The District of Columbia has failed to comply with a three-year-old agreement to correct serious deficiencies in its mental health system, is slow to respond to crises involving clients and often does not follow up with patients needing more help, according to the report on a year-long investigation filed in U.S. District Court yesterday by a monitoring group.
Based on its on-site tours, the group cited examples of delays as long as three days in visits by city staff members to the homes of mentally ill persons in crisis situations, violent individuals being tranquilized and released from the city's crisis center and sent to homeless shelters, and a person with a history of drug abuse being given a supply of medications and subsequently suffering an overdose.
It found significant staff shortages, a refusal of doctors at the crisis center to make emergency visits to homes because they had no malpractice coverage, and an example of one person seeking help from the crisis center being turned away because no one there spoke Spanish.
The Dixon Implementation Monitoring Committee, which tracks the city's compliance with a 1980 court decree ordering it to provide adequate community services to mentally ill residents, said that its findings "point to decision-makers' lack of commitment to meeting the needs of the chronically mentally ill people they have agreed to serve and inability of the system's present leadership to develop adequate services" for these patients.
The Dixon Committee had asked U.S. District Court Judge Aubrey Robinson in 1982 to hold the city in contempt of court for failing to comply with the 1980 decree and to appoint a "special master" to take control of the city's mental health system. The group later asked the court to delay action on that request because of the 1983 agreement in which the District promised to take specific actions to improve its crisis and outreach services.
A spokesman for the D.C. Department of Human Services said late yesterday afternoon that neither Director David A. Rivers nor Mental Health Services Administrator Gladys Baxley could be reached for comment on the report.
Virginia C. Fleming, director of the D.C. Mental Health System Reorganization Office, said she had not yet seen the report but that her office's proposed reorganization plan is designed to correct current problems.
Members of the monitoring committee and other mental health experts made on-site visits in 1985 to three D.C. mental health units: the Crisis Resolution Branch on the grounds of D.C. General Hospital, created to deal with emergency situations, and the city's two community outreach branches responsible for helping patients who cannot or will not seek help themselves.
The crisis center has no clear policy on when staff members should go to a person's home in response to a crisis call, and most home visits are scheduled at least two hours after the original call and sometimes as long as three days later, the Dixon group said.
"Often the client had left the site of the crisis before CRB staff arrived or the nature of the crisis had changed and emegency commitment had become necessary," the report said.
In one case, the mother of a 22-year-old patient with a history of drug abuse and hospitalization called to say that over the past month her son had been breaking windows, striking his siblings and ripping the telephone off the wall. Staff members did not make the visit they had scheduled for the next morning because the phone was disconnected, but on a visit three days after the original call they found the patient threatening his mother with a knife. He was committed to St. Elizabeths.
"The decision to make a home visit is too often guided by the availability of staff and transportation, instead of by clients' needs," it concluded.
The committee cited the case of a 32-year-old St. Elizabeths outpatient referred to the crisis center by the House of Ruth homeless shelter when she became violent. The crisis center tranquilized and released her. When the shelter sent her back to the crisis center, the physician there refused further assessment or treatment and told police that, if the House of Ruth would not accept her, they should take her to another homeless shelter.
"The case cited above is typical of CRB's pattern of service delivery: Clients are seen, then released with an appointment slip and no further support," the report said. It pointed to repeated failures to follow up on patients who did not show up for appointments.
The group found many patients without individualized treatment plans required under the 1980 court decree, a number of staff vacancies, poor record-keeping and improper budgeting. The mobile telephones in the cars used by the community outreach branches were not operating last year because the telephone bill had not been paid.
The city's mental health system is being reorganized in connection with its takeover in 1987 of St. Elizabeths mental hospital, now federally owned and operated. The Dixon Committee said its findings on the city's mental health system "augur badly" for the chronically mentally ill who will need crisis and outreach help under the new system.