FIVE MONTHS AGO, control over St. Elizabeths Hospital formally shifted from federal to D.C. government control. The city's newly formed mental health commission faced a difficult transition from hospital to community based care. Some 600 staff positions were unfilled, leaving the system with too few physicians and nurses. The shortage could have been eased by now, but no action has been taken. Perhaps the city's elected officials are waiting until the new system flunks its accreditation test.
The Joint Commission on Accreditation of Hospitals will pass judgment on St. Elizabeths and the city's outpatient care system within the next few months. The Chicago-based commission is the principal accrediting body for the nation's hospitals. A shortage of trained staff could be a major problem. The city's mental health system has 741 staff vacancies -- roughly 20 percent of the system's authorized work force. About 70 registered nurse positions are vacant, and 150 other registered nurse positions have been filled -- on an emergency basis -- by nurse assistants. The shortage of physicians is only slightly less serious.
Other jurisdictions face similar problems because of a national shortage of nurses, but factors peculiar to the District have created barriers to hiring. Those barriers must be removed. The D.C. government's hiring process must be streamlined: it apparently takes 25 personnel steps and about three months. Repeatedly, job offers finally have been made to people who have already accepted jobs elsewhere. Also, District mental health administrators have requested a waiver of the city's residency requirement, which needs changing. Until that happens, a waiver should be granted. Too many potential employees can't find affordable housing in Washington. Mental health care officials say they would also liketo develop and offer some incentives to lure promising job prospects. Action is needed there too.
Accreditation isn't the most important goal, although it would be a welcome boost to the D.C. government. Developing a mental health care system that successfully leads mental patients into independent living is more important. Rescuing the mentally ill from homeless shelters and the streets is also crucial. That won't happen if the system can't hire the skilled staff it needs.