Navigating Arizona’s SMI System of Care: Key Insights and Advice from Healthcare Leaders and Family Caregivers

Written by Robert Hess III, BSW, MPH, PMP, LEAN SSBB | Sep 11, 2026, 9:50:43 PM

Navigating Arizona’s behavioral health system can be daunting, especially when a loved one receives a Serious Emotional Disturbance (SED) or Serious Mental Illness (SMI) determination. While policy briefs and system frameworks outline how care should work, the reality experienced by families on the ground often tells a different story.

In a roundtable hosted by the Health Insights Hub by Hess III Consulting, healthcare leaders who serve simultaneously as system executives and primary caregivers shared their firsthand journeys. Moderated by Robert Hess III, BSW, MPH, PMP, LEAN SSBB (legal guardian to an adult living with SMI), the panel featured:

  • Dr. Don Fowls, psychiatrist, healthcare executive, and parent of an adult son living with schizoaffective disorder and ASD.
  • Susan Kennard, Administrator for the Office of Individual and Family Affairs (OIFA) at the Arizona Health Care Cost Containment System (AHCCCS) and mother to an adult son with schizophrenia.
  • Colleen McGregor, Administrator of OIFA at Banner Health Plan, person in long-term recovery, and mother/guardian to a son served within the system.

Below are the key takeaways, system challenges, and essential resources for families and providers navigating Arizona's adult behavioral health care system.

The Crisis System Front Door: Why Early Navigation Is Harrowing

For most families, the initial entry into Arizona’s behavioral health network does not occur through planned outpatient care; it begins in acute crisis.

  • The Hesitation Around First Responders: Caregivers frequently report feeling torn when emergency interventions are needed. Fearing involuntary police involvement during an acute psychiatric episode, families often hesitate to engage standard emergency routes unless specialized mobile crisis teams or trusted crisis leadership are accessible.
  • A Shared Family Trauma: When an individual enters a behavioral health crisis, the entire family unit experiences the shockwave. Caregivers often pivot within seconds from being on the receiving end of acute behavioral threats to advocating for their loved one's medical safety.
  • Opaque Crisis Processes: Unlike general emergency departments where family members stay at the bedside, crisis evaluation facilities don't often allow families in the room or on the floor, leaving loved ones uninformed about transfers, treatment plans, and discharge steps.

The Vital Role of Case Management and SMI Health Homes

Once an individual is assigned to an SMI Health Home, their integrated care team is designed to coordinate psychiatric care, primary physical health, medication management, housing assistance, and supported employment. However, panelists noted significant disparities in care delivery:

  • Workforce Turnover and Coordination Gaps: High case manager turnover remains a systemic challenge to meaningful family engagement. When handoffs fail or internal departments work in silos, families inevitably step into the role of unpaid, secondary case managers.
  • Caregiver Inclusion Is Crucial: When a case manager actively communicates and collaborates with the family, stability rates dramatically improve. Caregivers often track vital historical details that providers cannot observe during brief 15-minute consultations.
  • The High Cost of Small Clinical Shifts: Routine procedural changes—such as an abrupt medication switch during an overnight stabilization unit stay—can trigger disruptions that take caregivers months to re-stabilize.

Navigating and Advocating: Practical Guidance for Caregivers

Panelists shared actionable advice for individuals and families managing care within Arizona’s Medicaid managed care environment:

  • Be Proactive and Tenacious: Know who is on your loved one's team. There are often numerous people supporting them you may not have interacted with (e.g. employment specialist, Peer Support, housing coordinator, therapist etc.). Do not hesitate to contact clinic supervisors, medical directors, case managers, or prescribers directly. If your loved one is managing complex medication regimens or behavioral setbacks, consistent follow-up is essential.
  • Engage the Office of Individual and Family Affairs (OIFA): AHCCCS and each contracted Medicaid Managed Care Organization (MCO) health insurance company operates an OIFA department. OIFA leaders and plan ombudsmen provide neutral advocacy, system navigation, and resolution pathways when standard clinic channels stall. These are your greatest advocates from within. 
  • Pair Advocacy with Diplomacy: Effective systemic advocacy requires persistence paired with strategic diplomacy. Families have the right to file formal grievances and appeals through their health plan or contact state clinical resolution teams when basic care needs are ignored.
  • Seek Peer and Community Connection: Supporting an individual with serious mental illness can be deeply isolating. Joining organizations like NAMI or local family networks provides education on conditions like anosognosia (lack of illness insight) while mitigating the guilt and isolation often carried by caregivers.

Arizona Behavioral Health and SMI Caregiver Resources

If you or a loved one are navigating the SMI system of care in Arizona, these state and community resources offer advocacy, daily programming, and peer support:
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