Mental Health Frequently Asked Questions

A behavioral health crisis occurs when a person’s actions, feelings, and/or behaviors put that person (called the “proposed patient”) at risk of hurting himself/herself or others, or prevents the proposed patient from being able to care for himself/herself or function safely in the community. Some examples of this may include:

1. Using language, writing, or otherwise insinuating that the proposed patient plans to harm someone else– this could include physical violence;
   
   
2. Using language, writing, or otherwise insinuating that the proposed patient plans to harm himself/herself – this could include excessive talk of death or suicide;
   
   
3. Demonstrating an inability to complete activities of daily living, such as an inability to dress, bathe, brush teeth, etc.;
   
   
4. Withdrawing from the proposed patient’s regular social situations/patterns;
   
   
5. Exhibiting dramatic changes in mood, affect, or sleeping and eating patterns; and
   
   
6. Participating in high risk activity including reckless behavior and impulsivity.

The 988 Suicide & Crisis Lifeline offers 24/7 support for those experiencing a suicidal, substance use, and/or a mental health crisis.  For detailed information on 988, including Frequently Asked Questions (FAQ's), please visit the SAMHSA webpage.  Maricopa County residents are still able to call the Central Arizona Crisis Line at (602) 222-9444 or 1-800-631-1314, though 988 provides another option to gain access to crisis services.

If you or someone else is facing a behavioral health crisis, you can contact one of the following:

• Central Arizona Crisis Line (serves Maricopa County)
  (602) 222-9444 or 1-800-631-1314
  
  OR
  
  Text HOPE to 4HOPE (44673)
  Monday – Friday, 2:00pm – 10:00pm
  Saturday – Sunday, 8:00am – 2:00pm
  
  
• Maricopa County Warm Line (Non-Crisis)
  (602) 347-1100
  
  
• La Frontera-Empact Crisis Hotline
  (480) 784-1500
  
  
• Teen Lifeline
  (602) 248-8336
  
  
• Veterans’ Crisis Line
  1-800-273-8255 (option 1)
  
  
• 988 Suicide & Crisis Lifeline
  Dial or Text 988
  
  
• Solari
  A Division of CRN – Crisis Response Network
  1-800-631-1314

Or, you can go to one of the following urgent psychiatric care centers:

• For Central Phoenix
  Connections Health Solutions – Urgent Psychiatric Center
  1201 S. 7th Avenue, Suite #150
  Phoenix, AZ 85007
  (602) 416-7600
  
  
• For the East Valley
  Community Bridges/CPEC
  358 E. Javelina Avenue
  Mesa, AZ 85210
  (480) 507-3180
  
  
• For the West Valley
  Recovery Innovation International
  11361 N. 99th Avenue, Suite 402
  Peoria, AZ 85345
  (602) 636-4605
  
  Community Bridges (CBI) Avondale
  824 N. 99th Avenue, Suite 108
  Avondale, AZ 85323
  (623) 267-5763
  
  

Upon arrival at one of the urgent psychiatric care centers, you may be asked to complete an Application for Involuntary Evaluation and, possibly, an Application for Emergency Admission for Evaluation.  Staff at the three urgent psychiatric care centers will be present and available to assist in completing the necessary documentation.

If you are the guardian with mental health authority, you may sign your ward into a voluntary treatment facility. 

If your ward is refusing to be transported to a facility in order to be signed in, you may want to call one of the crisis facilities listed for additional assistance and/or to complete an Application for Involuntary Evaluation. (see FAQ - What should I do if I am, or someone else is, facing a behavioral health crisis?)

The Application(s) will be reviewed by a psychiatrist or psychiatric nurse practitioner who will determine if the Application(s) meet(s) the criteria for an emergency involuntary admission, meaning that, as a result of a mental illness, the proposed patient is an imminent danger to himself/herself or an imminent danger to others.

If the proposed patient is determined to be a danger to himself/herself or others, the provider may advise local law enforcement so the proposed patient can be detained and brought to the urgent psychiatric care center for evaluation.

