The District's poor record in running its own mental health services should be a warning about how it will operate St. Elizabeths Hospital, Henry Fulton, a lawyer with the Public Defenders Service mental health division, said at a hearing on a plan for transferring the hospital to District authority.
"Just look at their track record," Fulton said Thursday, speaking at a second day of city-sponsored hearings. The District plans to assume responsibility for the federal mental hospital by 1987.
"To turn this plan over to the same organizations that have been responsible for mental health services in the District . . . it's not good."
Fulton cited the city's inability to follow court orders to remove patients from St. Elizabeths and Forest Haven, a juvenile facility, into community residences. "I don't see any way the current organization, even if it's pumped up a bit, is going to accomplish this," he said of the city's plans to place 309 of the 1,600 patients now at St. Elizabeths into the community by 1989. The plan calls for a total patient population of 800 by 1988.
Fulton said the city has failed for three years to find a home in the community for one of his clients, a retarded man now living in St. Elizabeths. "Placement has been promised by the District for years, but has not been forthcoming," he said. "After three years, this man continues to live in a mental hospital when he is not mentally ill."
Instead of relying on existing city agencies, he recommended an independent authority be set up to run St. Elizabeths, much like the community board that now operates D.C. General Hospital.
Virginia Fleming, director of a city office in charge of the plan, acknowledged earlier that the city's Mental Health Services Administration had experienced "upset and uncertainty" for years. The administration has had rapid turnover of its top officers and serious financial difficulties in recent years. "It's hard to run a quality outfit in a system of uncertainty," she said.
"What's different now is we have a clear road map," Fleming said.
Under the plan, the city's Mental Health Services Administration would be merged with the management of St. Elizabeths to form a new city agency, the Commission on Mental Health. The commission would oversee the three existing community mental health centers, the hospital and outpatient services.
The daylong hearing attracted hospital employes worried about their jobs, citizens concerned about group homes moving into their neighborhoods and mental health professionals with ideas aimed at improving the city's proposal.
Dr. Roger Peele, chairman of the hospital's psychiatry department, asked that the plan include "asylum" beds at St. Elizabeths Hospital for people with dangerous behavior who cannot be released.
Peele also said it is a mistake for the city agencies handling alcohol and drug problems not to be part of the proposed Commission on Mental Health. ''We do not understand the rationale," Peele said. "PCP disorders are creating our most dangerous patients." Alcohol abuse accounts for the largest number of patient admissions, he added.
The ability of the city to find beds in the community for former hospital patients is a key part of the plan.
Judith Johnson, director of the Green Door, an adult day care center for 125 current or former St. Elizabeths patients, said that if the city would help pay for individual apartments, not just group homes, the plan's housing goals could be met.
The Green Door staff supervises 35 former patients who now live in private apartments. "We have a waiting list, but we can't afford any more apartments," Johnson said.
The city should underwrite apartments for those patients able to live independently, Johnson said. "It is one-tenth of the cost of hospitalization," which is estimated at $65,000 a year per bed, she said.
But the city's difficulty in locating community housing of any description, whether for the elderly, mentally ill, ex-offenders or juveniles, was illustrated by the emotional testimony of residents of Longfellow Street in Ward 4, who are angry that the city just granted a permit for a community residence on their block without notifying neighbors.
"We have struggled for years to pay for our homes and to give our children a stable and wholesome environment," said Roosevelt Fuller, a lifetime resident of Longfellow Street. "Our community is being threatened by a group home."
The hearings began 10 months of public debate concerning the city's mental health system. Comments on the city's plan will be accepted by Fleming's office until Dec. 1. The mayor is scheduled to present the plan to the City Council Jan. 1.