Dr. Edward J. Kelty, an official with the National Institute of Mental Health, set the tone for a recent community forum by describing the city's mental health care system as a vehicle moving in "fits and starts."
Kelty and several other speakers attributed the faltering system to several factors, including a lack of sustained support by local groups, financial mismanagement by city agencies, poorly trained and emotionally unstable staff members at some public mental health centers, poorly defined program goals, and failure to develop a comprehensive care system that would attract paying clients.
Dr. Leland Hall, deputy administrator for the D.C. Mental Health Administration, said personnel hiring ceilings and funding cutbacks have produced critical staff shortages.
"At the same time, it seems our proiorities are pretty much determined for us (by external forces),"said Hall, referring to two court suits that ordered more than 1,000 mentally ill and mentally retarded people out of local institutions and into community-based programs.
"The citizens are on both ends and we stand in the middle," Hall said.
The criticisms emerged during a day-long forum sponsored by the D.C. Mental Health Association and attended by community mental health advocates and specialists from government agencies. At issue was the preparation of the city's 1979-1980 mental health plan, which must be completed by July 1. The city is requesting $30 million in federal funds.
Most forum participants favored an expanded and improved community mental health system that would place special emphasis on resolving the social problems, as well as the mental problems, of the mentally ill.
Also discussed were plans to improve screening and evaluation of patients, intensive follow-up services for the chronically ill, alcohol prevention and treatment programs, job training and development, housing referral, and identification of the mental health needs of special groups, such as minorities, the elderly, and youth.
The forum was organized "to inform the public there is a state mental health plan and to alert interested persons about what should be in the plan," said Barbara Tobelman, executive director of the association.
Every five years, all states and the District of Columbia are required to submit five-year plans to the National Institute of Mental Health (NIMH) if federal funding is to continue. The five-year plans are reviewed and up-dated annually.
The District plan defines major goals for the five-year period the provides an overview of the resources available to implement them.
The 1979-80 plan will specify the amount of funds and other resources needed to carry out the last stage of the current plan, which was adopted in 1975. A new five-year plan will be drawn up next year.
Herbert Pardes, director of NIMH, told the audience that "Hud/ (the U.S. Department of Housing and Urban Development) has supported an estimated 1,000 national projects to develop suitable community residential facilities for previously institution-alized people.
"The Department of Health, Education and Welfare has developed a national plan for the chronically mentally ill to provide housing, social and other needs," he added.
In addition, Pardes said, a proposed revision of the Community Mental Health Systems Act, recently completed by a presidential commission, has the support of President Carter.
"The primary objective of the (revision) is (to develop) a comprehensive mental health system." If approved by Congress the act will:
Increase Medicaid and Medicare reimbursements for mental patients so that the patient only pays one-fifth of the treatment costs.
Increase the mental health research budget by $27 million.
Provide incentives, such as deferred loan payments, to medical students who specialize in psychiatry.
Train general practitioners in how to recognize mental patients and to make appropriate referrals.
Pardes said the revised act will now be placed before Congress.
"I think we are at a very difficult and formidable time," said Pardes. "There's a move that says if you spend anything for anything you're wrong. Community advocates and legislators will have to be especially vocal now," he said.