When it comes to getting treatment for a serious mental illness, many Tucsonans would be better off being destitute.
Fewer than half of the 765,000 or so working-age adults in Pima County have employer-provided medical benefits, census data show. And such plans vary widely in what they offer in the way of mental-health care.
Some plans - such as a state-sponsored medical plan for small businesses that covers about 2,500 local workers - don't include any treatment benefits for mental illness.
That wasn't the case for Jared Lee Loughner, the accused Jan. 8 shooter. It isn't known if Loughner, 22, ever received treatment for chaotic behavior many experts see as suggestive of schizophrenia. But with a mother who worked for Pima County, his family was eligible for mental-health coverage that is generous compared to what's available for many workers.
The county's lower-deductible health plan covers 90 percent of mental-health-care costs within its provider network once deductibles are met. And it covers the children of county employees up to age 26, regardless of whether they are still in school.
For many who need mental-health care, money is a major stumbling block.
Crisis services - assessment and treatment to stabilize someone who is suicidal, for example - are available free of charge. But to stay stable and improve, most people require ongoing treatment their insurance may not cover.
That's why some people recovering from serious mental illness choose not to work - or to work very limited hours - so they qualify for the state-run Medicaid program.
The Arizona Health Care Cost Containment System, or AHCCCS, covers a package of services including behavioral therapy, name-brand medications, hospital stays, rehabilitation services and caseworkers who are critical to many patients in recovery. But it takes a poverty-level income to qualify: less than $10,890 a year for a single person or $22,350 for a family of four.
Last month in Pima County, about 6,900 impoverished adults with serious mental illnesses were receiving care through AHCCCS. Another 2,600 or so who couldn't qualify got minimal help from the state such as generic psychiatric medication.
"If you qualify for AHCCCS, no problem," said Neal Cash, head of Community Partnership of Southern Arizona, the local agency that distributes public money for mental-health care.
"If you don't," Cash said, "there's a big problem."
Andrew Harvey came face to face with that problem last year at the lowest point of his life.
The 27-year-old was close to suicide after he suffered a mental breakdown on the job at a local Geico call center. His symptoms came on suddenly one day, Harvey recalled. For no apparent reason, he began trembling, sweating profusely and sobbing in the middle of the workday.
"I completely lost control of my emotions," he said. "It was horrifying. I felt humiliated."
He was diagnosed with major depressive disorder and social anxiety disorder. Initially, his workplace medical plan covered his care. But he was too ill to return to work, he said, and six months later the insurer stopped paying.
With no income, Harvey ran through his savings, then stopped taking psychiatric drugs when he could no longer afford them.
He fantasized about hiking into the desert and cutting his femoral artery to make himself bleed to death. When such thoughts take root, he said, it's as if a hungry shark is circling inside his head.
"The shark never goes away. When I wake up in the morning it whispers 'There's an easy way to finish this …' "
Eventually, Harvey's fortunes deteriorated to the point he was poor enough to qualify for AHCCCS.
Had it not been for that help, he said, he might not be here today.
"I never, ever imagined this kind of thing happening in my life," he said. "Now I fight every day for the chance to have a future."
Cash, who oversees AHCCCS spending in Pima County, said stories about insurance woes are familiar to those in the mental-health field. Federal health-care reform could lead to improvements when its provisions take effect in 2014, Cash said.
For one thing, Arizonans won't have to be quite so poor to get coverage through Medicaid. Now their incomes can't exceed the federal poverty line: In the future they'll be able to make up to 33 percent more and still qualify.
Insurers will no longer be able to deny coverage for mental illness as a pre-existing condition, and mental-health care will be deemed an "essential benefit" that certain types of plans must offer, though details have yet to be spelled out.
Cash said such coverage may not be as comprehensive as what AHCCCS offers. Still, it should help makes things better for people who now have no mental-health coverage at all. Cash finds it heartening that public interest in mental health and mental illness is evolving in the aftermath of the Tucson shootings.
But "the real test will be if people are still talking about all this a year from now.
"My hope," he said, "is that when we look back, we'll be able to see how far we've come."
Contact reporter Carol Ann Alaimo at firstname.lastname@example.org or at 573-4138.