From the time the proposed patient is detained, the provider has 24 hours, excluding weekends or holidays, to determine what course of action to take.

Prior to the conclusion of this 24-hour time period, the provider can choose to proceed one of the following ways:

• If the proposed patient has the capacity, the provider may allow the proposed patient to sign in voluntarily for assessment and treatment. At this point, the involuntary process ceases, and nothing is formally filed with the court.
• If the proposed patient’s condition is such that less-restrictive means for treatment are available, the provider may choose a means that is less restrictive than initiating a court-ordered mental health treatment case, in meaning nothing is filed with the court.
• If deemed appropriate, the provider may choose to prepare a Petition for Court-Ordered Evaluation, which then is filed with the Superior Court.

If the provider decides to have a Petition for Court-Ordered Evaluation filed, the Petition is assigned a case number and then the Petition, along with a proposed form of Detention Order, are presented to a Superior Court Judicial Officer for review.  If the Judicial Officer finds the Petition to be in proper form and to contain the allegations required by law, the Judicial Officer will sign the Detention Order, which then allows the proposed patient to be detained for up to 72 hours, excluding weekends or holidays, for evaluation.

If the Application(s) do(es) not meet the criteria for an emergency admission, the Application(s) still may be referred to a community crisis team, who may conduct further assessment to determine if the proposed patient meets the criteria for a “non-emergent” evaluation, i.e., whether the proposed patient, as a result of a mental illness, is both (a) persistently or acutely disabled or gravely disabled, and (b) is unwilling, or unable to accept voluntary treatment.  The community crisis team may prepare a Pre-Petition Screening Report and may refer the matter for the filing of a Petition for Court-Ordered Evaluation.

If a Petition is filed, the Petition is assigned a case number and then the Petition, along with a proposed form of Detention Order, are presented to a Superior Court Judicial Officer for review.  If the Judicial Officer finds the Petition to be in proper form and to contain the allegations required by law, the Judicial Officer will sign the Detention Order.  

For a “non-emergent” Petition, the Detention Order is presented to local law enforcement, who then will serve the proposed patient with a copy of the Detention Order and other paperwork and will bring the proposed patient to an urgent psychiatric care center.  Until local law enforcement does this, the proposed patient remains in the community.  If local enforcement does not bring the proposed patient to an urgent psychiatric care center within 14 calendar days after the date of the Detention Order, the Detention Order and the Petition both expire, and the process must by started all over again.

If the Petition was filed as “emergent,” meaning that the proposed patient is already at an urgent psychiatric care center, the evaluation process starts as soon as the Petition is filed and extends 72 hours, excluding weekends or holidays. 

If the Petition was filed as “non-emergent,” this same 72 hour period does not begin until the proposed patient has been detained and served with the Detention Order and a copy of the Petition.

On both an “emergent” Detention Order and a “non-emergent” Detention Order, the provider can choose to allow the proposed patient to sign in voluntarily (if appropriate).  The provider also may release the proposed patient from evaluation if the provider determines that further evaluation or treatment is not necessary or that less-restrictive means for treatment are available. 

The provider also may request that the proposed patient be admitted into one of the Valleywise Behavioral Health Centers within the 72 hour time period to continue the evaluation and determine whether the filing of a Petition for Court-Ordered Treatment is necessary prior to the 72 hour evaluation period’s conclusion.

Valleywise Behavioral Health Center has three (3) inpatient behavioral health hospitals, which are located as follows:

• Valleywise Behavioral Health Center – Mesa
  570 W. Brown Road
  Mesa, AZ 85201
  
  
• Valleywise Behavioral Health Center – Phoenix
  2619 E. Pierce Street
  Phoenix, AZ 85008
  
  
• Valleywise Behavioral Health Center – Maryvale
  5102 W. Campbell Avenue
  Phoenix, AZ  85031

Upon admission to a Valleywise Behavioral Health Center, the proposed patient will be evaluated by two (2) psychiatrists.  The time frame for completing those evaluations, excluding weekends or holidays, is either:

• 72 hours from the time an “emergent” Petition is filed, OR
• 72 hours from the time the proposed patient is detained/served on a “non-emergent” Petition.

