Gov. Jan Brewer is proposing to give the responsibility for mental health care to the state agency now charged with keeping them physically healthy.
In a filing Tuesday with Maricopa County Superior Court, Brewer said she believes that integrating the programs will result in better mental care for those who need it. She said it makes sense because many of those with mental problems also have physical ailments.
But the ultimate goal could be to finally end a lawsuit that goes back nearly three decades over what a judge concluded has been the failure to adequately care for the needs of those with mental illness.
In essence, Brewer's proposal would have all adults age 21 and older without serious mental illness who now receive behavioral health care through the state health department instead get it through the Arizona Health Care Cost Containment System, the state's Medicaid program. That agency already contracts with doctors and others who provide direct care to those eligible for free state-paid health care.
She also wants a separate pilot program which allows Maricopa County residents who have serious mental illnesses get all their care through an "integrated service model."
Brewer, in the court filing by Joe Kanefield, her attorney, said the ideas make sense.
"In recent years, the interdependence of mental and physical health has become increasingly clear," Kanefield wrote.
"Persons who have behavioral health needs often also have a variety of physical ailments, some of which may be exacerbated by their behavioral health conditions and treatments," he continued, like the medications they are taking. "Arizona's current fragmented system of funding and program administration may increase the barriers that persons with behavioral health needs face in getting comprehensive and high quality physical and behavioral health care."
The proposal left Anne Ronan, an attorney for the Center for Law in the Public Interest, totally unimpressed.
Ronan noted that Brewer was specifically directed by a judge last month to file a proposal "that details a specific plan for the structural reforms needed to comply with the existing court orders." And those orders, she noted, deal with those who are seriously mentally ill.
All Brewer provided, Ronan said, was the broadest sketch of a pilot program.
"It's very thin," she said. "After 10 months, I think we were seriously expecting a much more detailed proposal that would address the deficiencies that have been identified year and year after year in the behavioral health system."
But gubernatorial press aide Paul Senseman noted that the lawsuit has been dragging on since 1981, with various administrations trying, unsuccessfully, to resolve the issue.
"This is one of the more bolder proposals that have been made in recent years," he said.
The lawsuit followed the state's decision in the 1970s to "de-institutionalize" people who are chronically mentally ill. The idea was to provide care in the community rather than warehouse people at the state hospital.
But Maricopa County Superior Court Judge Bernard Dougherty ruled in 1985 that the state failed to fund services these newly released people needed to survive, services it was legally obligated to provide. He said that resulted in many people getting lost in the system and not getting the care they need.
In a 1995 deal, the state agreed to improve care in hopes of ending the lawsuit. But judges have concluded, repeatedly, that it has not actually been living up to that obligation.
Ronan said she could not comment about the part of Brewer's plan to move the obligation for behavioral health care for those not seriously mentally ill from the health department to AHCCCS.