The District of Columbia is still failing to provide adequate community-based mental health care for patients released from St. Elizabeths Hospital and as a result the patients are often rehospitalized or simply dropped from the rolls of the city's clinics, a new study concluded yesterday.
The report, based on an examination of the city's care for 52 of the 246 outpatients transferred last year from the hospital to community clinics under a 1980 court order, concluded that unless the patients require only minimal treatment, the city's mental health care system "breaks down." Patients "who need intensive case management, aggressive outreach to ensure they receive proper treatment , timely crisis resolution and monitoring and followthrough of their treatment plans are being harmed and will continue to be harmed" until the services required by the court order are made available, the study charged.
Moreover, the report said that the city's Mental Health Services Administration, beset in recent years by budget cutbacks and staffing shortages, "has repeatedly demonstrated that it is not capable of solving these problems."
The study was written by a committee that has regularly monitored the deinstitutionalization of more than 2,400 mental patients who are treated or hospitalized at St. Elizabeths and could be cared for in less restrictive settings in the community. It was submitted to U.S. District Judge Aubrey E. Robinson Jr., who is overseeing the pace of the transfer and the quality of the city's mental health services.
Dr. Ernest Hardaway, the city's public health commissioner, said yesterday he had not had time to read the latest report on the city's mental health care and declined comment until he could do so.
But Hardaway said that lately he is taking "a much more intensive role" in the affairs of the mental health agency and plans to review its activities "much more critically."
"If in the report I see evidence that there are items that should have been taken care of, I'll be very unhappy," he said.
Hardaway said that if he perceives that new management of the Mental Health Services Administration is needed, "We'll make some changes," possibly including the firing of the agency's administrator, Dr. Averett Parker. She was appointed to the job just last year in another shakeup of the agency's top-level managers.
Parker was reportedly out of town and could not be reached for comment.
Based on the monitoring committee's recent findings, the Mental Health Law Project, an advocacy group that won the 1980 court order, again urged Judge Robinson to appoint a special master to oversee the deinstitutionalization, in effect a boss over the city's mental health administrators.
The law project first asked the judge to appoint the master last fall. Robinson has so far declined to do so, but has frequently chastized city officials for their failure to provide the services they promised in 1980.
The study, which was done at the city's South Community Mental Health Center on the grounds of D.C. General Hospital, said that mental health officials have failed on a variety of counts to provide proper care for the released patients. Among other things, the report cited the lack of treatment plans for five of the 52 patients surveyed and noted that in 22 cases, "medication" or "chemotherapy" was prescribed but no mention was made of what type of drug to administer, in what dosage or how often to give it.
Three of the eight patients who were rehospitalized were at St. Elizabeths for months before city mental health officials realized it, the report said. Six patients were discharged from the community clinic's care despite the fact that they continued to need treatment.
In one instance, a patient was dropped from the clinic's rolls with the notation, "No show--will discharge for failure to follow through with prescribed treatment."