In a small office at the Arizona State Hospital, attorney Chick Arnold faces his client, Michael, a paranoid schizophrenic who has spent most of the past seven years at the hospital because he stabbed his grandfather to death. Michael has escaped from the hospital twice, but has come back of his own accord both times.
Arnold is conferring with Michael about his most recent escape-and-surrender episode. After Michael jumped a fence at the hospital, the daily newspapers and TV stations sounded the alarm: An insane murderer is loose! Bolt your doors! Lock your windows! Load your guns!
As it turned out, Michael simply wanted to go swimming in a lake. Once he had taken his dip, he came back to the hospital after two days on the lam, no worse for wear except for a highly contagious bacterial rash apparently contracted while he was undergoing his self-prescribed hydrotherapy.
Don't touch Michael, his doctor warns as he closes the door of a cluttered office, leaving Michael, Arnold and a reporter in silence.
Medicated, Michael, 34, has the demeanor of a sweet 8-year-old, not a man who brutally stabbed his grandfather and tried to kill his grandmother. He wears a worn green shirt, blue jeans and sneakers. He perches on the edge of a chair, focusing wide blue eyes as Arnold asks a few gentle questions. Why, Arnold asks, did you leave the hospital? Michael smiles, scratching his infected arms absently. He only wanted to go for a swim, Michael explains. He likes it here. He would never try to run away for good.
At the end of the conversation, Michael rises, grinning, and extends his hand. He's forgotten the doctor's warning, perhaps never understood it. Awkward seconds pass as Arnold considers the price of spurning his client's fragile affection. Finally, Arnold reaches out and grasps Michael's hand tightly. As Michael leaves, Arnold examines his palm, wincing. Then he smiles and rolls his eyes.
The gesture is a fitting metaphor for Chick Arnold's life. He readily embraces the untouchables, Arizona's great unwashed. They are his livelihood.
@body:Chick Arnold's private law practice is unique in Arizona, perhaps in the United States. He represents the mentally ill, the developmentally disabled and the elderly. Arnold, 46, is a soft-spoken man whose New York roots show up more in his theatrical shrugs and sighs than in his dialect. He looks like actor Steve Martin, but shorter. Like an actor, he shifts easily from role to role: lawyer, advocate, mediator, therapist, friend. One of his clients calls him Zorro. Another insists he's an act of God.
He's also the Arnold in Arnold v. Sarn, a celebrated lawsuit that was supposed to have forced Maricopa County to provide services to its mentally ill.
Most mental-health advocates come by their interest through a firsthand experience with a mentally ill family member. Not so in Arnold's case. He was inspired by Arizona's abysmal mental-health system.
After graduating from the University of Arizona College of Law and practicing general interest law for a few years, Arnold was appointed public fiduciary of Maricopa County in 1980. The public fiduciary is the guardian of county residents unable to care for themselves, including seriously mentally ill indigents.
Nationwide, services for the mentally ill were grossly inadequate, following the wholesale deinstitutionalization of mental patients in the 70s. Here in Arizona, the situation was dire. In 1981, this state ranked dead last in the nation for mental-health services.
And so as the public guardian, the young lawyer served as the plaintiff in a lawsuit filed by the Arizona Center for Law in the Public Interest against the state Department of Health Services (James Sarn, the department's director, was the named defendant), the Arizona State Hospital and Arnold's bosses, the Maricopa County Board of Supervisors.
The Board of Supervisors fired Arnold from his public fiduciary post. He fought for reinstatement and won, only to leave weeks later to establish his own private practice, specializing in mental-health law.
Meanwhile, the defendants appealed the case all the way up to the Arizona Supreme Court, which ruled in 1989 in Arnold's favor, saying that the state must follow its own statutes and provide services to mentally ill indigents in Maricopa County, regardless of cost. A detailed implementation plan designed to offer a continuum of services was coordinated by a court-appointed monitor and nicknamed "the blueprint." Arnold serves as lawyer to the court monitor.
