lists Arizona as among the top 10 states most hurt by mental-health budget cuts.

During previous state budget shortfalls, Brewer has made relatively smaller cuts to mental and behavioral health programs compared with other programs, said her spokesman, Paul Senseman.

"She is known and well regarded as a proponent of these types of services and as a protector of this type of funding," Senseman said.

Brewer said in a letter to lawmakers that Medicaid spending was "unsustainable," having increased by nearly 65 percent over the past four years.

"If we are to regain control of state spending, we must reform Medicaid," she wrote.

And with the state losing federal stimulus dollars in the next fiscal year, Senseman said the governor had little choice but to seek a waiver from the Obama administration to lower eligibility standards to the federal minimum, which would suspend benefits to those enrolled in the state's Medicaid alternative program.

Staff writers Dana Hedgpeth, Sari Horwitz and David Nakamura in Tucson contributed to this report.

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