The District's mental health system is in worse shape now -- two years into a court-ordered receivership -- than it was under the city's control. It urgently needs an independent financial audit and monthly oversight to resolve deficiencies and abuses cited during an Oct. 28 hearing before U.S. District Judge Aubrey E. Robinson.
The receiver's report presented at that hearing indicated an increase in service capacity. However, mental health advocates cited numerous cases in which the report overstated or misstated capacity growth.
For example, despite the receiver's claims, the number of crisis beds in the city has been reduced by 25 percent during his tenure, psychosocial program slots have decreased from 710 to 630, and 464 supported-housing units have been eliminated.
The judge heard testimony about numerous cases of neglect, abuse and unresponsiveness involving the Commission on Mental Health's case managers, psychiatrists, operators of community residence facilities and workers in the receiver's office itself.
An attorney from University Legal Services, an advocacy agency for mental health consumers, cited five cases of fraud, neglect or abuse by operators of community residence facilities; another Legal Services attorney described incidents of neglect in the community mental health centers. The attorneys said the commission had not responded to correspondence they sent on behalf of aggrieved consumers.
The District's mental health system shows other signs of failure too. Shelter providers reported a dramatic increase in the numbers of chronically mentally ill people they see, but they lack the resources to help the estimated 2,500 people in the District who are homeless and mentally ill. Many of these people end up in jail for behavior related to their mental illnesses. According to testimony from the director of mental health services at the D.C. jail, between 334 and 585 inmates there suffer from chronic mental illness; a third of them were homeless before being incarcerated.
The receiver also has been remiss in providing access to new anti-psychotic medications, which have fewer side effects; nearly 80 percent of the District's mentally ill citizens do not have access to these more effective medications.
Finally, concerns about the use of funds for mental health services prompted University Legal Services to request the commission's last and current fiscal years' accounting and budget records through the Freedom of Information Act. An experienced accountant called the information thus obtained "indecipherable."
Mayor Anthony Williams's plan to appoint a cabinet-level administrator for the four D.C. agencies in receivership is not enough. Nor is it sufficient to penetrate a system that for years has been unresponsive to reports of neglect, fraud and abuse as well as to requests for financial disclosure.
Only a third-party monitoring committee combined with an independent financial audit can begin to restore credibility and accountability to the District's troubled public mental health system.
-- Jesse J. Price
is president of the D.C. Mental Health Consumers League.