The psychiatrists may proceed in one of the following ways after completion of the evaluations, and prior to the conclusion of the 72 hours:

• Allow the proposed patient to sign in voluntarily (if appropriate);
• Determine that further evaluation and treatment is not necessary, and release the proposed patient; or
• Complete affidavits that become part of a Petition for Court-Ordered Treatment, which subsequently is filed with the Superior Court.

If the provider at Valleywise Behavioral Health Center chooses to proceed with a Petition for Court-Ordered Treatment, and if you are the applicant or a witness, a Valleywise Behvaioral Health Center social worker may contact you to obtain additional information.

If a Petition for Court-Ordered Treatment is filed, the Court will schedule a hearing within four (4) to six (6) business days.  Usually, but not always, the proposed patient will remain inpatient at the Valleywise Behavioral Health Center up to and including the date of the hearing.

At the hearing on the Petition for Court-Ordered Treatment, an attorney from the Maricopa County Attorney’s office represents the petitioner (who is the physician who completed the Petition).  An attorney from the Office of the Public Advocate represents the proposed patient unless the proposed patient has hired a private attorney.

At the time of the hearing, the proposed patient can waive the right to a hearing, in which case the Judicial Officer will render a decision based on the documents presented.

If the proposed patient does not waive the right to a hearing, the petitioner’s attorney typically will call at least witnesses to testify.  The proposed patient has the right to testify, and the proposed patient’s attorney may call other persons as witnesses.

The petitioner has the burden of proof and must demonstrate by clear and convincing evidence all of the following:

1. The proposed patient has a “mental disorder” as defined in A.R.S. section 36-501;
2. As a result of that mental disorder, the proposed patient is
   • a danger to self,
   • a danger to others,
   • persistently or acutely disabled, or
   • gravely disabled;
3. Is in need of treatment; and
4. Is either unwilling or unable to accept that treatment voluntarily.

If, after hearing all the testimony and considering any other evidence (e.g., psychiatric reports) presented, the court determines that the petitioner has met this burden of proof, the court will order the proposed patient (now called simply “the patient”) to undergo treatment for the mental disorder.  The Court does NOT determine what the treatment should be, but rather whether the proposed patient should be ordered to participate is such treatment.

Court-Ordered Treatment results from a court order that requires the patient to comply with the treatment prescribed and administered by the patient’s outpatient treatment provider.  Treatment often is administered in a combined inpatient and outpatient setting.

The Order for Treatment lasts for no longer than 365 days but may be renewed prior to its expiration date (more information on renewal is provided below).  The Order for Treatment specifies the maximum number of inpatient treatment days, which depends on the court’s findings as follows:

• Danger to Self (up to 90 inpatient days)
• Danger to Others (up to 180 inpatient days)
• Persistently or Acutely Disabled (up to 180 inpatient days)
• Gravely Disabled (up to 365 inpatient days)

To qualify for outpatient services, the patient must either be determined to be SMI (Seriously Mentally Ill) and/or have Title 19/AHCCCS insurance.  If neither is applicable, the patient may only be placed on an inpatient Order for Treatment that terminates upon the patient’s discharge from the inpatient setting.

If the patient qualifies for outpatient services, the patient is assigned to an outpatient clinic where the patient must go for appointments and the patient must follow all treatment recommendations, including taking any prescribed medications.  The treatment team, NOT the court, makes the treatment decisions.

If a person subject to an Order for Treatment is non-compliant with treatment after being released/discharged from an inpatient facility, the outpatient treatment team may file a Motion to Amend Court-Ordered Treatment, which requests that that patient’s treatment be changed back to an inpatient setting.  If the Court grants this request, the patient may be detained by law enforcement and transported to an inpatient facility.

