Treatment of Maricopa County’s seriously mentally ill continues to decline in some areas despite a court order, a court monitor and the infusion of hundreds of millions of dollars, according to a new audit.
The independent review, required under a 25-yearold class action lawsuit, also showed improvements, including the number of people who are working, participating in their recovery plans and getting the attention of a full team of mental health workers.
But court monitor Nancy Diggs said recent layoffs and budget cuts by the private firm that provides services to the county’s 55,000 poor and mentally ill raise questions about whether those gains can continue.
“Given all these factors, the improvements in compliance may be very fragile and not sustainable over time,” Diggs wrote in her report to Maricopa County Superior Court Judge Karen O’Connor.
The report comes as the state Department of Health Services opened bidding Friday for companies to run the embattled mental health system.
At least four private firms are expected to vie for the more than $1 billion contract, including ValueOptions, which has managed the system for the state’s division of behavioral health services since 1998.
The new contract, to be awarded in May, requires the winning bidder to oversee two separate provider plans from which clients could choose. Services include housing, therapy, medication, crisis services and other assistance.
Under the current system, ValueOptions operates 23 clinics in the Valley and is the largest provider of services.
ValueOptions CEO Ed Irby said the audit showed the system overall is improving, but its focus on paperwork requirements often obscured evidence that people were getting better.
“We think there’s some good data in there,” Irby said. “(But) I think there needs to be a much stronger emphasis on those who are being served.”
DHS spokesman Michael Murphy agreed, saying actual outcomes are better than what the numbers may show.
For example, the report says 60 percent of people had housing needs met, but another 14 percent were in appropriate housing that wasn’t documented, Murphy said.
The court-ordered audit followed 429 patients who have various psychiatric and mood disorders, many of whom had been in jail or the Arizona State Hospital but are now living on their own.
Since the last independent review in 2005, fewer patients had current, long-term service plans, fewer received help to participate in drafting their recovery plans, and slightly fewer had their behavioral health needs met based on a variety of factors, from housing to social interactions.
“For some areas, compliance improved,” Diggs wrote. “The problem, however, seems to be these findings do not result in improved clinical practice or better quality of care for class members.”
Diggs said 115 ValueOptions employees were laid off and budget cuts instituted after the audit’s field work was completed in November.
“It does call into question the likelihood that the improvements noted will be sustained over time,” she wrote.
But Irby said nearly all of the layoffs were administrative, not service positions, and budget cuts of 4 percent to 5 percent were necessary to match declines in the number of people on the rolls.
The state is bidding the Maricopa County contract even though ValueOptions had a two-year extension option on its deal. Murphy said that’s the only way substantive contract changes could be made.
Irby said he welcomes the new contract and believes it’s time for ValueOptions to get out of the business of providing services.
“As we move the system toward a recovery model, one of the key components is to have clients participate in the development of their service plans,” he said. “I would say there’s a fairly solid basis for future improvements.”
Diggs was appointed to monitor the county’s mental health system following a 1998 settlement agreement in the Arnold vs. Sarn lawsuit, which affects about 18,000 people with serious mental illness. The agreement also required additional funding to improve services.