The Dec. 21 letter from the District's mental health receiver, "Mental Health Care: Getting Better in D.C.," needs some reality testing. Scott H. Nelson writes that 1,600 patients are receiving the newer antipsychotic medication. This is 21.3 percent of the patients on the rolls. Why is it that states such as Texas and Georgia--which spend less than half what the District spends per capita on mental health services--can afford to place more than 60 percent of their patients on the newer medications?

And what about the 1,044 outpatients who have not been seen in more than 90 days? This is a 20 percent increase from two years ago. Is this progress?

The new hospital that Dr. Nelson celebrates requires closing 300 beds at St. Elizabeths. If past is prologue, a number of the people who occupied those beds will wind up on the streets or in jail. The shelter providers are reporting more homeless mentally ill persons than two years ago.

This is what we get for a $24 million increase in expenditures since the receiver came?



The writer, director of emergency psychiatric services for the District from 1986 to 1998, is associated medical director of mental health at Unity Health Care Inc., which provides medical care to the homeless.