EVERYBODY TALKS about the problems of St. Elizabeths Hospital: patient neglect, management inadequacies, bureaucratic confusion. And some people talk about them exceedingly well. Recently, these problems were brought into sharp relief in an exceptional series of reports by Jim Clarke on WMAL-TV. Mr. Clarke led his viewers through the maze of the 100-year-old institution known as "St. E's." He showed us a mental hospital unable to get accreditation for the past two years. He allowed us to listen to the concerns and complaints of the hospital's employees. Above all, he made it abundantly clear why, for all the talking about St. Elizabeths, nothing much is ever done about it.
The reason is that a lot of people have a hand in the hospital's affairs, but no one person or entity is ready to assume ultimate responsibility. The National Institute of Mental Health; the Department of Health, Education and Welfare; the appropriate subcommittees in both the House and Senate; the District committees; the Office of Management and Budget; the White House and the District government are all, somehow, involved. All agree that there is a "problem." What they don't agree on is whose problem it is. Not surprisingly, this disinclination to accept responsibility has made it difficult to solve St. Elizabeths' problems. And the result of that is that the institution has become a federal embarrassment.
St. Elizabeths is the only mental-health institution owned by the federal government - yet it cannot meet the federal health-care standards required of other institutions. It has an exceptionally high operating budget: $90 million for approximately 5,000 patients. And despite a court order to reduce the number of patients in residence, the hospital continues to house a high proportion of patients who should be placed in the community.
It is hard to remember that 25 years ago St. Elizabeths was a well-respected mental hospital. Its many buildings still dot more than 320 acres of one of the most scenic parts of Washington. But since that time, the number of patients living at the hospital has dropped from 6,000 to fewer than 3,000; the number of out-patients has increased. Administrative staff costs now absorb three-quarters of the budget. Many of the buildings - some very old - have become fire and safety hazards. Because of the lack of nursing homes, the city has sent elderly people to St. Elizabeths even when they had no psychological problems. Several times the Nixon and Ford administrations attempted to give the institution - problems and all - to the District. Each time the city wisely rejected the offer, suggesting that it was the federal government's responsibility to restore and reorganize the facility.
Although the National Institute of Mental Health supervises St. Elizabeths, the Department of Health, Education and Welfare, to which NIMH reports, has the legal responsibility for sound management of the hospital. So, in all logic, it does not seem to us unreasonable to ask Secretary Califano and his health officials at HEW to focus their attention on making the institution a model mental-health facility. The problems that must be sorted out are complicated, but not insurmountable. Undoubtedly money to improve the buildings and grounds will be required. But whatever the precise steps that need to be taken, it is clear the Department of Health, Education and Welfare must assume its legal responsibility for St. Elizabeths. In its present state, the hospital is not just an embarrassment to the federal government. It is a disgrace.