A mother writes about her concerns to judge dealing with D.C. mental health care suit

The year a group of psychiatric patients launched a class action lawsuit against the District, calling for a mental health system that offered more options than a troubled hospital, Annie Alatishe was in her 20s.

She had not yet given birth to her son, Tamir. She had not yet heard doctors tell her that a fall down the stairs had injured the 1-year-old’s brain. She had no idea that almost 40 years later — as the case approached a final settlement — she would have to consider whether she trusts the city’s mental health system to properly take care of her son, now 23, for the rest of his life.

“If something were to happen to me, no one else would take care of Tamir,” Alatishe, 61, said. Without proper attention from the city, she said, “he would sit there and rot.”

On Thursday, U.S District Judge Thomas F. Hogan is expected to approve a settlement in a case that has outlasted the terms of five D.C. mayors and is now known as Dixon v. Gray. The landmark day comes after about 27,000 notices were sent out in recent months, inviting D.C. residents such as Alatishe, who depend on the system, to express their objections. She was one of just 47 people who responded.

“I felt obligated because I have been dealing with mental health for so long,” she said. Her son, who lives in a group home, has been diagnosed with autism and psychosis. “I’ve had people say, ‘He looks fine. There’s nothing wrong with him.’ And I’d say, ‘If they only knew.’ ”

The widely anticipated settlement marks a major milestone for the city, ending court oversight of a mental health system that has made vast improvements, but that all sides agree has room for more.

“It communicates a message that the District is more than capable of operating its own agencies,” Stephen Baron, director of the city’s mental health department, said of the settlement. At the same time, he added, “We recognize there is still work to be done.”

When the suit was launched in 1974, lead plaintiff William Dixon and other patients at St. Elizabeths Hospital sought less restrictive treatment options than the problem-ridden psychiatric institution. That year, more than 3,600 patients were housed there.

“Essentially, it was a fifth-rate prison,” said Peter Nickles, who was one of the original Covington & Burling lawyers on the case and later served as attorney general for Mayor Adrian M. Fenty (D). “You had all these people who were effectively jailed.”

At that time, the federal government ran the hospital. In 1987, it transferred responsibility for the hospital to the District. Today, fewer than 300 patients can be found at the new St. Elizabeths Hospital, which opened in April 2010. More than 20,000 D.C. residents with mental health needs receive community-based care.

Dixon, who has since died, told The Washington Post in 1982 that the public’s perception of him changed when he went from living at St. Elizabeths to a convalescent home: “When you live in a hospital, they say you were crazy. In a convalescent home, they say he lives there.”