Our February cover story, Magellan, Maricopa pass contract midpoint, touched on the challenges faced by Maricopa County and its managed behavioral health contractor, Magellan, in delivering on a multi-year, $1.5 billion contract to provide mental health and substance abuse services to 21,000 county citizens with serious mental illness. In 2009, care for these individuals accounted for $285 million of the county’s $563 million budget for behavioral healthcare, with the price tag expected to rise further for 2010.
The rights of those with serious mental illness to receive state-funded services are detailed and funded in an Arizona law that formed the basis for the landmark 1989 court decision, Arnold v. Sarn. This suit found Maricopa County deficient in its responsibility to provide services to citizens with serious mental illness and detailed service requirements, or “exit criteria,” which must be fulfilled in order to vacate the court order.
After more than 29 years, enforcement of this court order was stayed for two years by agreement by Joe Kanefield, the legal counsel representing Governor Jan Brewer, and Anne Ronan, the counsel representing Maricopa citizens with serious mental illness. The stay agreement, which was approved by Maricopa County Superior Court Judge Karen O’Connor, requires both sides in the long-running lawsuit to renegotiate terms of the court order, in light of the state’s yawning budget deficit. It also closes the office of court monitor Nancy Diggs, whose work documented the inability of the county, and more recently, the county’s behavioral health contractors to meet the lawsuit’s complex and detailed exit criteria.
But why would advocates for those with serious mental illness agree to the stay and renegotiation of a strong court order backed by the enforcement power of a court monitor? The answer came from Governor Jan Brewer, who—after years of support for the needs of mentally ill citizens and two rounds of bruising budget negotiations that kept this funding largely intact—finally decided to drive a settlement by recommending repeal of the law that outlines the state’s mental health service entitlement. Faced with the choice of staying the agreement or seeing the law go, the logic of settlement was clear to advocates.
While neither side sees a silver lining in this cloud, which will result in dramatic service cuts for the foreseeable future, both agree on the necessity of continued funding for services for individuals with serious mental illness. Such service will be centered on the promise of a renegotiated settlement that more strongly embodies recovery-oriented principles and aims not at providing processes of care, but instead more positive life outcomes.
Amid an array of very ugly possible outcomes, and against a backdrop of economic misfortune for so many Americans, this outcome—sadly—seems the best available.