D.C. Mental Clinic Clients Worried Over Privatization

Plan's Fate May Depend on How Well It's Managed

The District's plan to close six public mental clinics and send the clients to private facilities is a money-saving move that eventually will increase the number of residents who could receive services, city officials have said.

But Emma Dent is worried. Dent, 53, has spent the past three years using the Spring Road clinic in Columbia Heights, and these days -- like more than a dozen other clients interviewed -- she's distraught over the idea that her world could be overturned.

Plus, Dent said, she's had her fill of private clinics. In the 1980s, when she began hearing voices and having visions, she got private care. "When I really needed help, they discharged me," she said.

The city's Spring Road facility has given her better care, Dent said, adding: "My doctor is fantastic. I love her to death."

Dent's story is a case in point for some in the mental health-care industry who argue that private clinics can be inadequately staffed, can cherry-pick patients and sometimes even close unexpectedly, leaving clients hanging.

The city sees things differently and notes that it already successfully has more than 8,000 residents in private care. The D.C. plan calls for closing the six city clinics by March 2010. The city would then enter into contracts with about 30 private clinics.

The D.C. Council will hold an oversight hearing on the Department of Mental Health on Thursday.

City officials have said that privatization could save $14 million a year, funds that can offer treatment to more than the 4,000 or so Medicaid recipients who get it now. Residents who are indigent because of a psychiatric disability qualify for federal Supplemental Security Income, which comes with Medicaid, according to the Department of Mental Health. About 45,000 low-income residents with mental illness who don't qualify for supplemental income and cannot afford other insurance go untreated.

"I think this . . . will benefit consumers in the long run, and it's going to benefit a lot more people who need mental health services," said Shannon Hall, executive director of the D.C. Behavioral Health Association.

But there is evidence of success and failure on both sides of the debate, and the difference, some say, can be how well a system is planned and monitored.

Critics of the District's plan to transfer 4,000 clients say that the staffs at the public clinics are better paid, are better trained and tend to stay on the job longer than at private clinics. Those critics -- clients, psychiatrists, caseworkers and union leaders representing workers who stand to lose their jobs -- have a vested interest in keeping the clinics open. But others, such as Ken Duckworth, medical director for the National Alliance on Mental Health, also raise similar concerns.

"Outpatient mental health is notoriously difficult to fund," Duckworth said. "The clinics soon realize that doctors are expensive and want fewer of them. Doctors get overwhelmed and say, 'I didn't come here for this.' "