PHOENIX — State officials signed a deal Thursday with mental health advocates that could finally end a 31-year-old lawsuit against the state.
The agreement spells out a litany of services the state health department has promised to use its “best efforts” to provide for the seriously mentally ill. These range from crisis intervention for people having immediate problems to helping people stay in their own homes.
And the health department will help people identify and maintain suitable employment.
There have been various efforts since the lawsuit was filed in 1981 — and since a judge ruled the state was breaking the law several years later — to resolve the litigation. That even included various promises by state officials to do a better job of meeting their legal obligations.
All of the tentative pacts, however, have fallen short, resulting in attorneys going back to court.
But Charles Arnold, the original plaintiff in the lawsuit, said he believes this time will be different, even though that, technically speaking, this deal is good only through June 30, 2014.
“This agreement is a landmark agreement in that it provides certainty, and redoubles the commitment of our community leaders, of our elected officials, of Gov. (Jan) Brewer,” he said.
Potentially more significant, Arnold said the agreement provides “a monitoring process that provides objective external review” of how effective are the state’s programs, as well as a yardstick against which to measure if Arizona is living up to its commitment.
“These models will provide objective standards to regularly assess and measure services and treatment so we can improve the system, making sure individuals with serious mental illness are receiving good care with the goals of a successful outcome,” said Brewer.
The lawsuit actually traces its roots to the 1970s when Arizona, like many other states, decided to deinstitutionalize the mentally ill. The idea was to provide care in the community rather than have people “warehoused” in the Arizona State Hospital.
But Maricopa County Superior Court Judge Bernard Dougherty, ruled in 1985 these people were simply released from the hospital, with the state never setting up and funding the services these people needed to survive.
The result, as even some state officials conceded, was that many former state hospital patients ended up living on the streets or getting arrested.
Dougherty ordered the state to provide the “continuum of care” for the chronically mentally ill as they had promised.
There were some interim agreements which did add funding. But the situation slipped two years ago when Brewer announced the state just did not have the money for the care. Even the independent court-appointed monitor disappeared.
Attorney Ann Ronan, who represents those who need care and their families, said there is reason to believe that this new agreement will stick — and the state will follow through with its commitment.
She pointed out that Brewer, in seeking temporary financial relief from the state’s obligations two years ago, promised to work to restore the cash when the economy improved.
“In this legislative session, she’s made good on that promise and secured for class members an appropriation that will provide significant increases in funding for community-based services that we know work,” Ronan said, citing the $39 million in the new budget for mental health services.
Ronan acknowledged this agreement self-destructs in mid-2014.
But she said it provides a basis for going forward. And Ronan said she doubts that the state will take back the gains it provided to the mental health community.
One reason the pact is not final is because of the uncertain future of the federal Affordable Care Act.
Don Hughes, the governor’s health care adviser, said if that law takes effect as scheduled in 2014, it will extend federal Medicaid coverage to a significant number of people who now rely solely on the state for their care, including their mental health services and medications.
Hughes said even those who do not qualify for Medicaid will be eligible for subsidized commercial insurance because the federal law requires states to set up insurance exchanges aimed at those with prior existing medical conditions who cannot get coverage anywhere else. And Hughes said the Affordable Care Act requires all insurance policies issued to cover behavioral health and substance abuse treatment on the same basis as physical ailments.
Yet that possible reliance on the federal law comes as Brewer is in court with other states trying to kill it. But gubernatorial press aide Matthew Benson said he sees nothing inconsistent.
“Whatever its benefits, the governor opposes Obamacare because she believes it is unconstitutional and would result in a host of other costs to the state,” Benson said. He said this two-year deal will give everyone a chance to know whether the federal mandates are coming and what the state needs to do to permanently settle the lawsuit.
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