Ing Says: What Happened to Malene, is what Predictably Happens in Systems like The Guidance Center in Flagstaff, AZ
An educational framework for survivors of institutional mental health harm
There is a term used in managed care and public health that most survivors have never heard — even though it describes exactly what happened to them.
Calculated neglect.
It is not a clinical diagnosis. It does not appear in the DSM. You will not find it in the discharge paperwork. But it appears in public health research, in managed care critique, in the historiography of deinstitutionalization, and in the work of researchers trying to explain why systems that are supposed to help people keep producing predictable, patterned harm instead.
Calculated neglect is the deliberate withholding or underfunding of resources for specific populations — not because the resources don’t exist, but because those resources have been directed somewhere else. It is distinguished from ordinary neglect by two things: pattern and choice.
It is neglect with a budget. It is neglect with a Board of Directors. And it is designed, from the inside, to look like an accident.
Why “Accident” Is the Wrong Word
Ordinary neglect can happen in a genuinely underfunded system doing its best with too little. It is still harmful. It still deserves accountability. But it has a different cause and requires a different response.
Calculated neglect is something else entirely.
When researchers use this term in the context of deinstitutionalization — the mass closure of psychiatric hospitals beginning in the 1950s and accelerating through the 1980s — they are describing a system that promised community-based care and then deliberately failed to fund it. Not by accident. Not through oversight. Through a series of policy choices that redirected resources away from the people who needed them most, toward sectors that were more profitable or more politically convenient.
That pattern did not end with deinstitutionalization. It continued into managed care. It continued into the private nonprofit sector. It is continuing now, in facilities across this country, in ways that are traceable — if you know where to look.
The money is always where you look.
A Man Died at The Guidance Center in 2016
I want to say that plainly, because it deserves to be said plainly.
A severely disabled man died at The Guidance Center’s PAC unit in Flagstaff, AZ in 2016.
I do not know everything about what happened. I do not need to know everything to know this: a person in the care of this institution died. And the institution is still operating. Still billing AHCCCS. Still accepting the most vulnerable people in Flagstaff through its doors. Still, as of fiscal year 2023/2024, keeping its training budget below $20,000 while leadership approves its own salary increases.
That death did not produce the transformation it should have produced. That is not an accident either.
When a person dies in your care and your response is not a fundamental reckoning with how that happened — when it does not produce lasting, documented, funded change — that is calculated neglect operating exactly as designed. The system absorbs the harm. It protects itself. It continues.
And the next person walks through the doors not knowing any of this happened.
What It Looks Like From the Inside
Calculated neglect rarely announces itself. It presents as:
- Staff who are undertrained and overwhelmed — not because training doesn’t exist, but because it hasn’t been funded
- Policies that exist on paper and are never enforced in practice
- Complaint processes designed to exhaust rather than resolve
- Leadership that responds to documented harm with silence, legal maneuver, and institutional distance
- A culture in which the people receiving care are treated as liabilities to be managed rather than humans to be served
Each of these, individually, can be explained away. Together, they describe a system that has made a choice — and is living with the consequences of that choice at the expense of the people inside it.
And those consequences are not abstract. They are not bureaucratic. They are:
Suicidal thoughts that weren’t there before treatment. Suicidal actions taken by people who entered the system asking for help. New trauma responses in people who arrived without them. The slow erosion of a survivor’s willingness to ask for help at all — because the last time they asked, the institution made things worse.
I am one of those people. I am not the only one.
How to Recognize It in Your Own Experience
If you are trying to determine whether what happened to you was calculated neglect or ordinary system failure, here are the questions worth asking:
- Was the harm you experienced a one-time incident — or part of a pattern you saw repeated with others?
- When you reported harm, did the institution engage with it — or route it through a process designed to exhaust you?
- Did leadership respond to your complaint — or go silent until you stopped?
- Is there a gap between what the institution claims to value and what it actually funds?
- Has anyone died in this institution’s care — and what changed afterward?
You do not need a lawyer to ask these questions. You do not need a clinical record or a formal complaint already filed. You need your own experience, clearly remembered, and the willingness to name what you saw.
That is enough to start.
It Is the Money. And It Is Also the Design.
Calculated neglect is not just a financial phenomenon. It is structural. It is the inevitable output of a system designed to extract value from the most vulnerable people — people who cannot easily leave, cannot easily complain, and are routinely disbelieved when they do.
Managed care, as a system, creates the conditions for calculated neglect. It rewards cost-cutting. It penalizes complexity. It treats psychiatric crisis as a billing category rather than a human emergency. It builds institutions that are structurally incentivized to underinvest in the care that would actually help — because that care is expensive, slow, and hard to measure.
Within that system, individual institutions make choices. And those choices show up in the budget.
At The Guidance Center in Flagstaff, AZ, the tax Form 990 tells a story that the mission statement does not.
Leadership extracts salaries — with yearly increases — that are, in the plainest language available, shocking for a nonprofit of this size serving this population. The training budget — the line item that would determine whether staff know how to respond to a person in crisis, how to work with a service animal, how to de-escalate rather than restrain, how to provide anything resembling the trauma-informed care they advertise — sits below $20,000 in the fiscal year 2023/2024
Below $20,000.
A man died in their care in 2016. Their training budget is below $20,000.
In my opinion — stated openly and held firmly — that is not mismanagement. That is looting. That is leadership using a nonprofit chartered to serve the most vulnerable people in Flagstaff as a vehicle for personal financial extraction, while the people inside the building suffer the consequences.
The people responsible for those choices are:
Devon Forest, CEO Jon Perez, PhD, Board President Dr. Stephanie Babbitt, Clinical Director Dr. Teresa Bertsch, MD Mary Jo Gregory, RN And the full Board of Directors
They should resign. All of them.
If they will not, they should be removed — by their funders, their regulators, their board, or the political pressure that is building and will not stop.
The design of the system made calculated neglect possible. The choices of these individuals made it inevitable.
If This Mirrors Your Experience
You are not alone. What happened to you was not inevitable. It was a choice made by a provider or a facility — and choices can be documented, reported, and challenged.
File with your state’s licensing board, the Office of Civil Rights, and the Attorney General. File knowing that these bodies rarely impose meaningful consequences — because the record matters regardless.
And then come to us. Between Trust and Trauma documents what happened, names the providers and facilities responsible, and connects survivors who experienced the same pattern of harm.
One incident is enough. One person harmed is enough. We document it because it happened — not because we need a pattern to justify our pain.
“Nothing About Us Without Us.”
