The year a group of psychiatric patients launched a class action lawsuit against the District, calling for a mental health system that offered more options than a troubled hospital, Annie Alatishe was in her 20s.

She had not yet given birth to her son, Tamir. She had not yet heard doctors tell her that a fall down the stairs had injured the 1-year-old’s brain. She had no idea that almost 40 years later — as the case approached a final settlement — she would have to consider whether she trusts the city’s mental health system to properly take care of her son, now 23, for the rest of his life.

“If something were to happen to me, no one else would take care of Tamir,” Alatishe, 61, said. Without proper attention from the city, she said, “he would sit there and rot.”

On Thursday, U.S District Judge Thomas F. Hogan is expected to approve a settlement in a case that has outlasted the terms of five D.C. mayors and is now known as Dixon v. Gray. The landmark day comes after about 27,000 notices were sent out in recent months, inviting D.C. residents such as Alatishe, who depend on the system, to express their objections. She was one of just 47 people who responded.

“I felt obligated because I have been dealing with mental health for so long,” she said. Her son, who lives in a group home, has been diagnosed with autism and psychosis. “I’ve had people say, ‘He looks fine. There’s nothing wrong with him.’ And I’d say, ‘If they only knew.’ ”

The widely anticipated settlement marks a major milestone for the city, ending court oversight of a mental health system that has made vast improvements, but that all sides agree has room for more.

“It communicates a message that the District is more than capable of operating its own agencies,” Stephen Baron, director of the city’s mental health department, said of the settlement. At the same time, he added, “We recognize there is still work to be done.”

When the suit was launched in 1974, lead plaintiff William Dixon and other patients at St. Elizabeths Hospital sought less restrictive treatment options than the problem-ridden psychiatric institution. That year, more than 3,600 patients were housed there.

“Essentially, it was a fifth-rate prison,” said Peter Nickles, who was one of the original Covington & Burling lawyers on the case and later served as attorney general for Mayor Adrian M. Fenty (D). “You had all these people who were effectively jailed.”

At that time, the federal government ran the hospital. In 1987, it transferred responsibility for the hospital to the District. Today, fewer than 300 patients can be found at the new St. Elizabeths Hospital, which opened in April 2010. More than 20,000 D.C. residents with mental health needs receive community-based care.

Dixon, who has since died, told The Washington Post in 1982 that the public’s perception of him changed when he went from living at St. Elizabeths to a convalescent home: “When you live in a hospital, they say you were crazy. In a convalescent home, they say he lives there.”

Mental health advocacy groups praise the District’s progress in moving people to community-based care, but they warn that the needs of the city’s most vulnerable remain great. In 2009, the National Alliance on Mental Health gave grades to mental health systems throughout the country, and the District earned a C. Overall, the nation received a D.

Shannon Hall, executive director of the D.C. Behavioral Health Association, which represents the city’s mental health providers, said that in the past 18 months, eight providers have closed mental health programs, laid off a majority of their staff or gone out of business.

“Despite the Department of Mental Health’s success, I don’t think the big picture looks good,” she said. “If nothing is done to help our providers, mental health care in the District will be left hollowed and inadequate.”

And the city still struggles to meet the mental health needs of children, said Judith Sandalow, the executive director of the Children’s Law Center.

“There’s no question that D.C. is failing its children on the mental health side,” Sandalow said. “We have well-educated, well-trained lawyers who have difficulty getting mental health services for our clients. And it’s not just that they can’t access services; there aren’t services.”

Dennis Jones, the court monitor who has overseen the case since 2002, said he saw the city go from having a poor-to-nonexistent mental health system to one that is “good and at times, very good.”

“I think the challenge for the District is to go from good to great,” he added, “and I think it has the capability of doing that.”

Among the improvements that the District has agreed to meet by 2013: adding 300 supported housing units for people with serious mental illness and reducing the amount of time young people spend in psychiatric residential treatment facilities.

D.C. Council member David A. Catania (I-At Large), chairman of the Health Committee, which oversees the Department of Mental Health, said the District spends more money per capita on mental health services than any other jurisdiction in the country.

“Where we started in 1974 versus where we are in 2012 is night and day,” Catania said. “At the end of the day, the Dixon case will have laid the foundation to help the District be a national leader in mental health services.”

Annie Alatishe, a former crossing guard, said she had never heard of the Dixon case until she received the notice in the mail. She said the intent of her letter was not to stop the settlement but to inform the court about the way the system has treated her son.

During psychotic episodes, her son has been known to lock himself in his room and turn the television up loud to drown out voices in his head. At least one time he hurt himself. “It got to the point I couldn’t handle him on my own,” Alatishe said.

He has spent years going in and out of community-based treatment facilities and hospitals, including St. Elizabeths, and Alatishe said she has seen a system that has responded to her son’s overarching needs but that has failed him on basic levels. One place had bedbugs, she said. Officials at another place didn’t understand that her son needed help showering. In her letter, she said the settlement should provide more housing options. Her ultimate goal is for her son to live on his own, with the help of an aide who would check on him daily.

“I feel like if they work with him like they’re supposed to, he will get to that level of independence,” Alatishe said. “But they have to work with him closely.”

Research director Madonna Lebling contributed to this report.

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