The number of seriously mentally ill people in Maricopa County has exploded in recent years and is expected to grow another 45 percent by 2015, according to state estimates.
Maricopa’s mental health population has grown by 94 percent since 2000, and that rise will likely put a further strain on the county’s 23,000 mental health patients, who already aren’t receiving effective treatment.
And state officials say they don’t have the resources necessary to provide adequate care.
Arizona taxpayers spent $360 million this year to help Maricopa County residents. But billions of dollars spent over the years and a series of bureaucratic transformations haven’t helped most of the county’s mentally ill patients.
An annual state audit of the system’s performance released in January found it fails nearly all of its patients on key measures: placing them in stable housing and providing them with a job or other meaningful activity.
Among those who have not been in jail or hospitalized for their illness, the system failed 86 percent. Among those who have, it failed 83 percent, the audit found.
Nationally, the life expectancy of a mentally ill person is 25 years shorter than that of a healthy person. In Maricopa County, their life expectancy is 32 years shorter.
Without a place to live, a job or supportive friends and family, the county’s mentally ill often wind up homeless or in jail.
In 2007, Magellan Health Services won a three-year, $1.5 billion contract to overhaul the system. But the January audit argued that care had deteriorated under Magellan, a for-profit company based in Connecticut.
Magellan officials acknowledge the need to improve the quality of care on a variety of measures. But they also say the audit’s findings didn’t reflect substantial gains made since late last year, when it was conducted.
More than half of the audit’s quality indicators have no bearing on whether a patient’s condition improves, officials said. Other indicators, such as clinic staffing levels, have improved.
“The system is not in crisis. The system is in
transformation,” said Dr. Richard Clarke, Magellan’s chief executive.
Magellan has planned several new initiatives to improve performance. Clarke’s team is working with the state to post clinic performance data online for public viewing. Case managers will receive better training on suicide prevention. And patients with multiple recent hospitalizations are beginning to get extra attention from Magellan staff.
In 1989, the Arizona Supreme Court agreed with the plaintiffs in Arnold vs. Sarn, a lawsuit that alleged that Arizona failed to provide Maricopa County with comprehensive health care for those with serious mental illnesses as required by state law.
In 1995, the state formally agreed to provide a wide variety of services to the mentally ill as required by the lawsuit. Three years later, a review found that it would cost more than three and a half times as much as the state was then spending to meet those obligations.
Instead, the system’s budget has been cut. In the most recent fiscal year, Magellan saw its contract reduced by about $10 million. The Department of Health Services has absorbed $55 million in cuts in the past two years and faces additional cuts this year.
Chris Heller, a former director of a clinic in Maricopa County, said the state has asked too much of Magellan and its predecessors.
“They dangle a billion and a half dollars out there and one of those companies comes along and bites, because they’re going to try to make it work,” Heller said. “And they get in here and they realize it’s a lot of money, but it’s not nearly what it takes. It’s not all the vendor. The state is cutting an unrealistic deal.”
Maricopa County Superior Court Judge Karen O’Connor has asked the state to prepare a progress report. A status conference in the Arnold vs. Sarn case is scheduled for Sept. 17.