The system has only just begun to respond to the needs of the estimated 12,000 seriously mentally ill residents of the county. The state is no longer at the bottom of the heap. A 1990 survey ranked Arizona's mental-health system 38th in the nation (tied with six other states for places 38 through 44). That's far from laudatory in a nation where even the best states have problems, says Fuller Torrey, who conducts the surveys in conjunction with national mental- and public-health advocacy groups. "Even if you're Number 10, you're among the bright kids in the dumb class," Torrey says. Arnold says it is still a system designed to keep people out rather than let them in. So he applies his legal skills and knowledge of Arizona's mental-health statutes (ironically, the laws on the books in 1981 were--and still are--among the best in the country) to force a response on a case-by-case basis. He charges $175 an hour. Only about half the hours he works are actually billed because many of his clients are penniless. But Arnold points out that he does "just fine"; today his law office employs eight people--including two other attorneys.
Arnold uses an odd combination of expertise, persistence and charm, and he almost always gets his way. He doesn't just deal with law. Arnold is often able to recognize a mental condition and recommend the right doctor or the right service. He can guide you through the labyrinthine public-health system.
Arnold is able to get clients the right kind of treatment--whether it's admission to the county psychiatric annex or the state hospital, placement in a long-term facility or a case manager who will respond to their needs. Perhaps it is because he's the Arnold in Arnold v. Sarn. Or maybe it's just that he refuses to take no for an answer.
"I'm not smarter than anyone else," Arnold demurs. "I just seem to be able to find the buttons to press in the system."
@body:The impact Chick Arnold can have on the lives of Arizona's most neglected citizens is vividly illustrated by the cases of Michael Wiebe and Daniel Chase. Their mental-health problems and family situations were similar, but the outcomes were starkly different. Michael Wiebe was rescued by Chick Arnold. Daniel Chase wasn't--at least not yet.
When Michael Wiebe was 12, he tried to crawl out of the window of a moving school bus. Michael told his mother the bus driver was trying to kill him. The episode was the first sign of adolescent-onset schizophrenia, but Alicia Tocco, Michael's mother, wouldn't know that for years. For six years, Tocco, a lawyer and single mother, lived in constant fear for her son's life. She spent half a million dollars (on top of what was covered by insurance) in her search for an explanation. What could possibly lead her gifted, beautiful son to withdraw from society, to talk about suicide, to torch the family room? She redecorated her home in soothing colors, offered Michael gold stars for completion of homework and household tasks and even moved with him to another state--all on the advice of professionals who told Tocco repeatedly that her lousy parenting skills were to blame for her son's behavior.
With each change, Michael became more withdrawn and violent. Tocco gave up her law practice and took a job teaching law school in a small town in Arkansas; shortly after they arrived, Michael stole Tocco's car, wrecked it and fled the accident scene, leaving two injured people behind. Tocco moved back to Phoenix and put Michael in a residential treatment facility. When the facility kicked Michael out, unable to deal with his violent behavior, Tocco panicked. How could she keep him at home? Where else could he go? A colleague suggested she call a lawyer named Chick Arnold. Tocco had never heard of him, but it was her last resort.
That afternoon she found herself in Arnold's office, describing Michael's problems. Arnold recognized the symptoms of serious mental illness immediately, and led Tocco to a doctor who examined Michael and prescribed lithium. Arnold also helped Tocco negotiate the county's mental-health system to find a long-term care facility, convincing her that it was impossible for her to try to keep Michael at home. Now 20, Michael is paying for his lost years. Sometimes the clarity that lithium brings is too much for him to bear, for the world that has finally come into focus is filled with anguish and memories of his violent teen years. Sometimes Michael refuses to take his medication. Sometimes he drinks.
But he is holding on. There is hope.
