Report Finds Administrative Problems, Questions City's Use of St. Elizabeths
By Serge F. Kovaleski
Washington Post Staff Writer
Thursday, May 5, 2005
Ongoing problems with District mental health services raise "serious public safety concerns" as well as questions about whether the city is meeting its legal obligation to help the mentally ill, according to D.C. Superior Court Chief Judge Rufus G. King III.
King's criticism of the D.C. Department of Mental Health is contained in a March 29 letter to U.S. District Chief Judge Thomas F. Hogan, who is overseeing the mental health system's efforts to emerge from three decades of court intervention.
King wrote that the agency's problems in paying doctors have caused disruptions in court-ordered mental health evaluations of children in juvenile and neglect cases.
He also complained that the department has sharply curtailed voluntary and involuntary admissions to St. Elizabeths Hospital, the only public psychiatric hospital in the District. He said the department stopped all admissions last spring, informing judges that it was doing so because of an electrical emergency at the hospital. But after the electrical problem was fixed, the agency made a policy decision to continue to significantly limit patient intake at St. Elizabeths, King said.
He also wrote that he is concerned about an "alarming and apparently increasing number" of cases in which people are being readmitted to St. Elizabeths within a few days or weeks of their discharge. He said the cases could reflect either the premature release of patients or inadequate community services.
Last week, another Superior Court judge criticized the department's treatment of a Haitian immigrant who, after being held at St. Elizabeths for nearly three months, was discharged and readmitted the same day. The judge said agency officials misrepresented the circumstances of the case by claiming that the immigrant, Helene Joseph, was brought back to the hospital after she acted erratically in the street. A psychiatrist testified that Joseph was simply trying to get away from a group of St. Elizabeths workers who were following her.
Finally, King's letter expressed disapproval of the agency's decision to close the outpatient pharmacy at St. Elizabeths late last year. He said the pharmacy was critical in helping criminal defendants comply with court-ordered treatment.
"We are concerned about the availability of mental health services, the consequent safety of the community and the criminalization of the mentally ill, which appears to be resulting from the discontinuance of needed services to mentally ill individuals in our city," King said in the letter, a copy of which was obtained by The Washington Post.
According to department figures, 16,273 people are receiving outpatient care in the District's mental health system and about 450 people are inpatients at St. Elizabeths.
The federal court's intervention stems from a 1974 class-action lawsuit brought by St. Elizabeths patients seeking community-based treatment.
Asked about King's criticisms, the department's director, Martha B. Knisley, said that although the court-mandated receivership that controlled the District's mental health services for five years was terminated in May 2002, the system still has a lot of rebuilding to do.
"There may have been an assumption on the part of some people that the improvements, post-receivership, would be seen over months. But realistically, we are looking at years," she said. "We are decades behind other mental health service delivery systems in the U.S. because for 30 years we were not moving consistently toward being community-based. That's what is going on now. But it is an arduous task."
In late 2003, a federal judge approved 19 performance targets that the agency would have to meet and sustain for four consecutive quarters to end the court supervision. Knisley said the department is in the process of asking the court to give it credit for achieving the first of those targets: Sixty percent of its budget is now dedicated to community-based expenditures.
The court-ordered plan for the city's mental health system that was approved in 2001 calls for razing St. Elizabeths and building a smaller facility that would be used as a forensic and long-term treatment hospital to back up community care programs.
Leonard H. Becker, general counsel to Mayor Anthony A. Williams (D), responded to King's concerns in an April 18 letter to King.
The delays in payments to doctors were caused by difficulties the District government had in making the agency's current budget available for use, as well as technical problems with a relatively new automated payment system, Becker said. The department "has identified the providers not paid and has intensified its efforts to address their problems," he wrote.
Becker said the reduction in admissions to St. Elizabeths resulted from changes the department has made in its process for determining which patients are neediest.
"Such a reduction does not indicate that DMH is failing to fulfill its statutory responsibility to hospitalize those patients deemed to be a danger to themselves or others," his letter said.
Becker noted that the agency has kept the court updated on negotiations with community hospitals to provide services to involuntarily committed patients, although he said those discussions have not progressed as quickly as the District would like.
On the subject of readmissions of patients soon after their discharge, Becker said the current readmission rates "appear to be in line with previous trends."
As for the shuttering of St. Elizabeths' outpatient pharmacy, Knisley said it was closed because only 26 people were using it and others were filling their prescriptions at community pharmacies.
Staff researcher Bobbye Pratt contributed to this report.