Lawyers for more than 2,000 mental patients at St. Elizabeths Hospital asked a federal judge yesterday to set a strict timetable for the release of the patients to community-based housing and treatment, charging that the hospital and the District of Columbia had failed to comply with a 1980 court-approved plan to provide better mental health care in the city.
The Mental Health Law Project, which represents the patients, said the hospital's and city's shortcomings are "symptomatic of fundamental management deficiencies in the mental health service systems" they administer. The project said if St. Elizabeths and the District cannot meet their obligations, it will ask for a court-appointed receiver to run the D.C. Mental Health Services Administration and the hospital's patient discharge activities.
The project's director, Norman Rosenberg, said the group was seeking the strict timetable and the creation of new mental health services because "unless the court intervenes, compliance with the original order will not be achieved anytime soon." He said "much too much time" had already passed without sufficient progress being made in transferring hospital patients who are capable of living and being treated in the community to mental health facilities operated or hired by the city.
The project's brief constituted a sweeping indictment of the manner and speed with which U.S. District Judge Aubrey E. Robinson Jr.'s original 1975 order calling for the deinstitutionalization of St. Elizabeths has been carried out. It said the hospital's and city's "violations of the court order have placed the interests of the patients in jeopardy and have caused and will continue to cause them irreparable injury."
The project's 31-page brief said patients "are harmed by being unnecessarily confined at St. Elizabeths Hospital and denied community services . . . by living in unlicensed community residence facilities . . . by having no crisis resolution services available when they are in psychiatric crisis . . .and by the denial of client advocacy services to ensure that their individual rights are being upheld."
Joseph Davitt, the city's coordinator for the deinstitutionalization effort, and James Pittman, who oversees St. Elizabeths' operations for its parent organization, the National Institute of Mental Health, both declined specific comment on the allegations since they had not seen the project's court filing.
But Pittman, while acknowledging the slow pace of the transfer of patients, said, "Overall, we believe the deinstitutionalization has gone reasonably well." Davitt said, "If the city of Washington with the greatest percentage of psychiatrists per capita in the nation can't provide the needed services , I don't know what city can."
But the project said that most of the patients who need day mental health treatment--a combination of counseling, medication and living skills instruction--are poor and cannot afford the $100-a-day or more charges that are customary here. Moreover, the project said few private groups here will accept Medicaid payments for day treatment or more traditional psychotherapy.
The project also cited a variety of statistics on the slow pace of the transfer of patients from the hospital's rolls to those of the city.
The project said St. Elizabeths now has 492 patients remaining at the hospital "although they have been determined . . . to be suitable for placement in the community. . . " and should have been released by last December. The project charged that the hospital has transferred few outpatients to the city's community mental health centers, while the city has been lax in creating services for the released patients and failed to complete licensing inspections at 73 of the city's 320 community residential facilties for the patients.
Judge Robinson is likely to hold a hearing on the issues before ruling.