The Rev. George Anderson recalled peering through the little window in the locked door to the infirmary at the D.C. Jail and seeing a juvenile inmate shackled spread-eagle to the metal frame of his bed. He had been a suicide risk, and guards could not watch him continually, so he was left there in the physical restraints.
The inmate's grandmother later told Anderson, a jail chaplain, that the youth had a long history of mental illness and had been in St. Elizabeths Hospital several times.
"Why was his situation being handled in a way that I can only describe as brutal?" Anderson said last week at a D.C. City Council hearing. "They are treated as animals."
A spokesman for the D.C. Department of Corrections said that inmates deemed suicide risks may be shackled in the infirmary, but only under direction of medical personnel, and that the inmate must see a psychiatrist within 24 hours.
Anderson was among a number of social service providers and mental health advocates who testified that they have grave doubts about the practical impact of a city plan for treating more mentally ill people in the community as more are released from St. Elizabeths Hospital.
Unless community services and supervision are vastly improved in a short time, many of the witnesses said, the mentally ill will end up in the jail, the streets and homeless shelters where they will not receive treatment.
"We are truly fearful for the future of the mentally ill in this city," said Celeste Valente, a social worker at Mount Carmel House shelter for women.
Under a 1984 agreement, the District government in October 1987 must take over management of St. Elizabeths, currently a federal institution that is jointly funded by the city and federal governments.
At the same time, the city is trying to comply with both court and legislative mandates to deinstitutionalize mental patients who can live in the community and to develop a community mental health system to treat them. A scaled-down St. Elizabeths psychiatric hospital would become part of that comprehensive system.
The mental health reorganization plan developed by Mayor Marion Barry's administration is under consideration by the City Council and then must go to Congress for review.
Most witnesses gave city officials high marks for the design and goals of the plan, but many added that reality could be far different.
"We who work day to day with clients, who work in the shelters with psychotic women, with women who are not receiving any city services, tend to be very practical," Valente said. "And we ask ourselves when and how this system will so suddenly be transformed . . . . The current system of crisis services, of outreach services and of followup by the community mental health centers is woefully inadequate."
Valente told of a woman who tried to strangle a shelter staff member last summer and then wandered into traffic wearing only her bathrobe. The city's crisis unit responded to Mount Carmel's call and took the woman to a city mental health clinic. There, according to Valente, a psychiatrist gave the woman a shot of psychotropic medicine and released her to another shelter for the homeless, without telling the shelter operators of the woman's violent behavior earlier that day.
Barbara Bick, president of Friends of St. Elizabeths, a group of hospital patients' family members and mental health advocates, said the plan was based on a "bankrupt public policy of deinstitutionalization" and decried the available community facilities.
"Some mentally ill are warehoused in the new snake pits of unsupervised, dilapidated, unstructured and unprogrammed community residential facilities," Bick testified.
Leonard A. Higgs, coordinator of the Dixon Implementation Monitoring Committee, which oversees deinstitutionalization, said the policy itself has not failed but agreed with others at the hearing that proper community alternatives have not been created. He and others stressed the need for monitoring of mentally ill individuals, crisis resolution and community outreach.