Arizona State Hospital opens up about how it cares for seriously mentally ill

The Arizona Department of Health Services has launched a dashboard that provides real-time patient data for the Arizona State Hospital, but it doesn't include information about assaults or deaths.

The Arizona State Hospital is the last resort and highest level of care for patients in Arizona with serious mental illnesses and none of the patients are there voluntarily. The facility sits on 93 acres at 24th and Van Buren streets in Phoenix and dates back to Arizona's territorial days in 1887, when the facility was known as the Insane Asylum of Arizona.

The dashboard includes data about patients in both the 117-bed civil side of the hospital and in the 143-bed forensic side, as well as discharges, admissions and length of stay. "Future enhancements are planned," hospital CEO Mike Sheldon wrote in a Jan. 24 blog post about the dashboard, specifying that such enhancements are expected to include age ranges, gender, race and ethnicity, primary language,

Sheldon added that the hope is that "this new tool will provide insight into the hospital's performance."

However, state Health Department officials say those enhancements will not include any information about patient deaths, including suicides that could indicate a problem with staffing, medication management and treatment.

"In order to protect patients’ rights to privacy, in accordance with HIPAA (Health Insurance Portability and Accountability Act of 1996), we are legally unable to provide data regarding patient deaths," an emailed statement from the department says.

Critics of the state hospital want more outside oversight

The Arizona State Hospital has been under the state Health Department's jurisdiction since 1974, but critics say conditions, staffing levels and transparency have more recently become a problem, though not everyone agrees.

The dashboard is the second major change that state officials have made concerning the state hospital over the past two months, after public criticism of how the facility operates, including stories and opinion columns in The Arizona Republic. The first change, announced Dec. 11, was to expand the hospital's governing body from 11 voting members to 20 voting members.

The second change was the public dashboard.

But the efforts do not provide accountability that's adequate to appease some critics who still want a completely new governance structure for the state hospital because it is operated, licensed and regulated by the state Health Department, a setup that some have likened to the fox watching the henhouse.

The existing governing body is appointed by the director of the state Health Department, which skeptics say is problematic.

"We don't need more data, we need better care," said Holly Gieszl, a Phoenix attorney who represents several state hospital patients, reacting to the announcement about the new dashboard.

What the Arizona State Hospital needs, Gieszl added, is a truly independent governing board.

Will Humble, a former state Health Department director who is executive director of the Arizona Public Health Association, said expanding the hospital's governing body and adding the public dashboard gives the appearance of improved transparency.

Like Gieszl, Humble believes what's really needed is a governance restructuring to provide the state hospital with outside oversight that "separates the operations from the regulation," he said.

Two bills introduced this Arizona legislative session by state Sen. Catherine Miranda, D-Phoenix, would make changes.

Catch up: State health officials won't disclose reports on Arizona State Hospital patient deaths

Senate Bill 1100, would make the state hospital a private entity and Senate Bill 1103 would establish a five-member separate governing board responsible for hiring and managing the hospital director. And the state hospital would report to the governing board, according to the legislation.

Miranda is sponsoring another bill concerning the state hospital, Senate Bill 1102, which would create a civil reintegration unit to serve as a step down from the state hospital, where patients could stay following discharge, but before they go to into the community.

Dashboard leaves out suicide, assault data

Recordings and minutes from the Arizona State Hospital Independent Oversight Committee indicate at least two suicides happened at the hospital in 2021, which was first reported by the Center for Investigative Reporting. The Independent Oversight Committee in an Oct. 20, 2022, audio recording acknowledged the death of another patient who choked to death while eating a hot dog in September 2022.

The all-volunteer Independent Oversight Committee holds monthly meetings and reviews operations at the hospital, including hearing about problems like assaults and treatment issues. The committee's role is to make recommendations to the health department director but not to override the director.

The Republic previously reported on another patient who died in 2019 in an apparent homicide committed by a fellow patient.

State health department officials last month told The Republic that 15 Arizona State Hospital patients have died since 2015: 10 from medical issues and five from undisclosed reasons.

The new state hospital dashboard, in addition to excluding information about patient deaths, doesn't include any data on assaults.

State health department officials told The Republic that assault data can be found in the agency's annual report. Officials noted that the hospital defines an assault as "any unwanted contact between parties" and said that more than 90% of assaults result in no injuries.

"The hospital continues to see significant reduction in our overall assault counts; specifically, Fiscal Year to Date there has been a 27% decrease in the number of assaults, compared to the same period last fiscal year," a Health Department statement says. "We are committed to providing an environment that is both safe for patients and staff."

The Republic requested a copy of Phoenix Police Department calls for service to the Arizona State Hospital for a five-year period between 2018 and Jan. 31, 2023. As of Jan. 31, more than a year later, the request remains unfulfilled.

The information that's on the dashboard as of Jan. 30 said the hospital was housing 111 patients out of 117 beds on the civil side, and that on the forensic side, 120 out of 143 beds were full. The average length of stay on the civil side is 3.6 years and on the forensic side it's 3.3 years, the dashboard says.

The "forensic" side of the hospital is for patients with criminal justice system involvement: people who either have been found "guilty except insane" in committing serious violent offenses or who are hospitalized in an effort to restore competency to stand trial.

The "civil" side is for patients court-ordered for care because their mental illness is so serious and disabling that they need state's highest level of long-term psychiatric care,

"As highlighted in the recent report to the Governor’s Office and the State Legislature, system-wide clinical collaboration is critical to the successful treatment and community reintegration of our patients," Sheldon's blog post says. "Monitoring shifts in patient demographics will help all parties better understand emerging treatment needs in the community."

In addition to the civil and forensic beds, a separate, 131-bed Arizona Community Protection and Treatment Center is on the 93-acre campus. It's for patients who have committed sexually violent offenses and are deemed unsafe to return to the community. The Arizona State Hospital is responsible for oversight and management of the center, too.

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X, formerly known as Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: Arizona State Hospital opens up about how it cares for mentally ill