More mentally ill and homeless people roam the District's streets than ever before, many D.C. group homes for the mentally ill are in terrible shape, and access to treatment is difficult, say advocates who will ask a federal judge today to force changes in the city's troubled mental health system.
The advocates plan to tell U.S. District Judge Aubrey E. Robinson Jr. that the city's Commission on Mental Health--already operating under a court-appointed receiver because of past shortcomings--continues to fall well short of providing adequate service. In fact, the advocates say, services for the mentally ill and the homeless actually have declined since the receiver was appointed two years ago.
"Record numbers of people with a serious mental illness roam the streets of Washington," said Mary Ann Luby, of the Washington Legal Clinic for the Homeless.
"Deplorable conditions exist in group homes which house individuals with a serious mental illness," said Kelly Bagby, of University Legal Services, which advocates for disabled residents. Bagby said sewage is backing up in one home's basement and bathrooms.
Today's court hearing on the status of mental health care in the District will focus largely on the efforts of psychiatrist Scott H. Nelson, the $224,640-a-year receiver Robinson appointed to bring order to the city's dysfunctional mental health system.
Nelson said in an August report that his agency--which has an annual budget of $208 million and is charged with serving more than 9,000 mentally ill clients at St. Elizabeths Hospital and several outpatient clinics--has made "continued and substantial progress" in providing community-based mental health services.
But Luby, Bagby and other advocates who work closely with the mentally ill and the homeless aren't buying it. And in a report to be submitted to Robinson today, they make their dissatisfaction clear.
"The mental health community is outraged at the lack of progress by the receivership," Luby said. "We want the receiver to do his job. We have the most expensive mental health system in the country per capita, and we have the worst services. Where is the money going?"
Nelson, in an interview yesterday, did not discuss the court report except to say that he and the advocates "have different views on how much progress has been made."
"I have no question about their commitment and concern for the mentally ill," Nelson said. "These are good people with skills and commitment, and I want to work with them. I hope as a result of [today's court hearing] we will have an even better working relationship."
Luby and the other mental health advocates are planning to ask the judge to establish an oversight committee and approve a plan for improvements over the next three months, she said. They also are asking for a grievance procedure for mentally ill or homeless residents.
"There is no mechanism for people in St. Elizabeths or in group homes to have a voice in their own care and treatment," Bagby said. "They have no say in their own lives. We need a grievance system to make sure their complaints are heard and resolved in a timely fashion."
Luby said, for example, that the commission's emergency psychiatric program doesn't have enough cars and is understaffed. Last month, Luby said, a woman came in with too much of the psychiatric drug lithium in her system but wasn't taken to an emergency room quickly enough and later died at D.C. General Hospital.
In another case, Luby said, an 82-year-old woman was kept in the commission's emergency psychiatric unit for 36 hours before being taken to St. Elizabeths, where she was committed. Patients are supposed to be transported within a couple of hours.
Another place suffering from a lack of mental health services is the D.C. jail, said Andrea Weisman, the jail's director of mental health services. She said the jail admitted 636 mentally ill people from D.C. streets last year. Sixty percent of them were charged with misdemeanor offenses, and a third of them were homeless.
"They are here but for the services that failed to be provided in the mental health system in the first place," Weisman said. "And here, we have a hell of a time getting these people linked to services. Coming into the [corrections] system also puts them at risk of being preyed upon by other more organized, more predatory detainees. Jails and prisons are simply not therapeutic environments."
Among other complaints in the report:
* The commission's community mental health centers--the main source of mental health treatment in outpatient settings--provide inconsistent and ineffective services because of long intake procedures and a lack of work and accountability by many staff members.
* The services the commission provides through contracts with private providers--such as beds in crisis situations and mental health services to the deaf--have decreased since the receiver took over.