The D.C. government plans to hospitalize more mentally ill homeless people who demonstrate an "inability to care for themselves," following a court ruling that broadens the city's authority under an existing commitment policy.
Robert A. Washington, D.C. commissioner on mental health services, said the ruling will spare the police and health professionals the threat of lawsuits when they hospitalize people who may be endangering themselves because of a lack of proper food, clothing or shelter. The old standard required that such persons pose a physical threat to themselves or others.
"This gives us the authority to do something that is in the best interest of clients and clearly something that the public wants," said Washington. "But I don't think it will make enough difference to reduce the clamor about the mentally ill homeless."
Robert Keisling, chief of the District's Emergency Psychiatric Response Division, said the ruling will lead to consistent enforcement of the commitment law, which until now was interpreted conservatively by police and liberally by some health care professionals when removing mentally ill homeless people from the street and conducting psychiatric evaluations.
The city's liberal application of the standard was tested in October, when the D.C. Court of Appeals ruled that a homeless woman's behavior -- blocking the path of other shelter residents, throwing food at people and standing on a curb shouting at passing cars -- placed her in danger because she was likely to cause others to retaliate.
In a memo to Washington, District Deputy Corporation Counsel Ann O'Regan Keary wrote that the ruling is "legally and politically significant" because it is now clear that "inability to care for oneself can qualify as meeting the likelihood of injury standard necessary for commitment under the District's present civil commitment statute."
Norman Rosenberg, director of the Mental Health Law Project, said he views the court ruling as a "slightly more expansive interpretation" of the existing law. While he said he does not consider it sound policy because it does not address the conditions that forced the people into the streets, he does not plan to challenge it legally.
"I do not take the view that someone ought to be allowed to die on the streets," said Rosenberg. "I am not and this organization is not going to go after the city for getting these people out of harm's way."
City officials said they could not estimate the number of people who may be picked up as a result of the court ruling, but they said there are no plans to do a roundup of the mentally ill homeless living on the streets.
While the District's authority to hospitalize the homeless is now similar to New York Mayor Ed Koch's controversial new policy of hospitalizing the mentally ill homeless who are incapable of caring for themselves, some advocates for the homeless predict that, unlike New York, the District will not aggressively enforce its policy.
Terry Lynch, executive director of the Downtown Cluster of Congregations, predicted that the city will shy away from putting large groups of people in St. Elizabeths Hospital because it is under a court mandate to reduce the hospital's population. He said some shelters encounter problems with disruptive mentally ill patients but have trouble getting the city to remove them for psychiatric evaluation.
During a panel discussion at a mental health conference Tuesday, Lynch gave this account of what he called a too-frequent occurrence at local shelters:
Last Friday, a mentally ill homeless man at a shelter began behaving irrationally and the psychiatric response division was called. A worker, saying the division was short on staff, recommended calling the police. The police said that because the man was not attacking anyone, shelter officials should call St. Elizabeths. St. Elizabeths said: "Call the psychiatric response division. It's their job."
Washington and Keisling said that a shortage of housing for the mentally ill homeless released from the hospital or treated as outpatients forces many of them into city shelters or back on the streets. Keisling said his workers have begun to drop the homeless off on a corner near shelters because some shelters will not accept homeless people directly from the psychiatric division.
Washington, however, said the city will have no choice but to become more aggressive in hospitalizing people who cannot take care of themselves.