Care Management
Every Person With SMI
Deserves Real Treatment
Arizona's behavioral health system is failing the people it was built to serve. We are fighting for real care — not warehousing, not neglect, and not fraud.
The System Is Broken
Four Failures That Kill People
Arizona spends billions on behavioral health — and still, people with serious mental illness end up homeless, incarcerated, or dead. Here's why.
Behavioral Health Residential Facilities (BHRFs)
Most BHRFs in Arizona provide non-hospital housing without nurses or doctors. Staff are Behavioral Health Technicians — generally high school graduates who are not state-licensed. Most facilities are unsecured, meaning patients can walk out even during active psychosis.
Insufficient Secure Facilities
Arizona lacks sufficient secure treatment facilities for people with SMI. The result? Incarceration or homelessness become the default outcomes — not treatment.
Behavioral Health Fraud
Billions of dollars flow through Arizona's behavioral health system with inadequate oversight. Facilities collect Medicaid payments while providing little to no actual treatment. Residents are warehoused, not helped.
Medication & Treatment Gaps
Many SMI individuals cycle through emergency rooms and short hospital stays without access to consistent, skilled psychiatry. The medications that work — including clozapine — are dramatically underused.
The Hidden Crisis
What Is Treatment-Resistant Mental Illness?
Treatment resistance occurs when a person with a serious mental illness — most commonly schizophrenia — does not adequately respond to at least two different antipsychotic medications given at proper doses for sufficient time (typically 6–8 weeks each).
Approximately 1 in 3 people with schizophrenia are treatment-resistant. They cycle through medication after medication, hospitalization after hospitalization — while families watch their loved one deteriorate.
For these individuals, standard antipsychotics simply do not work. The voices don't stop. The delusions don't lift. The psychosis persists. And without the right intervention, the outcome is predictable: homelessness, incarceration, or death.
But there is a medication that works — and almost nobody is prescribing it.
Signs of Treatment Resistance
The Gold Standard
Why Clozapine?
Clozapine is the only FDA-approved medication for treatment-resistant schizophrenia — and the most underused lifesaving drug in psychiatry.
~30%
of schizophrenia patients are treatment-resistant
60–70%
of treatment-resistant patients respond to clozapine
<5%
of eligible U.S. patients actually receive clozapine
#1
most effective antipsychotic according to research
✅ Why Clozapine Works
- ✓Works when all other antipsychotics have failed
- ✓Reduces suicidality — the only antipsychotic proven to do so
- ✓Dramatically reduces hospitalization rates
- ✓Reduces aggression in treatment-resistant patients
- ✓FDA-approved specifically for treatment-resistant schizophrenia
❌ Why It's Underused
- ✕Requires regular blood monitoring (WBC counts)
- ✕Psychiatrists unfamiliar with prescribing it
- ✕Pharmacies often don't stock it
- ✕REMS program created bureaucratic barriers (now removed by FDA in 2025)
- ✕Liability fears and misinformation among providers
The bottom line: Clozapine saves lives. In 2025, the FDA removed the burdensome REMS program that had restricted clozapine access for years. There are now fewer barriers than ever. If your loved one has tried multiple medications without improvement, ask their psychiatrist about clozapine. If the psychiatrist won't consider it, find one who will. Arizona Mad Moms can help you advocate for access to this life-changing medication.
The Legislative Fight
The Fight for ALTCS-SMI
Arizona's Long-Term Care System (ALTCS) provides home and community-based services for the elderly and physically disabled — but has never included people with Serious Mental Illness. Senate Bill 1630 would change that.
Why ALTCS-SMI Matters
Right now, a person with Alzheimer's can receive attendant care, medication administration, supervised living, and respite care through ALTCS. A person with a serious mental illness — equally unable to care for themselves — gets none of that.
Instead, SMI individuals are placed in unlicensed BHRFs staffed by high school graduates, with no nurses, no medication oversight, and no security. They walk out during psychosis. They end up homeless. They end up in jail. They die.
Services SMI Families Would Finally Receive
Comparable to existing ALTCS benefits — adapted for behavioral health needs
This Bill Needs Your Voice
SB 1630 is currently moving through the Arizona Legislature. Contact your state senator and representative and tell them to support home and community-based services for people with serious mental illness.