MENTAL HEALTH MASQUERADE

ARIZONA SET OUT TO CREATE THE BEST MENTAL-HEALTH-CARE SYSTEM MONEY COULD BUY. IT ENDED UP WITH A PROGRAM AS DYSFUNCTIONAL AS THE PEOPLE IT SERVES.

Jerry Millison was overcome with anguish on the afternoon of May 12.
"He wondered for a second just how screwed up he had to be before someone would help him," a friend of Millison's recalls.

Millison, 41, had a history of mental illness, substance abuse and three suicide attempts. The most recent one, in August 1994, had landed him in a psychiatric ward.

He'd gotten some dispiriting news earlier that day, when the federal government rejected his application for disability assistance. That's not unusual: About 80 percent of the applicants are turned down the first time.

But it came on the heels of another devastating rejection.
Weeks earlier, an evaluator from ComCare--a firm that oversees the care of about 11,000 seriously mentally ill people in Maricopa County--also had informed Millison he wasn't disturbed enough to qualify for its help. An outside psychiatrist had urged Millison to go to ComCare for therapy.

Late on the afternoon of May 12, he returned to his room at a Tempe group home for the ex-homeless.

Millison went into his room and shut the door. He didn't appear for the nightly group dinner, which concerned the home's manager, John Todd.

Todd knocked on Millison's door. No answer. He walked in. Millison was sprawled on the floor, unconscious. Todd administered mouth-to-mouth resuscitation. Another resident called 911.

The rescue attempts failed. Jerry Millison died, Tempe police say, of an apparent drug overdose. He left no note, so it may never be certain if he committed suicide.

But Lisa Perry of Advocates for the Disabled, who had helped Millison with his application for disability aid, knows in her heart what happened.

"Mr. Millison was a decent man with big problems," Perry says. "When the systems in place to help him told him to get lost, I think he just couldn't take it anymore."

Although Arizona has poured more than $250 million through companies like ComCare since 1991, too many of the state's seriously mentally ill still can't find refuge in the system. And those able to get in often don't get the help they need.

The sophisticated professionals who run the system seem incapable of acknowledging its many obvious flaws--except to say it's underfunded. Confronted with evidence of their dysfunctional network, nearly all parties close ranks to quell dissent and defend the lucrative cottage industry.

One frustrated caseworker says the system--ComCare in particular--exhibits the afflictions of some of its clients. Her diagnosis: "Denial with acute paranoia."

"It's a ludicrous system," agrees state Representative Sue Gerard, a Phoenix Republican. "It's wasteful, and we're not even getting good patient care."

Here's how ComCare fits into Arizona's unique mental-health scheme:
The Department of Health Services contracts with ComCare--short for Community Partnership for Behavioral Health Care--and five other firms around the state. Those firms in turn contract with local counseling and other agencies, called "providers."

As of May 1, ComCare had 10,908 seriously mentally ill adults--most of them indigent--on its rolls. The nonprofit company has about 850 employees.

ComCare also provides direct services to clients, mostly case management and some medical services. DHS allocated ComCare $147 million for fiscal 1994-95, with about $75 million earmarked for care of the seriously mentally ill.

Structured like a health-maintenance organization, ComCare collects about $590 monthly from the government for each client, regardless of services provided.

If ComCare sends less than that to providers for a client's care, it gets to keep the balance. If it pays more than $590, ComCare takes the hit.

The result is a system with built-in disincentives for providing comprehensive treatment. Those disincentives could grow under the state's new contract with ComCare: DHS officials say the contract likely will allow it to become a for-profit company.

And accountability is elusive--even to those who dole out the money.
"ComCare can just continue to call the shots the way they want, spend the way they want," says state Representative Sue Grace, a Phoenix Republican. "They don't give us statistics or any kind of detailed information about what services are being delivered. They only give very raw numbers."

ComCare president Pamela Hyde would rather focus on the company's success stories. She notes that the firm's deficit--which stood at $6.3 million last July 1--is almost gone. But she quickly adds that the only way ComCare can reach its long-term goals is through more funding.

But a New Times investigation has found deep, systemic problems at ComCare--problems independent of funding shortages. A review of hundreds of documents and interviews with ComCare employees, human-rights advocates, legislators, bureaucrats and ComCare clients show that:

ù The State of Arizona allows ComCare to keep taxpayer dollars whether it provides meaningful--or, sometimes, any--services to clients on its rolls. The firm has received hefty financial breaks from the government to help cure its multimillion-dollar debt.

ù ComCare supervisors have instructed case managers to falsify client "progress notes," so as not to reflect poorly on the firm.

ù ComCare last year put hundreds of seriously mentally ill people in jeopardy during a power struggle with a large counseling agency. Some still aren't getting adequate services. One ComCare employee says his bosses canceled the agency's contract because the agency was becoming "another political pain."

ù Cozy relationships exist between ComCare and people who are supposed to be acting as watchdogs over the firm. For example, for a time in 1993, ComCare president Hyde actually shared a residential address with Linda Glenn, the court monitor whose job is to evaluate ComCare's performance.

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