Mentally Ill Will Be Shifted to Private Clinics

By Darryl Fears
Washington Post Staff Writer
Friday, January 23, 2009

Mayor Adrian M. Fenty's administration will close the D.C. agency that serves the mentally disabled in March 2010, sending 4,000 clients for treatment at private clinics and nearly 300 public mental-health employees in search of jobs, according to a plan released yesterday.

Department of Mental Health officials said the Implementation Plan for the Transition and Closure of the District of Columbia Community Services Agency will save between $11 million and $14 million and end most managed mental-health care. But union officials said the plan will disrupt the care of some of the city's most vulnerable residents and send them to agencies not equipped to provide appropriate care.

Officials at the Mental Health Department said that it serves nearly 14,000 clients overall, more than half through private agencies. According to the report, the city will monitor the private care facilities for the 3,600 adults and 450 children being transferred.

Starting in March, city officials plan to hold fairs to introduce Community Services clients to private providers. By August, they hope to place 2,500 people with 24 corporate and nonprofit clinics.

According to the report, the private agencies said they would need more money to accommodate additional patients. Nine of the 24 private agencies that responded to a Department of Mental Health survey to determine their resources said they also would need more space, and some proposed using government facilities.

The department proposed paying the agencies $6.5 million over 12 months to augment their services -- nearly $4 million in fiscal 2009 and the rest the next year.

The report angered union officials who represent Community Services workers.

"Based on the information I have, the implementation plan is complete nonsense," said Vanessa Dixon, a representative for the Doctors Council of the District of Columbia. "What they propose to do is take a public system that works extremely well and close it down and give it to private providers who admit that they don't have the capacity to serve clients."

Stephen Fitzgerald, a retired doctor who worked in mental-health care for more than 30 years, said private mental-health clinics come and go, mostly because of financial problems. Fitzgerald said that closing five Community Services clinics, including the only facility east of the Anacostia River, could have devastating results.

"If a group of mentally ill people do not get services, there are other places where they can go," he said. "They could end up in jail or hospitalized in general hospitals or at St. Elizabeths, or they could end up homeless on the street."

St. Elizabeths Hospital is a psychiatric facility in Southeast Washington. It was the target of a 1974 lawsuit demanding community-based treatment for patients rather than closely confined hospitalization.

Since then, St. Elizabeths passed from the federal government to the city, which responded to a court-ordered alternative to hospitalization by establishing the Department of Mental Health and ultimately the Community Services Agency. The agency was part of a three-year plan to shift patients to home-based care. But the operation has stretched to seven years, and the court-appointed receiver decided it should end.

An audit found that Community Services caregivers were better trained and produced better outcomes for patients but that private agencies were capable and less expensive.

"At a time of economic downturn, increased job loss, increasing numbers of uninsured and unemployed, the need for mental-health services is likely to increase," Fitzgerald said.

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