If a person subject to an Order for Treatment is a danger to himself or herself or to others after being released/discharged from an inpatient facility, the outpatient treatment team may file a Motion to Amend Court-Ordered Treatment, which requests that that patient’s treatment be changed back to an inpatient setting to address the urgent symptoms. If the situation warrants urgent intervention to protect the patient or others, the patient’s outpatient treatment team, as well as law enforcement, should be notified immediately.

Prior to the conclusion of the 365 days, the Order for Treatment may be terminated in any of the following ways:

• If all the inpatient days set forth in the original Order for Treatment have been used, meaning that the patient has been inpatient for a total of (including the original inpatient time as well as any inpatient status resulting from an amendment) 90 days (if danger to self), 180 days (if danger to others OR persistently or acutely disabled), or 365 days (if gravely disabled), the outpatient provider may need to file a petition to continue (or renew) the Order for Treatment for an additional year, which will allow for additional inpatient days. This petition to continue (renew) needs to be filed no sooner that 14 days prior to the expiration of the existing Order for Treatment or the expiration of inpatient days, whichever date is earlier.  Note that, technically, the exhaustion of the inpatient days does not terminate the Order for Treatment; however, it may render the Order for Treatment impractical if the patient needs additional inpatient treatment.
• After 60 days following the date the Order for Treatment was issued, the patient may request a Judicial Review.  This is a request for a follow-up evaluation to determine whether the patient should remain subject to an Order for Treatment.  An attorney, usually one from the Office of the Public Advocate, is appointed for the patient.  The Judicial Officer will review the information filed, including the provider’s evaluation and recommendation, as well as the patient’s position and may choose to grant the request, deny the request, or set the matter for a hearing.

Yes.  Prior to the expiration of the Order for Treatment, the outpatient provider may file an Application requesting that the Order for Treatment be renewed for an additional 365 days.  When this Application is filed, an attorney, usually one from the Office of the Public Advocate, is appointed for the patient.  This attorney will meet and/or speak with the patient, and will either request a hearing on the Application or will ask the Court to make a decision based on the documents filed.  If the court grants the Application, the Court will enter an order that renews the Order for Treatment, typically for another 365 days, and providing for a new number of maximum inpatient days.

The outpatient treatment provider may not disclose any information unless the patient has signed a document (usually called a “Release of Information” or “ROI”) that authorizes the provider to release information. Without an ROI, the provider may receive information from people other than the patient, but the provider may not share information with people other than the patient.

The National Alliance on Mental Illness (“NAMI”) is a great resource for families who are looking for education and support regarding behavioral health. NAMI offers family support groups, among several other signature programs, in Maricopa County and nationwide.  

NAMI Arizona can be accessed online at www.NAMIArizona.org, or by calling Information and Resources at (480) 994-4407.

The Office of Human Rights (OHR) is also able to provide assistance to all SMI members in Arizona and their families.  For education and technical assistance on SMI rights, call OHR at (602) 364-4585.

First, understand what services the outpatient treatment provider is able to provide. For example, if the patient is eligible for benefits under AHCCCS/Title19 but has not be determined SMI, the patient may qualify for only limited services.

Additionally, if the patient is eligible for certain services, the patient does not have to accept those services even if the patient is subject to an Order for Treatment (e.g., counseling or housing services).

If you believe the clinic is not providing the mandated services, you may file a grievance with the outpatient treatment provider or the Regional Behavioral Health Authority (for Maricopa County:  Mercy Care RBHA Grievance Line – (602) 586-1717.

The Office of Human Rights (OHR) is also able to provide assistance to all SMI members in Arizona and their families.  For education and technical assistance on SMI rights, call OHR at (602) 364-4585.

The OHR can provide technical assistance to anyone in the community, regardless of their SMI status.  An "Advocate of the Day" is available Monday through Friday to help and answer questions.  The OHR works to promote patient rights and ensure access to entitled services.  For more information on the OHR, visit their website.  To contact the OHR Technical Assistance Line, dial (800) 421-2124.