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D.C.'s mobile mental health unit reaches those in need

Luis Vasquez, left, Nicholle Hill and Isha Edwards of D.C.'s mobile mental health unit talk to a woman with a history of schizophrenia who was refusing to return to her nursing home.
Luis Vasquez, left, Nicholle Hill and Isha Edwards of D.C.'s mobile mental health unit talk to a woman with a history of schizophrenia who was refusing to return to her nursing home. (Henri E. Cauvin/the Washington Post)
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By Henri E. Cauvin
Monday, November 9, 2009

The woman wasn't budging.

It was late on a Friday afternoon last month, and there she was, 64 years old, mentally ill and refusing to return to her Southeast Washington nursing home.

"I am fed up," she shouted as she sat bundled in a motorized wheelchair that was stuck on F Street NW. "I have had it."

The MetroAccess van that was to have taken her back had left hours before. Police had come and gone, unable, they thought, to do anything.

So the woman's attorney, who had been with her that morning in D.C. Superior Court and was with her outside the Judiciary Square Metro station, made one last call -- to the city's mental health mobile crisis unit.

A year earlier, the lawyer might have been stuck. The mobile unit was just an idea taking shape, an effort by the D.C. Department of Mental Health to rebuild its capacity to help people in crisis and those veering toward one.

Now, counselors crisscross the city every day and night, the frontline of the District's reinvigorated emergency psychiatric care program. In its first year, the mobile unit, with 17 counselors, psychiatrists and social workers, has helped more than 1,500 people.

With the city's mental health system in the midst of a major overhaul, the need for a mobile crisis team has perhaps never been greater.

The District has been shifting thousands of its outpatient consumers to private providers, raising the risk that some patients will become disconnected from their care and medication. For years, the city's public psychiatric hospital, St. Elizabeths, has been reducing its patient population, now down to about 340 from more than twice that in the 1990s.

In an agency with hundreds of employees and a budget of more than $200 million, the mobile crisis team and the rest of the Comprehensive Psychiatric Emergency Program play an outsize role in the effort to provide treatment and curb unnecessary admissions to psychiatric wards.

"A mobile crisis team is the backbone of a public mental health system," Stephen T. Baron, the District's mental health director, said in a recent interview.

'We're here to help you'

For decades, the District's mental health agency has operated under federal court supervision, and for years, the court-appointed monitor has been calling on the department to do better by people such as the woman in the wheelchair to create a way to serve people in crisis when and where they need help.


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