Yeah! Sure! They will fix all the problems!Arizona Republic Article
Valley's mental care worsens, audit finds
Despite an infusion of more than $230 million in the past four years, the public mental-health system is still failing some of the Valley's poor and uninsured, with case managers not doing their jobs and officials not providing oversight, according to an audit filed in court Thursday.
The audit, conducted by the state Office of the Court Monitor, also shows that Arizona is out of compliance with requirements of a 23-year-old lawsuit aimed at improving care.
The audit, the first in four years, in particular blasts two groups: the Arizona Department of Health Services and ValueOptions, a Virginia-based, for-profit mental-health contractor that runs Maricopa County's system. Michael Zent, chief executive officer of ValueOptions' Arizona operations, insists the system is in better shape than the report reflects.
The audit is the second blow to the state's mental-health system this month. Last week, health department officials had to file a plan to fix problems at the Arizona State Hospital, which houses the state's most seriously mentally ill. If that plan is not approved, the state could face federal sanctions.
Supervision of ValueOptions and the State Hospital is handled by DHS' Division of Behavioral Health Services, but ValueOptions and the State Hospital are separate groups.
Charles Arnold, who filed the Arnold vs. Sarn lawsuit in 1981, called the audit's results "dreadful."
"I look at this in connection with the State Hospital survey and see some really disturbing commonalties," he said. "They don't seem to get it, and the 'they' is those in charge, the Division of Behavioral Health (Services)."
The Arnold lawsuit was filed on behalf of six mentally ill patients to pressure the state to improve services. In 1991, the parties negotiated an extensive system of care, but the state has yet to meet the court-ordered requirements.
According to Thursday's audit, "It appears that oversight efforts by both ValueOptions and DBHS (the Division of Behavioral Health Services) have not been effective."
When patients do get good care, it's because of the actions of individuals such as nurse practitioners, rather than the system itself, the report found.
The state hired ValueOptions in 1998, making it the first for-profit company to run Maricopa County's public mental-health system. The move has drawn ongoing complaints from critics who accuse the firm of putting profits over patient care. Since getting the contract, ValueOptions has made a total before-tax profit of $84 million, a 6.5 percent profit margin. The contract is believed to represent 30 percent of its 2003 revenues.
In February, the state awarded ValueOptions a new three-year contract, with an option to renew for two more years. DHS Director Catherine Eden said the contract is not in jeopardy, nor is the firm facing sanctions.
"We're all on the hook," she said, adding that the audit shows that the state as well as ValueOptions were not monitoring the system.
Neither the state nor ValueOptions dispute the audit's findings, and each pledges to address the deficiencies. All parties in the Arnold case will report to Maricopa County Superior Court in October to discuss plans to fix the problems.
Nancy Diggs, a court-appointed monitor hired as a result of the Arnold case, said the findings surprised her.
"We made the assumption through all the meetings and conferences over the last three years that people were really paying attention to the issues," she said.
"This is very, very serious to me. I have no intention of sitting back and then letting them (the state and ValueOptions) submit a plan. This will be a collaborative process."
Diggs said her office will conduct annual audits as well as smaller reviews, some of which may be unannounced.
The audit found a system where case managers "abdicated" care, didn't follow up on patients when they missed appointments and didn't visit them in their homes.
ValueOptions and the state helped conduct the audit, in which reviewers checked patient files and talked with patients, families and staff. Reviewers found that 18 of 27 categories had worse results than in 2000. Some of results centered on patients being left out of treatment planning and a general lack of services. They found a handful of improvements, such as greater use of timely plans for discharging patients from hospitals and reasonable goals for patient improvement.
The mental-health system is better than the auditor's report reflects, Zent said. He said the system has improved and has focused on expanding services such as housing. Reviews done by Medicaid inspectors and an internal audit also show gains, he said.
"I don't agree that there haven't been a lot of improvements," he said.
Zent thinks that case managers are spending time with patients but that they are just not recording it.
ValueOptions has started reviewing all treatment plans. It will train staff on how to write better plans and will have people in the clinics to help them.
The state also has several proposals to improve the system, said Leslie Schwalbe, deputy director of Behavioral Health Services. Plans call for using an outside mental-health consultant to make changes, having state health officials on site at some clinics and routinely reviewing patient care with ValueOptions, rather than waiting for a report from the firm.
The state has increased funding for mental-health and substance-abuse services delivered through ValueOptions by $231 million since 2000. Eden said the increases are justified by the dramatic increase in clients.
ValueOptions clients and their families give the system mixed reviews.
"As long as you know the system and stay on the case manager's case, it works," said a mother whose son has been a client for five years.
"Right now, we have a fabulous case manager, but that is not par for the course," added the Phoenix woman, who asked that her name not be used for fear of jeopardizing her son's care.
ValueOptions has helped her son get housing but doesn't provide other services, she said, forcing the family to pay for private counseling.
Carolyn Hinkle of Scottsdale has a 40-year-old son enrolled in ValueOptions. Her grandson, 25, was a client until recently being admitted to the Arizona State Hospital.
Hinkle said her son, who has schizoaffective disorder, has generally had a good experience with his case manager and services.
"When he misses (an appointment), they're real good about coming out and doing home checks," she said.
Her grandson, who is schizophrenic, doesn't want treatment and is a tougher one to deal with, she said. Hinkle said it was hard to get him services until she joined a statewide advocacy group.
"ValueOptions has a lot of programs," she said. "By going to (the advocacy group's) classes and learning how to work with the system . . . it's just changed things for my family."
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