In 1974 — four years after a federal study concluded that more than half the patients in St. Elizabeths Hospital didn’t belong there — William Dixon and other hospital patients went to court to compel federal and District officials to provide more suitable care. A year later, a federal judge found in their favor, ruling that government couldn’t just confine the mentally ill but was obliged to provide treatment in the least restrictive environment possible. Decades of failure followed; promises were made but broken repeatedly. That the District is now able to deliver these critical services is cause for celebration, albeit tinged with regret for the lives irreparably harmed by the decades of government inaction.
U.S. District Court Thomas F. Hogan gave preliminary approval Monday to a settlement agreement in the long-standing Dixon case, a move that could end court supervision of the city’s mental health system. The settlement, subject to a final ruling by the judge after a period of public comment, reflects the city’s compliance with a number of court-ordered requirements, outlines additional improvements and eases other mandates. “This is a momentous and historic settlement,” said the judge, noting the “long and tortured history” of the case that began as Dixon v. Weinberger when Caspar Weinberger headed the federal agency then responsible for the hospital.
Federal litigants were dropped after control of the hospital shifted to the District. The administrations of Mayors Marion Barry, Sharon Pratt Kelly and again Mr. Barry proved unable or unwilling to create an effective community-based health care system. What was particularly appalling about the city’s behavior is that it never really contested the policy of deinstitutionalization; repeatedly it entered into consent decrees promising reforms, but it didn’t follow through. So frustrated was the court that, in 1997, it placed mental health services into receivership.
Mayor Vincent C. Gray has built on progress made under former mayors Anthony Williams and Adrian M. Fenty to achieve this important milestone. He reappointed Mental Health Director Stephen T. Baron, whose able leadership since 2006 has by all accounts been a major factor in the improvement of services. In 1974, there were more than 3,600 patients in a crumbling and decrepit St. Elizabeths. Today, there are fewer than 300 patients in a state-of-the-art hospital, and there is a flourishing system of community health care. Challenges still exist and the District will be required to make additional reports on its progress.
The significance of a District finally able to manage its mental health services cannot be overstated. Hopefully this achievement will serve as precedent for the other class-action lawsuits — involving child welfare, delinquent youth, services for the developmentally disabled and special education, among others — where the city likewise was deemed not competent.