Education
Knowledge Is the First
Line of Defense
Families are thrown into crisis with no roadmap. First responders aren't trained. Providers don't understand the diseases they're treating. Education isn't optional — it's survival.
Understanding SMI
What Every Family Needs to Know
When a loved one is diagnosed with a serious mental illness, families are overwhelmed with medical terms, legal processes, and a system that nobody explains. Start here.
What Is Serious Mental Illness (SMI)?
Serious Mental Illness (SMI) refers to a group of brain-based medical conditions that significantly impair a person's ability to function in daily life. These are not mood disorders or temporary struggles — they are chronic, biological diseases of the brain.
The most common SMI diagnoses include schizophrenia, schizoaffective disorder, and bipolar disorder (with psychotic features). These conditions affect approximately 5–6% of the adult population.
SMI is characterized by psychosis — a break from reality that can include hallucinations (hearing or seeing things that aren't there), delusions (fixed false beliefs), and disorganized thinking. During psychotic episodes, individuals may not recognize they are ill.
These are not choices. They are not character flaws. They are medical conditions caused by structural and chemical differences in the brain, and they require medical treatment — just like diabetes, cancer, or heart disease.
The Care System
Understanding the Programs That Serve (or Fail) Our Families
Families are told their loved one will receive “services.” But what does that actually mean? Here's what you need to know about the programs in Arizona's behavioral health system.
Behavioral Health Residential Facilities (BHRFs)
What Is a BHRF?
A Behavioral Health Residential Facility (BHRF) is a licensed residential setting that provides 24-hour supervision and behavioral health services for individuals with serious mental illness. BHRFs are intended to be a step down from inpatient hospitalization — a structured environment where individuals can stabilize, build daily living skills, and eventually transition to more independent living.
Who Qualifies?
To be placed in a BHRF, an individual generally must have an SMI designation in Arizona and demonstrate a need for 24-hour supervised care that cannot be met through outpatient services alone. Referrals typically come through the RBHA (Regional Behavioral Health Authority), crisis services, hospitals, or the court system.
What Services Should Be Provided?
BHRFs are required to provide medication management, behavioral health counseling, daily living skills training, case management, crisis intervention, and coordination with outpatient providers. Residents should have individualized treatment plans with measurable goals and regular reviews.
The Reality
Many BHRFs in Arizona operate with minimal oversight and accountability. Investigations have revealed widespread fraud, neglect, and abuse — facilities collecting Medicaid payments while providing little to no actual treatment. Residents are warehoused, not treated. Medications are mismanaged. Discharge happens without plans. Arizona Mad Moms is fighting for real RBHA oversight, provider accountability, and facility standards that protect the people these places are supposed to serve.
The System
The Continuum of Care — And Where Arizona Fails
A functioning mental illness system has a continuum of care — from community living all the way to inpatient hospitalization. Individuals should be able to move up and down this continuum based on their needs. In Arizona, the continuum is broken at nearly every level.
Community Living
InadequateIndependent or supported living with outpatient services
- ✕6,000+ on housing waitlists
- ✕Case managers overwhelmed with 100+ caseloads
- ✕Outpatient providers don't understand SMI
- ✕No family education or support programs
Intensive Outpatient / ACT Teams
Severely UnderstaffedAssertive Community Treatment teams providing wraparound care
- ✕Not enough ACT teams to serve the population
- ✕Teams are not truly assertive — they wait for clients to show up
- ✕No integration with family caregivers
- ✕Medication management is inconsistent
Crisis Services
Revolving DoorCrisis stabilization, mobile crisis teams, crisis hotlines
- ✕Crisis services stabilize but don't connect to long-term care
- ✕People cycle through crisis centers repeatedly
- ✕No follow-up after crisis discharge
- ✕Families call 911 because crisis teams are unavailable
Residential Treatment
BrokenBHRFs, group homes, supervised residential facilities
- ✕Widespread fraud and neglect in BHRFs
- ✕No campus-style models with multiple levels of care
- ✕Facilities discharge residents without plans
- ✕IMD Exclusion blocks Medicaid funding for larger facilities
Inpatient Hospitalization
Critical ShortageArizona State Hospital and private psychiatric hospitals
- ✕Not enough beds at Arizona State Hospital
- ✕County-based bed caps create artificial limits
- ✕Premature discharge due to bed pressure
- ✕ER boarding for days or weeks waiting for a bed
Forensic / Court-Ordered Treatment
FailingTreatment for individuals in the justice system
- ✕Months-long wait in jail for competency restoration beds
- ✕Jail days counted against hospital treatment limits (fixed by HB 2944)
- ✕NCNR defendants mixed with civil patients (fixed by SB 1604)
- ✕No transition planning from incarceration to community
The Bottom Line
“When every level of the continuum is broken, families become the system. That was never supposed to be the plan.”
You Don't Have to Learn This Alone
Arizona Mad Moms hosts weekly education sessions and has peer mentors who can walk you through every topic on this page — in real life, with their own experience.