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Two reports find progress, lingering problems at St. Elizabeths

The District hopes a soon-to-be-opened building will restore a little of the prestige St. Elizabeths Hospital once knew and end years of court oversight brought on by chronic dysfunction.

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Washington Post Staff Writer
Monday, February 7, 2011; 9:22 PM

St. Elizabeths, the District's long-troubled public psychiatric hospital, continues to improve but is still plagued by frequent patient violence and shortcomings in training and care, according to new reports.

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The findings, by a federally funded watchdog organization and the U.S. Department of Justice, come almost nine months after St. Elizabeths moved into a $166 million state-of-the-art building that is a key piece of the effort to modernize and reform the District's mental health system.

In its report, "Behind Locked Doors," the nonprofit University Legal Services cites hospital statistics showing that in the past fiscal year, St. Elizabeths recorded almost 400 patient-on-patient and patient-on-staff assaults, including more than 150 that led to injury. Overall, the hospital recorded almost 350 physical injuries, a significantly higher rate than the national average, according to hospital statistics.

The Justice Department, in its findings, found that the hospital had made strides in tracking such serious incidents but was failing to consistently carry out thorough and prompt investigations.

Completed as part of a settlement agreement with the District, the Justice Department report is notably positive in its assessment of St. Elizabeths, even as it repeatedly points out that the hospital is falling short of most of the benchmarks set out in the city's 2007 agreement with the federal government.

The University Legal Services report takes a more narrow and critical view of the hospital's performance, although it, too, notes improvements. It focuses on weaknesses in nursing care and on patient injuries, particularly those stemming from assaults.

The ULS report spotlights several serious incidents from the past few years. One, from 2009, involved a patient who had a history of suicide attempts and faced criminal charges. Initially sent back to jail, the man was returned to St. Elizabeths with a court warning that he was suicidal.

Despite the warning, the man obtained a razor blade and was cutting himself for four hours before he called for help. "As we entered the room, he took the razor, looked at us, and in one clean swipe, he made cuts up both arms," an employee told internal investigators.

For the Department of Mental Health, the new reports reflect the progress that the District has made in recent years and the challenges that remain as it tries to exit not only the St. Elizabeths settlement agreement but a federal class-action suit that has shadowed the city's mental health system for 37 years.

In a statement released Monday in response to the ULS and Justice Department reports, the mental health agency said it had moved aggressively to deal with the recent surge in violence, which was concentrated in three of the hospital's 13 units. The hospital launched an initiative to train staff members to reduce violence, and some employees were suspended or fired. Over the past four months, assaults in the three units have fallen by 15 percent, according to the agency.

"Unfortunately, fundamental changes take longer than any of us would like," the statement said, "but we are on the right path."

The new building is seen as a vital part of the changes. Once spread across dozens of buildings and home to thousands of patients, St. Elizabeths had been shrinking as mental health systems here and across the country began focusing on providing more care in the community and less in institutions. Today, St. Elizabeths has slightly fewer than 300 patients.

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