A mentally ill man was harassing students at two Northwest Washington schools this week, but an understaffed D.C. emergency psychiatric team could not go get him. A mentally ill woman recently was pronounced dead at St. Elizabeths Hospital but later was found to still be alive. A mother was told that her schizophrenic son at St. Elizabeths was using up too much taxpayers' money and should go home.
These and other allegations of poor or improper care by the District's mental health system were leveled by advocates yesterday during a hearing before U.S. District Judge Aubrey E. Robinson Jr. In a courtroom packed with homeless and mentally ill people, the advocates speaking on their behalf vented frustration and anger about the lack of services provided by the Commission on Mental Health and expressed concern for some of the city's most vulnerable residents.
"There is nothing more shameful than a system that dismisses your concerns and disrespects you," said Maureen Veech of the National Alliance for the Mentally Ill. "Our question is, who is this system for?"
The advocates told Robinson that the commission--operating under a receiver because of past shortcomings--is in worse shape than when the receiver began work two years ago. Robinson, who appeared frustrated at the end of the all-day hearing, wondered aloud whether control of the mental health commission should return to the city.
Speaker after speaker described problems with securing contracts for mental health services and with finding housing for homeless and mentally ill people and getting them appropriate medication. Nearly 80 percent of the city's estimated 9,000 mentally ill residents don't have access to newer, more effective psychiatric medications that do not have the side effects of older medicines, they said.
"Those of us who work in the trenches know that if we don't have available to us the new medicines, we will never make a dent in homelessness here," said Mary Ann Luby, of the Washington Legal Clinic for the Homeless. Luby estimates that 2,500 to 3,500 people in the District are homeless and mentally ill.
Luby and other advocates asked the judge to establish an oversight committee and to approve a plan for improvements in the mental health system over the next three months. They also sought details on how the $208 million budget of the Commission on Mental Health is being used.
"We still don't know where the District's mental health money is going," said Ira Burnim, of the Bazelon Center for Mental Health Law. "That is profoundly disturbing."
Yesterday's court hearing put a spotlight on the tenure of psychiatrist Scott H. Nelson, the $224,640-a-year receiver Robinson appointed to try to bring order to the mental health system.
Outside the hearing, Nelson rejected many of the advocates' allegations and defended his stewardship of the mental health commission--which is charged with serving mentally ill clients at St. Elizabeths and several outpatient clinics. He said he has increased the availability of medications, boosted the agency's budget by $35 million, hired "superb staff" and done a better job of following up on patients' cases.
"It's not perfect, but we're making progress," said Nelson, who took notes during the hearing and was supported by a lawyer from the D.C. corporation counsel's office, an indication that Mayor Anthony A. Williams (D) backs Nelson's efforts.
"We all want the same thing," Nelson said. "But a lot of people here don't have a sense of how complicated solving some of these problems is. . . . I'm totally committed, but it's going to take time to solve these problems."
But the commission is running out of time, some advocates said. Lynn Shea, executive director of the Community Council for the Homeless at Friendship Place, which provides services and housing to homeless people in Northwest Washington, said one of her groups has severed ties with the commission's mobile treatment team and won't house any more of its clients.
Shea said the action was taken after her organization offered to house and provide services to a mentally ill man at no cost to the commission. The panel rejected the offer, Shea said, and the client was discharged from St. Elizabeths to a hotel for three nights and then became homeless again.
Several advocates said they are disappointed that Williams has not taken a more active role in helping to find solutions for the troubled mental health system.
"Where was the mayor or a representative of his office today?" asked Claudia Schlosberg, a former monitor of the mental health system. "As a District taxpayer, I'm outraged by the waste. As a mental health advocate, I'm appalled by the indifference."
Peggy Armstrong, a spokesman for Williams, said "it's not a matter of picking sides--the receiver versus the advocates and the providers. . . . The mayor is working with all the involved parties to assure that quality services are delivered."