His mother still must spend eight hours a week writing letters and making telephone calls, ensuring that Michael is getting his medicine and following his daily schedule. It has been a constant battle to find Michael the right case manager and place to live. Often, Tocco says, it takes eight tries to get a call back from someone in the system. She keeps a log. She also pays for Michael's therapy; the system won't. When Tocco is out of town, Michael's sister, Laura, 26, takes over for her mother.
Two framed pictures of Laura hang on the wall of Tocco's office. Michael is just as beautiful, his mother says, but he won't allow anyone to take his picture.
Tocco keeps Arnold on retainer as Michael's attorney. When Michael needed to be treated at the state hospital, Arnold got him in. When the hospital refused to release him, Arnold got him out, and back into residential treatment. (Often when patients are released from the hospital, they find that their beds at residential treatment facilities have been filled.) When Tocco's demand for a meeting with all of the people involved with Michael's care was ignored, Arnold got the parties assembled.
The system responds for Michael Wiebe, but only with constant attention from his mother. And only with Chick Arnold's intervention, something that Mary Chase doesn't have.
At first, Chase thought her son Daniel--the youngest of her three sons--was just a typical troubled teen. To show what a good kid he was, she produces copies of respectable report cards and glowing teacher evaluations.
Suddenly, in his senior year, Daniel dropped out of high school. He earned his GED and even took a few college classes, but Daniel couldn't hold down a job. He began holing up in his bedroom all day while his mother went to work. Half-hearted suicide attempts began. He tried to starve himself. He swallowed bottles of over-the-counter sleeping pills, producing little more than a sore throat. Each evening, Chase returned home terrified that she would find her son dead.
As a clerk with the state Department of Economic Security, Chase, a single parent, earned about $20,000 a year. She could barely afford the mortgage payments on her modest south Scottsdale town house, let alone insurance for her dependents, which would have paid for a psychiatrist for Daniel.
Finally, one night in 1986, after Daniel wrecked the family car and began to insist that his name was Mike, Mary Chase took her son to the Maricopa County Psychiatric Annex. Daniel pounded on the glass door of a locked unit until they let him in. He was diagnosed as schizophrenic, medicated and released a month later. For a few months, Daniel received outpatient counseling through the county. The sessions lasted just minutes, his mother remembers.
Years passed, and Daniel's behavior deteriorated. He began to steal money from his mother. She would come home to find notes from Daniel, telling her that he had been directed to leave town; she still keeps a notebook filled with receipts from plane and bus trips. But Daniel always returned home to his bedroom. By the summer of 1990, he was spending his days sleeping and watching rented videos about police brutality.
Mary Chase scraped together enough money to take Daniel to a psychiatrist, who diagnosed him as manic-depressive and prescribed lithium. The lithium made him sick, so he stopped taking it.
Convinced that he was in grave danger, plagued by demons only he could see, Daniel bought a gun at a pawn shop. Alone at home on a Friday evening, he realized that he was losing control, that he might hurt someone. He called the police. They dropped him off at the psych annex. Once there, the intake personnel refused to admit him; Daniel says a man there told him he was "too lucid," and that even if they did let him in, he would have to leave the next day. He walked home to Scottsdale.
One night not long after that, after his mother had cooked him dinner and settled herself down in the living room to watch television, Daniel walked behind his mother and shot her in the back.
He describes the episode as an anxiety attack; no harsh words had passed between mother and son. Daniel immediately called 911 and waited for the police and paramedics to arrive. The bullet passed through Mary Chase's heart, destroying the bottom third of her left lung and exiting through her breast. The bullet then grazed her leg and scraped the skin of her finger. The doctors told her she had no vital signs when she arrived at Scottsdale Memorial Hospital. After two operations, days in intensive care and months at home, Mary Chase fully recovered. She says she's always been a very healthy person.
Daniel pleaded guilty to a charge of attempted murder and was sentenced to six months in jail and seven years' probation in the county's mental-health program. He was placed in a residential treatment facility in Glendale. His case manager had more than 70 clients to handle and barely spoke to Daniel, Mary Chase says. Daniel didn't receive therapy. The facility sent him bills that he couldn't pay, and his anxiety grew.
