Arizona is facing, and has faced for a long time, a major gap in our mental health care system: the lack of secure residential treatment settings (ABHRFs) for folks with serious mental illness resistant to treatment.
These are sometimes folks with conditions like schizophrenia or bipolar disorder who, because of their illness, won’t engage in voluntary treatment. Their families are left watching loved one’s cycle through emergency rooms, jails, and homelessness without access to the long-term, structured care they need.
In 2019, families and advocates achieved a significant milestone when legislation was passed to authorize SBHRFs in Arizona. The idea was that these facilities would offer a secure, therapeutic environment where individuals with SMI could receive intensive treatment while also being protected—and protecting others—from the consequences of untreated illness.
But despite our work not a single SBHRF has opened because of sabotage from the ACLU of Arizona (who appears to have a hotline to the Governor’s Office) and the Arizona Center for Disability Law.
The absence of secure residential treatment has real human consequences. It leaves Arizona’s most vulnerable residents (and their families) without hope for recovery and puts their families in a position of helplessness. It also means there’s a huge gap in discharge opportunities from the Arizona State Hospital, Valleywise and other inpatient hospital systems – impacting the entire system.
As we’ve written before, Arizona’s behavioral health system has a missing middle. People who are too ill for an open setting often end up in the wrong place like ERs, jails, or staying longer than needed at the state hospital.
SBHRFs are meant to help with that fix that. They’re small, secure, treatment-focused secure residential facilities for people under court order who need structure and supervision to stabilize.
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After years of post-bill-passage advocacy, there’s finally hope we might actually get them built and staffed.
AHCCCS released a Request for Proposals this week to develop SBHRFs:
https://azpha.org/wp-content/
This is the first step in several years that could turn the statute into actual service.
The RFP (open until 1/1/27) asks for providers to step up and run these facilities. That means figuring out staffing, security, clinical models, and how to run within AHCCCS contracts.
The RFP lays out the basic expectations for providers that want to build and run these facilities. SBHRFs are expected to be small, secure settings (generally up to 16 beds) with 24/7 staffing and supervision. They’re designed specifically for people under court-ordered treatment, so the facilities need both a clinical model and the ability to safely manage restricted movement.
On the clinical side, the contractor will need to provide behavioral health treatment, medication management, and structured daily programming aimed at stabilization and step-down to a less restrictive setting. There’s a clear expectation that these aren’t just “places to stay”—they’re treatment environments with defined care plans and discharge goals.
Security is a core feature. The RFP calls for controlled access, secure perimeters, and policies that balance safety with patient rights. That includes coordination with courts, guardians, and treatment teams.
There’s also a strong emphasis on care coordination. Operators will need to work closely with AHCCCS health plans, the courts, and other parts of the system to manage admissions, transitions, and length of stay.
Finally, the RFP gets into the operational nuts and bolts—staffing ratios, qualifications, reporting requirements, and performance expectations tied to AHCCCS contracts.
