Scream Dement

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"Another time, I went there extremely agitated, cursing and screaming. The receptionists there are cold and unsympathetic--they treat the clients like little kids or idiots. They told me to calm down and stop acting like a child. Finally, a doctor came out, and they just called a taxi and sent me home."

He adds that the receptionists' attitude is the same at every appointment.
Some of Stevens' claims would be comical if they weren't so disturbing. "They made me see a psychiatrist who was working for them for free as part of his community service for drunk driving. He'd show up for our meetings reeking of beer . . .

"When I asked to see my medical records, they refused. They said it was their own private business. I threatened them with the Freedom of Information Act, and they got scared and agreed to give me some but not all. When they gave it to me, they'd blanked out parts of a report written by an outside psychologist they'd sent me to. When I requested the rest of my records, they said I had it all, even though they'd already admitted that I didn't."

Things are better for him now. But he attributes that to his medicine--"Zoloft has worked wonders," he says--rather than to any improvement in ComCare's behavior. "Things have been fine over the past year or so, except that about half of my appointments get canceled because doctors are sick or on vacation or whatever."

When listening to people who are, by their own admission, delusional, you have to allow for exaggeration, or outright fabrication. But it's not just the clients who have horror stories to tell--professionals working in the field paint a similar picture of ComCare as a vicious bureaucratic jungle.

Michael Balch is a social worker and clinical specialist who works with homeless people who are mentally ill. He says that, even prior to the much-publicized cuts in services, it was almost impossible to get ComCare to treat his clients. ComCare apparently doesn't like the inconvenience of dealing with those who are less than functional citizens.

"My clients are usually not on SSI when they come to me, and ComCare won't take them if they're not on SSI. We're supposed to stabilize them, and then pass them on to ComCare--who won't take them if they're stable! What're we supposed to do--take them off their medication?

"Then when they do get accepted, it can take four to six weeks for them to be seen."

Balch wonders how severe a person's illness has to be before ComCare will consider him to be an emergency.

"I had a guy threatening to cut his jugular vein . . . He soaked himself in oil and threatened to set himself on fire . . . And ComCare said he didn't need psychiatric treatment."

The client he's referring to is Angelo White. After 12 years in the mental-health system, White understands that the mentally ill are regarded as second-class patients.

"Medicare will pay for only 190 days of [mental health] treatment in a lifetime," says White. "If you have cancer, or any other physical illness, you get forever. When your Medicare runs out, you resort to the county, whose resources are limited.

"Psychiatrists aren't held to the same standards as other physicians. Doctors can't open you up and then just leave you that way, but psychiatrists can just drop you when the money runs out.

"The American public is being defrauded," White says. "They're paying for services that aren't being rendered. The authorities think they can subcontract their way out of all responsibility."

Lloyd Vacovsky, a case manager for Central Arizona Shelter Services, expresses admiration for some of the individuals who work for ComCare.

"There are good people there," Vacovsky says. "They send an intake worker to our shelter every week, and she's one of the best I've seen. She's very caring." But his view of the agency as a whole is considerably less positive. "The system means that the clients get screwed."

New Times has reported the death of Donald Ellison, a homeless and mentally ill Vietnam veteran who succumbed to heat prostration on the street. Many people believe ComCare's incompetence and neglect contributed to Ellison's death. Ellison was Vacovsky's client.

"After that, I swore I'd never lose another client to ComCare," he says. "He had attempted suicide, and they did nothing. They said suicide attempts weren't enough. What do they want, blood?

"They want good little SMIs [seriously mentally ill] who do what they're supposed to," says Vacovsky. "But mentally ill people, by definition, don't do what they're supposed to do.

"You have to tell ComCare what they want to hear--yes, I'm crazy, no, I haven't used alcohol . . . Sad to say, a mentally ill person is better off coming to the shelter and letting us case-manage them. Accessing ComCare direct is a scary thing, even for us."

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Barry Graham