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One on one with Governor Brewer
Now, let’s fast forward. In previous pieces, I told you about the severe cuts that the state of Arizona made to behavioral health services in 2010 and in 2011. Governor Brewer and legislators were able to restore this funding in fiscal year 2013. This seemed like a good time to talk with the Governor again and ask her some questions about next steps in areas related to behavioral health.
Lori: Governor, you’ve had to make some tough decisions in the area of behavioral health, especially during the past few years.
Governor Brewer: Yes it certainly feels like there have been a lot of tough decisions to make in this area. There are two that come to mind: One was to restore Medicaid in Arizona. This did not make me very popular with some of my closest allies. But when I weighed the benefits to our people of having the influx of revenue for services, I could not in good conscience turn it down. Of course the down side of this is that the funds are only for three years. I signed us up and added a clause that if the funds do not continue, we have the option of pulling out. Is it better to have the funds for three years than not at all? That’s what I had to wrestle with. I think so since this will give us opportunities to build interventions upstream from the problems with some good prevention and early intervention programs. I would rather put money on keeping people well instead of treating them after they are sick. This is a lot more cost effective and better for people too.
The other tough decision related to behavioral health has to do with the Arnold vs. Sarn class action lawsuit that had been active in Arizona since 1981. In May 2012, we reached a historic two year agreement that reaffirms Arizona’s commitment to a community-based system of services for people diagnosed with a serious mential illness. While the initial agreement does did not conclude the lawsuit, it does represent a significant step toward a final settlement. For years I fought to keep the lawsuit in force because it seemed to be a way to assure services for folks with serious mental illnesses. Given the progress we’ve made toward establishing better services and the plans for integrating services, I feel confident enough to finally settle the lawsuit. As we speak, the requirementsregulations are being updated to reflect recovery values. As with the decision to accept the federal funds, I am including a clause that allows us to revisit the lawsuit if we begin to lose ground. I don’t think that will happen, but if it does, we have some options.
Lori: How do you go about making these tough decisons?
Governor Brewer: I start by learning as much as I can about the issues. I try to explore all sides of the situation, asking people with differing points of view for input. Once I have a good idea of what seems to be the best resolution, I move ahead, knowing that there will probably be groups that don’t agree with me. The things that guide my decision-making are my commitment to a conservative approach to government, while at the same time investing in areas that will produce solid results over the long haul, such as education, health care, and services for children.
Lori: It takes courage to make controversial decisions. Where do you get the courage to stand up to opposing forces?
Governor Brewer: Well, I have not always led a charmed life. I think the tough times I’ve weathered have given me perspective. I realize that at the end of the day, I have myself to answer to. I don’t know if I’d call that courage. I think it has to do with beleiving in myself and in other people as well. That’s what you’d say about recovery isn’t it; believing in people?
Lori: You and I have had a few conversations about recovery and we’ve agreed that believing in someone is key to supporting their recovery. It does take courage to believe in people who are struggling with a mental illness because it may not look like they have much of a chance to recover. Yet, most of us do recover. Our strengths get bigger than our deficits.
Governor Brewer: I know people in recovery have gotten much stronger but the system is still very complicated and difficult to negotiate, even for the strongest among us. There are bureaucratic hurdles that make it hard to get services. People seeking treatment for a serious mental illness often have to deal with as many as five health care systems.
Lori: I understand that you plan to integrate behavioral health services with phyical health services to make it easier and more cost effective for people to get health care.
Governor Brewer: Yes that’s true. We want to see a fundamental restructuring of services. Integrating services holds great promise to improve the quality of life for people and families struggling with the challenges of serious mental illness. The approach we are taking is designed to coordinate and integrate behavioral health and physical health for people with serious mental illnesses by establishing health homes. This way most services can be delivered in one stop with less overhead costs and better outcomes. I’m hoping this approach will give people a better chance of staying well so we can reduce the use of crisis services and hospitalizations.
Lori: I agree that integrating serivces sounds like a good idea but I worry that the progress we’ve made with the recovery movement will take a back seat to traditional medical appraoches. What are your thoughts on this?
Governor Brewer: The goal is to provide behavioral health and physical health care services that are integrated at both the administrative and clinical levels to improve the overall health, wellness and quality of life for SMI members. As Governor, my focus will remain on recovery, but it will be up to people like you to make sure the recovery focus is maintained. It is my hope that what we’ve learned about recovery over the past few years can be spread to people with other ailments so more can benefit from learning how to use their strengths to deal with their health challenges.
Lori: If health homes improve services this should have an impact on the increasing the life span of people diagnosed with a mental illness.
Governor Brewer: That’s one of the results we are hoping for. In Arizona, the life expectancy for a person diagnosed with a serious mental illness is on average 32 years shorter than the general population. This is largely due to otherwise treatable medical conditions such as hypertension and diabetes, as well as modifiable health behaviors such as smoking and obesity.
Lori: Seems like a strong role for behavioral health – helping people change their behaviors so they can have a fuller life.
Thanks for your time governor. In closing, can you tell us what your advice might be to a new Governor? What have you learned in the job related to behavioral health that you think is important for people new to the position to know?
Governor Brewer: The behavioral health system is definitely complex and unique. My advice would be to study it carefully and understand the nuances. Then do it well. It will pay off by helping people play a valued role in their communities. Probably most Governors have not had a personal exposure to mental illness and don’t understand it so they may not know how to support it. During my first year in the Arizona House of Representatives (1983), I had a different view from today. Like most of us, I thought we needed to take care of people and manage their lives for them. I knew very little about the system. I spent a lot of time trying to understand it and to understand the Arnold v. Sarn Lawsuit. Once I understood it I became an advocate for behavioral health in the legislature. Now Charles Arnold and I are working together toward a final settlement.
Lori: Any final thoughts?
Governor Brewer: Really, it comes down to believing in people.