When Daniel told his probation officer he needed hospitalization because he was losing control again, he was ignored, he says. Mary Chase didn't know what to do. Neither did Daniel. So he set fire to his bedroom.
Now Daniel, 26, is living on the sixth floor of the Madison Street Jail. He pleaded guilty to a felony count of attempted arson, and is waiting to hear this week if his plea bargain will be accepted. If it is, his mother says she hears that Daniel could have to wait in jail for a year until a space is available in a residential treatment facility. A jail psychiatrist, Dr. Jack Potts, has convinced Daniel to take Prozac, an antidepressant. Potts believes Daniel suffers from chronic depression. Although Daniel says the medication doesn't affect him, others say the change is remarkable. Daniel is a tall man with long, curly brown hair and a frank, deep-blue gaze. He's friendly. Charming. He likes stories about vampires and literature from the Victorian era.
His mother visits every Saturday morning. Daniel's two brothers refuse to see him. Mary Chase says Daniel's illness has ripped the family apart.
The mental-health system has failed Daniel, according to his public defender, Leonard Whitfield. Dr. Potts agrees. So does Mary Chase.
"If we had had money, Dan would not be in jail today. Because I would have taken him to a . . . residential treatment center. He would have been treated," Mary Chase says.
Along with the plane and bus receipts, Mary Chase keeps Daniel's medical records, articles about mental illness and copies of the letters she has written to state officials. She has examined "the blueprint" for resuscitating the mental-health system and compiled a list of the ways the system has failed to uphold Arnold v. Sarn with regard to her son.
Observers say that the mental-health system has improved since Daniel's last experience. If he's placed back into residential treatment, chances are that his case manager will have 40 cases, not 70. Potts believes that with medication, therapy and the right supervision, Daniel will improve dramatically.
But there are no guarantees. Mary Chase has considered seeking Chick Arnold's help.
@body:There's almost a studied calmness about Janet and Chick Arnold as they ease into pool furniture in the backyard of their central Phoenix home. The sun has begun to creep below the horizon. The April evening is completely still. It's rare that the Arnolds find themselves--along with their younger son Mason, a junior at Central High--at home together on a weeknight. Janet, who met Chick between her freshman and sophomore years of high school (he's two years older) and married him after his first year of law school, keeps a schedule even more hectic than her husband's. Many of her nights and weekends belong to the Arizona Jewish Theatre Company, where she's producing director.
Janet, Chick and Mason giggle and tease, acting more like friends than family. Mason comments sarcastically on his father's "dry" sense of humor, adding that his friends all think his dad is cool cause he drives a little white convertible Mazda Miata and coaches their sports teams. Janet shows off Chick's prize collection of "snow domes." Chick looks embarrassed, but can't resist; he disappears into a bedroom, returning with a framed second-prize ribbon from the Arizona State Fair. The Arnolds don't have much time tonight; they have to pack, for they're leaving tomorrow for the East Coast. Chick's parents live in Connecticut, and they're also going to visit Josh, Mason's older brother. He's a freshman at Tufts University near Boston. More and more these days, Chick ponders the notion of leaving Arizona and its philosophical deficiencies for good. He'd like to teach mental-health law at an eastern law school--maybe in Boston, to be close to Josh. Janet confides that she and Chick sent rsums off to Washington when Bruce Babbitt was named to the Cabinet. Just for fun. The Arnolds know it wouldn't be easy to leave. This month marks the 18th year they've lived in this comfortable, ranch-style home. Mason points to the bedroom where he was born. Janet's extended family lives here in the Valley.
And then there's Chick. "I think he's almost stuck. It's like we can't leave," Janet says, turning to smile at her husband. "So much of it simply is because of who he is." Chick blushes, embarrassed again. "But please, don't misunderstand. I don't have to lift anything heavy," he says, displaying that "dry" humor.
