District Seeks To Privatize Services for Mentally Ill

D.C. officials are planning to privatize the city's mental health agency, a cost-cutting move that union leaders say would put about 200 health-care professionals out of work and force thousands of emotionally troubled residents to seek private care.

An audit of the D.C. Community Services Agency this year found that the city could save as much as $14 million by contracting the bulk of its services to private agencies. Health-care advocates who support the transition said the shift is needed because the agency duplicates many services provided by private clinics.

The Department of Mental Health is preparing a transition plan that is expected to be submitted to the D.C. Council soon. The plan is expected to recommend shifting most mental health services provided by the Community Services Agency to private agencies by the start of summer.

The city agency would continue to provide unique public services, such as its pharmacy, outpatient clinics and a program that deals with multicultural issues. But the department has established a transition office to manage the switch of other services to private providers.

Union leaders who represent some employees said the transition is risky. They said city counselors provide care to the most difficult cases, people with deep psychiatric troubles. Those patients have developed a trust with their counselors and are less likely to make the transition to a private care provider, they said.

In addition, union leaders said, about 200 workers would lose their jobs in the midst of a recession. They probably would seek work in the private sector, where pay is lower and job turnover is higher, the leaders said.

"What they're more concerned about are these vulnerable patients," said Vanessa Dixon, a labor representative for the Doctors Council of the District of Columbia. Unlike private agencies, Dixon said, the city treats patients regardless of whether the program is overbooked.

Private agencies "say, 'Oh, we can't see you right now. You have to come back in a month,' " Dixon said. "But you can't tell a mentally ill person to come back in a month. They need the medication immediately. When they don't get the medicine, they can't function in society at all. They can hurt themselves. It becomes a community issue more than just a family issue."

The audit of the Community Services Agency, conducted on behalf of the Department of Mental Health, said otherwise. The department shared some of its findings with the D.C. Council in September.

"There is no appreciable difference between the demographics or the clinical presentation of consumers served by the DC CSA when compared to those served by the private provider network," the synopsis said.

Private providers are more efficient than the city agency, according to the audit, delivering more care at less cost. The yearly Community Services Agency budget is $33 million, and its revenue is $10.5 million, guaranteeing losses year after year.

Shannon Hall, executive director of the D.C. Behavioral Health Association, said the shift should have happened years ago. With the city agency in place, the District has two mental health-care systems providing the same coverage to the same individuals. Hall said the system needs to be expanded to help low-income residents who cannot afford to pay for private care but who do not qualify for Medicaid.