D.C. Falls Short on Money and Management.

Tragically, for too many people with mental illness, the troubled condition of the D.C. mental health system remains in the backwaters of the public consciousness. But as a volunteer member of the board of directors of Green Door, a nonprofit organization that has provided mental health services in the city for nearly 30 years, I am all too aware of how the system is struggling -- and of the potentially serious consequences for those Washingtonians who suffer from mental illness and for the public at large.

In the past 12 months the city has lost some important resources for helping the mentally ill. After nearly four decades of service, for example, the nonprofit Center for Mental Health closed its doors, and both the Lutheran Social Services and the Marshall Heights Community Development Organization have eliminated their mental health treatment programs. Other well-established D.C. mental health service providers have had to take emergency action just to stay afloat -- including turning away people in need of treatment. Unless something changes quickly, treatment options for city residents are likely to continue to dwindle.

While the demise of any one agency is not a cause for wailing and gnashing of teeth -- and some reorganization of the provider network is undoubtedly appropriate -- the pattern of closings and cuts indicates that something is amiss. What exactly?

First, federal funding, which is a critical component of assistance to mentally ill people, is now driven by Medicaid. This means that important support programs that do not fit the standard of medical necessity -- for example, providing employment opportunities that are so essential to one's sense of dignity and worth -- are left to the mercy of strained local resources.

Of particular concern is that housing assistance for mentally ill people is not funded by Medicaid. Experts in mental health are clear that a stable housing arrangement is critical to getting -- and keeping -- those who suffer from mental illness on their necessary regimen of medications. Without a renewed emphasis on housing, some of the District's mentally ill people will wander the streets or cycle in and out of jail.

Second, serving today's sufferers from mental illness has become more difficult and more expensive. A greater percentage of new clients at Green Door, for instance, have substance abuse problems. Many -- more than 40 percent of new intakes in 2005-06 -- are homeless or are referrals from jail. Not only is it often more labor-intensive to properly serve these clients, many are not on the Medicaid rolls, exacerbating the funding squeeze.

Third, a consistent, coherent management approach from the D.C. Department of Mental Health is absent. Every provider has a horror story of an 11th-hour funding hassle or other problem with the city agency. This situation makes orderly planning and provision of services next to impossible. A recent assessment by the consulting firm KPMG delineated the organizational challenges that face Steve Baron, the new director of the D.C. Department of Mental Health. Thankfully, Baron has demonstrated a solid understanding of the issues and a willingness to get out and meet the folks carrying out the front-line work.

Finally, local money to take care of existing patient needs, let alone any growth in those needs, is in short supply. Even if Baron is a management miracle worker, this reality must be addressed.

Solutions to these problems will be neither painless nor cheap. But if a society is measured by how well it treats its most vulnerable citizens, the plight of the mentally ill in our nation's capital deserves no less than our full attention and best efforts.

-- Ted Lutz