@body:The fluorescent light in the media center at Shadow Mountain High School accentuates the fatigue and worry that line the faces of the men and women who have gathered on a Thursday evening to hear Chick Arnold speak. These parents meet weekly as part of a support group for families of children with serious behavior problems. Arnold's recommendation (delivered with some sarcasm, though he says he means it) is "Greyhound therapy." Move out of Arizona. If you can't, force the system to work for you. The irony, Arnold tells these parents, is that "every one of us is a participant in the public mental-health process." Not many insurance policies will cover residential treatment programs at $1,000 a day. Not many people can incur such expenses out of pocket. So Arnold has devised a method to manipulate the system to put children in the custody of the court, in order to get treatment. The parents absorb the information like beggars desperate for food, snatching up Arnold's business cards after the meeting.
Some of those parents will call, and Arnold will help them get their kids into treatment. He knows that the money for those services isn't always waiting there in the public coffers, but that's not Arnold's concern. This is the government's responsibility. He has believed since his civics class at West High that it is the responsibility of government to provide for those who cannot provide for themselves.
Not so in Arizona and Maricopa County, according to Arnold, who says that a "totally conservative approach to the concept of government" keeps services away from those in need. When it's suggested that Arnold v. Sarn is forcing government to act at last, Arnold sneers. "They're under court order," he says.
As a mental-health lawyer, Arnold constantly balances his client's rights against the public's safety. The goal is the least restrictive community-based living situation. But because of limited resources, patients are kept at Arizona State Hospital. Most shouldn't be there. The Arizona Center for Law in the Public Interest estimates that Maricopa County now uses about 420 beds at the state hospital. With a fully developed community-based mental-health system, that number should drop to 120. But the money necessary to develop those services just isn't there. In this and other areas, completion dates set forth in "the blueprint" are being pushed back. In the meantime, the state pays $225 a day for each patient in the state hospital. Mental-health advocates say they're afraid to complain too loudly, because if they do, the legislature might pass a law changing the state's mental-health statutes--mandating that services be offered only to the extent that funds are available and emasculating Arnold v. Sarn.
Jodi Weisberg, who works mental-health cases for the county on a full-time basis as a public defender, says she has more clients sitting in the hospital than ever. She's not optimistic about the future.
"It's sort of like working with a human dump," she says. "It's like when people are no longer useful to society . . . you just dump them. It's a human landfill that I work in."
Chick Arnold traverses that landfill like an altruistic rag picker ready to salvage any soul.
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On the day he visits Michael the swimmer at the state hospital, Arnold stops by the Juniper unit. He stands to the side in a dim hallway, watching as patients are herded from group therapy into the dining hall. None of them appears to notice Arnold, out of place in his dress shirt and tie. Look at their hands, look at the way they walk, he whispers. Heads down, arms hang heavy as lead. As much a result of the institutionalization as the medication.
Meanwhile, the Cholla unit, the maximum security wing at the hospital where Michael is now staying, reminds Arnold of One Flew Over the Cuckoo's Nest. After Michael has been led back to a supervised room, Arnold asks to tour the unit; it's been redesigned since his last visit. The doctor escorts him through secured doors and down a narrow hallway decorated with brightly colored posters. The posters are framed under glass, then bolted to the walls. Strong disinfectant doesn't quite mask the odor of urine, but otherwise the unit and its occupants seem clean and well-cared-for. Arnold compliments the doctor.
On this weekday morning in early spring, patients shuffle, childlike, across the courtyard's sun-splashed asphalt. Most are heavily medicated. Some doze on concrete benches. Others approach Arnold, peering at him and mumbling questions only they understand. He pauses briefly, then continues through to an adjacent building and out into the street and refreshing freedom. The patients stay behind. Way over their heads, chain link stretches the length of their courtyard. Even the sky is fenced.