Meanwhile, experts say other counties and states have notable programs for patient care. New Hampshire and Vermont, for instance, have comprehensive services that integrate mental health care with treatment for substance abuse. Wisconsin is known for its PACT model, which emphasizes intensive case management, where mental health workers keep close watch on their seriously mentally ill clients, at times driving them to their jobs or calling them at their parents' homes. Criticized at times for being coddling and intrusive, PACT also has been praised for keeping people out of the hospital and in meaningful jobs. Last year, Arizona legislators were gung-ho to create a PACT program of their own, but Hull vetoed it because she said there was no money.
Some observers say Arizona's system needs even more than new policies and programs.
In 1997, in fact, the state government ran mental health services in Maricopa County by itself for over a year after it replaced ValueOptions' predecessor. The state operates similar programs for the developmentally disabled without the benefit of a middleman, Arnold said. Others suggest that the state could eliminate the Department of Health Services from the multilayered system. The state's Medicaid agency, the Arizona Health Care Cost Containment System, could oversee mental health services, as it already does for physical medical services. Karen Shore, a psychologist and president of an advocacy group called the National Coalition of Mental Health Professionals and Consumers, wants to revamp managed care itself.