A group of the city's mental health clients cried out to D.C. Council members from the steps of City Hall yesterday, asking them to reconsider a plan to close six public clinics, lay off dozens of health care workers they trust, and send clients to get treatment at private clinics from doctors they distrust.
The D.C. Department of Health began taking steps to close its Community Service Agency (CSA) clinics by March 2010 and enter into contracts with about 30 private clinics, saving an estimated $14 million a year. About 4,000 clients are affected.
Organizers said the demonstration was a chance to give visibility and voice to clients who oppose the change. About 75 people participated, organizers said. The estimate could not be confirmed.
"I trust all of my providers" at CSA, said Sylvia Adegoke, 55. After suffering what she called "a terrible breakdown" years ago, Adegoke said a CSA psychiatrist brought her out of the dark when she was afraid to leave her bedroom.
Adegoke's faith in public clinics is so strong that she refuses to attend meet-and-greet events held by the health department to introduce clients to staff members at private clinics.
Mental health officials say the concern is unfounded. Private clinics in the District, such as the Green Door, have been around for more than 40 years, far longer than CSA and the Department of Mental Health, which were created under court order in 2001, they say. Moreover, 64 percent of the city's mental health clients already seek treatment at private clinics under contract with the mental health department.
States and cities have turned to private mental health care with mixed results. In North Carolina, the process was disastrous. Clients who were once treated at state facilities wound up causing a ruckus in emergency rooms. Sheriffs complained of being overwhelmed by calls to arrest unruly mental health clients.
But in south Florida, a private company greatly improved on the public system with careful therapy and a state of the art facility, so much so that nonprofit mental health interest groups that criticized the move to privatize now praise it.
Fair or not, negative views of private care echo among public clients in the District, presenting a sticky problem for the health department and perhaps D.C. citizens in general, said Vanessa Dixon, a representative of a coalition of union groups that organized the march. Dixon and others said upset, insecure and distrusting clients have skipped psychiatric appointments and gone without their medicine.
Alfred Wilson Jr. and Leavon Reeves, both of whom attended yesterday's demonstration, have. "I refuse to go."
Wilson, 47, said many clients view private clinics the way he does. Nine years ago he climbed out a window during a business trip in Paris and threatened to jump. At private clinics, doctors insisted on treating him with medication for six years. Finally he turned to CSA clinics, where he said his bipolar disorder was diagnosed and he was treated with psychoterapy.
"The thing about private hospitals and privatization is this: it's just a job, it's just money," Wilson said. "That's the starting point. They are there one day, gone the next."
Like Wilson, Reeves, 51, goes to the 35 K Street facility for treatment of post traumatic stress disorder that originated when he was a jail guard.
"Too many private agencies I went to made me feel like they didn't hear what I was saying," Reeves said. He was scheduled to meet with representatives from private clinics on Thursday. "But they already know I don't want to deal with a private facility. There's no trust. They're just trying to line their pockets."