The D.C. mental health program, beset by budget cutbacks, staffing shortages and inadequate services, has failed to meet its 1980 pledge that it would provide comprehensive community-based treatment for more than 1,200 patients now being served at St. Elizabeths Hospital.
The city, under a court-ordered plan, had agreed that by today it would assume responsibility for 1,127 outpatients now being treated at St. Elizabeths, but 872 of the patients are still receiving some or all of their care there, according to the hospital.
In addition, 370 patients identified by the hospital as being able to live independently, in a group home with some supervision or in a nursing home, remain hospitalized at St. Elizabeths, although they were supposed to have been released by the end of 1980 or last December.
As a result of those shortcomings, the Mental Health Law Project, an advocacy group that won the 1980 order requiring the deinstitutionalization of patients at St. Elizabeths, yesterday asked U.S. District Judge Aubrey E. Robinson Jr. to hold the city in contempt of court.
It also asked him to impose a fine heavy enough to pay for a special master who would oversee the District's mental health program.
Robinson is now likely to hold a court hearing on the requests.
A team of mental health professionals who have monitored the slow pace of the transfer of St. Elizabeths patients to the city's community system told Robinson in a separate report that the District is "out of compliance with the 1980 plan . . . in virtually every regard.
"The areas of noncompliance are so fundamental, so numerous and so pervasive that the mental health professionals earnestly believe that without the appointment of a powerful overseer to manage their efforts, the District defendants are incapable of achieving compliance on their own, no matter how much more time they are given."
The mental health professionals also recommended that the operation of the federally owned hospital and the city mental health system be combined under a single new authority, a proposal that has been made in various forms eight times since 1964.
A variety of conflicts between the hospital's federal overseers and the city government have not only stymied the proposals for the combined mental health system, but also hindered the deinstitutionalization effort.
City mental health officials concede there are shortcomings in their services, although not to the extent alleged by the patients' advocates.
Dr. Averett Parker, administrator of the D.C. Mental Health Services Administration, said yesterday she had not had a chance to read the court filing and declined comment. But in an earlier interview this week she said the city's two mental health clinics have "come up obviously to a capacity." She said if more patients are released to the clinics the "quality of care would be lesser" without a corresponding increase in the size of the clinics' staff.
"We need more people to serve more," she said. But she said that as the new fiscal year starts today she does not know how many more staff members will be hired this year. There now are 25 vacancies on the staffs of the two clinics, the result of sharp budget cuts at the facilities over the last 18 months.
The city's mental health budget has been cut nearly $700,000, to $11.6 million, for fiscal 1983. But Parker and her boss, Human Services director James A. Buford, said they nonetheless somehow expect to fill the vacancies to meet the plan's requirements.
In recent weeks, the deinstitutionalization effort had slowed, even as the deadline for the transfer of the outpatients approached. A court-ordered report in August by eight mental health care professionals questioned the city's readiness to handle the projected influx of patients from St. Elizabeths and criticized the District's performance on the programs it does provide.
Because of the report, Dr. Bernard S. Arons, who heads St. Elizabeths' office overseeing the transfer of patients to the city, said that hospital clinicians have been "exercising extreme caution in discharging patients when the quality of care has been called into question."
Parker, a psychiatrist, disputed some of the August report's findings. "I think we serve the chronically mentally ill very well," she said, noting that the city is already providing most of the care for 654 of St. Elizabeths' outpatients, although 399 of those have not been formally discharged from the hospital.
Norman S. Rosenberg, director of the Mental Health Law Project, said he believes "there apparently isn't an overall thoughtful strategy by the city on how to provide services.
"There is a resource shortage, money and staff," he said. But just as important, he said, is a lack of cooperation between the 127-year-old hospital and the city.
"There has to be a major restructuring of the system, better coordination between St. Elizabeths Hospital and the community," Rosenberg said. "Here are two independent groups who barely communicate with other."
Sambhu N. Banik, the director of the city's mental health clinic on the grounds of D.C. General Hospital, blamed the staffing shortages on the hospital, contending that St. Elizabeths officials have moved only eight of the 52 medical professionals to the city clinics it was supposed to. The staff members are supposed to help care for the increased number of patients on D.C. rolls.
"We found they're not cooperating at all," Banik said. "If we had that staff we'd be able to provide all the services that are at St. Elizabeths Hospital."
Arons said only eight St. Elizabeths staff members have gone to work for the city because the plan calls for transferring one hospital worker for every 40 outpatients who are discharged to the city rolls. He said a total of 255 have been discharged so far.
Banik said be believes neither the city nor the hospital is "willing to yield. It's an institutional clash between the federal government and the city. The answer is that they have to come to terms for the sake of the patients."