SHORTLY AFTER he took over as secretary of health, education and welfare in 1977, Joseph Califano made a promise of special importance to this city: St. Elizabeths, the federally run, dilapidated and unaccredited mental hospital for the District, would be made respectable again. Today, only weeks after Mr. Califano's departure from office, the results of his commitment to this project are in -- St. Elizabeths has regained accreditation. Though there are still some construction and renovation improvements needed, the serious deficiencies in management and patient care that were found by inspectors four years ago have been addressed. That is an impressive accomplishment that leads to another question of long standing: What about the transfer of St. Elizabeths to the city government?
Not so fast. Certainly accreditation had to be one precondition for the transfer. Another has been the removal of patients who don't belong there. The number of patients is now about 1,800, which is down from 2,300 two years ago and 7,000 a decade ago. That's fine, too, but today some experts are worried about the extent and pace of these transfers. For one thing, community facilities to accommodate these released patients still need upgrading; only this April, 10 women were killed and 6 others injured by a fire that swept a group home for St. Elizabeths outpatients. Also, more thought should be given to improvements in living conditions of those patients who should remain under some restrictions, for certainly not every patient can or should be released. Though the construction and repairs so far have helped, the atmosphere on the grounds, the number of village-like activities or other facilities for patients could be improved.
But even with all these changes, St. Elizabeths shouldn't be foisted off on an unprepared local government.While improvements are continuing -- in other words, right now -- Mayor Barry and the District Council should step up their consideration of how best to absorb St. Elizabeths into a local mental health administration. For example, it may best be run by a local independent commission, as D.C. General Hospital now is. More important than where it sits on a chart, however, is how it serves the city's patients, who now get shifted back and forth from federal to local mental health care. Whatever these decisions, at least the improvements achieved under Mr. Califano make it possible for officials to step up preparations for an orderly transition of St. Elizabeths to the city it serves.