District of Columbia community mental health centers are inadequate and not prepared to handle a massive shift of patients from St. Elizabeths Hospital scheduled to take place by October, a panel of experts reported this week.
The report said resources at the city's centers for mental outpatients already are taxed to the limit and that the centers are unable to adequately care for severely disabled patients. Conditions at the centers, the experts said, are such that many patients who have been released are forced to return to the hospital for treatment.
The study was prepared by a committee of national health experts and local psychiatrists at the order of U.S. District Judge Aubrey E. Robinson, who has been asked to enforce a 1980 ruling requiring the transfer to city treatment centers of a number of St. Elizabeths patients who are considered capable of living outside the hospital.
"We are extremely displeased with the District's inability to develop the services and programs they promised," said Norman S. Rosenberg, attorney for the Mental Health Law Project, which brought suit in federal court on behalf of St. Elizabeths patients seven years ago. The MHLP is a national group active in promoting the legal rights of mental patients.
"The time for developing programs has long passed by now," Rosenberg said. "What we should have is an adequate health care delivery system and we are deeply distressed that it does not exist."
Robinson said yesterday he has not yet seen the report. St. Elizabeths and city health officials also said they had not seen the report and declined comment.
Members of the expert panel who visited city treatment facilities last month reported finding "a system so disjointed that many clients cannot cope effectively in the community and as a result disappear from the mental health system . . . or are hospitalized."
The report found that city centers were underfunded and had insufficient professional staffing. While patients with minor disabilities received adequate care, it said, staff members in many cases were not trained to treat severely disabled patients.
Caseloads for some treatment center workers violate court standards, according to the report. At least one center had a waiting list of two weeks to two months for admission.
According to the report, city centers designed for chronically mentally ill patients "are stretched to the limit and cannot absorb more clients."
The MHLP suit originally was filed in the wake of a national movement to deinstitutionalize mental patients and integrate them into the community by providing treatment at local outpatient centers. Two years ago, city and hospital officials agreed to develop a plan for deinstitutionalizing patients here.
Earlier this year, however, The Washington Post reported that the plan was barely moving forward, in part because of bureacratic confusion and lack of cooperation between St. Elizabeths and the city.
As of March, the hospital had transferred only 45 of its 1,448 outpatients to city rolls, though 600 should have been moved by then and all were to be transferred by October. Some city officials have said that it is impossible to meet the needs of all patients coming out of St. Elizabeths when the city's 400-member mental health staff has been trimmed by about 25 percent in the last two years and its $13.6 million budget has remained virtually the same.
Members of the panel are scheduled to meet again after Labor Day to consider specific recommendations for improving the system, Rosenberg said.