A Phoenix judge chastised Arizona officials for failing to improve mental-health care in the state's largest county, saying they essentially ignored an audit that declared the system in crisis.
Maricopa Superior Court Judge Karen O'Connor on Monday criticized the Department of Behavioral Health Services for its latest response to a lawsuit that was filed in 1981.
"The bottom line is the department did not address their noncompliance," O'Connor said. "Nor did they offer any realistic solutions."
O'Connor, who is presiding over a class-action lawsuit involving the department, made the comments in response to an audit from the case's court-appointed monitor, which found that the system had worsened under its latest managed-care provider and needs a complete overhaul.
O'Connor asked the state to address the system's historic instability, its lack of local controls and whether its shift to a for-profit provider needlessly took money out of the system.
In its response, the state argued that there was no crisis, only "room for improvement."
O'Connor ordered the state to issue a new progress report on the lawsuit by Sept. 3.
State law requires Arizona to provide treatment for the 19,000 people in Maricopa County with serious mental illnesses. Deficiencies in care sparked a successful class-action lawsuit against the state, and the plaintiffs and state officials have been working on a solution since the first "blueprint" for improvement was developed in 1991.
In 2007, Magellan Health Services won a three-year, $1.5 billion contract to overhaul the system. The January audit argued that care had deteriorated under Magellan, which promised to make vast improvements over its predecessor, ValueOptions.
In one key measure, the percentage of seriously mentally ill people who have a stable living situation and job or "meaningful day" declined from 44 percent under ValueOptions two years ago to 14 percent under Magellan. The 2008 target was 80 percent.
Magellan officials say the audit does not accurately reflect the strides they have made in several areas and that they need more time to complete a large-scale transformation.
"We've been working over the last 19 months to bring the system out of its low point," said Richard Clarke, CEO of Magellan of Maricopa County. "And I think we've been making very good progress and steady progress on all the issues that the court is concerned about."
He said employment figures have improved dramatically and that the number of vacant case-manager positions is at an all-time low.
A plan for improving the system could not be developed until after the state resolves its budget crisis, said Joe Kanefield, an attorney representing Gov. Jan Brewer and the state. Brewer has convened a task force to issue recommendations on whether and how to overhaul the system.
Steven Schwartz, an attorney representing the plaintiffs, said further delays would be unacceptable.
"People have been waiting for years," he said. "And the situation has been regressing, not improving. Something's got to change."