STATUS OF TREATMENT OF MENTAL ILLNESS IN THE DISTRICT OF COLUMBL4

The status of treatment of mental illness in the District of Columbia was the subject of the Brown Bag Dialogue convened by the LWV-DC and held in the national office of the League of Women Voters of the United States, on September 27, 1999. About 35 League members and guests considered current information about the delivery systems for services to those people in our community who need treatment, medication, homes, or employment to assist their recovery.

Guest panelists represented both government and non-government community organizations whose missions are to provide support, advocacy, and assistance to the diverse population who suffer mental illness. Children, old folks, many homeless, and many who are suffering other health problems in addition to mental illness are, or should be, among the "consumers" of mental health services.

The following guest panelists gave brief overviews of the status of services and treatment, each from the perspective of the organization represented: Johnny Allem, Director of Operations for the RECEIVERSHIP of the D.C. Commission on Mental Health Services; Norma Melendez, a board member of the National Alliance for the Mentally Ill (NAMI); Nancy Lee Head, Program Director of the D.C. chapter of NAMI (NAMI-DC); Mary Ann Luby of the Washington Legal Clinic; and Phyllis Morgan, President of the D.C. Family Advocacy and Support Association (FASA). Also participating in the dialogue were Mrs. Merion Kane, who founded the D.C. chapter of NAMI, and Ms. Elaine Bush, a member of the board of FASA.

Panelist 1: D.C. Commission on Mental Health Services [Receivership] Johnny Allem spoke about the progress and plans of the RECEIVERSHIP. A meeting to review its status has been scheduled by Judge Aubrey Robinson and Dr. Scott Nelson, the Receiver, for October 28, 1999. Mr. Allem mentioned the following projects and plans:

• a comprehensive mental health plan describing how care is provided;
• the plan to make a major shift in focus from the current traditional supervised housing to provide instead community housing and a recovery-based approach. Community integration for persons with serious mental illness would be achieved by focusing on regular housing, consumer choice, goals, and preferences, and highly individualized support and services.
• this new approach will make available 1,512 new units of housing in three years, and 15 of these units are already in place.
• two mobile teams (EMCOT), each staffed by 12 to 15 people, are operating around the city to support and assist potential consumers of mental health services;
• a "drop-in" home has been opened in Southeast D.C.; and
• the RECEIVERSHIP is in process of acquiring a property to relieve overcrowding in Bldg. 25.

[ED. NOTE: A report in the CMHS Mental Health Quarterly, August 1999, states: CMHS plans to more than double its community housing capacity in the next three years and embark on a major systems change initiative. Implementation of the supported housing approach will drastically change the way housing and services are provided. "This recovery-based approach endorses community integration for persons with serious mental illness by focusing on regular housing, consumer choice, goals, and preferences, and highly individualized and flexible support and services. This shift will require both philosophical and organizational changes.... The shift from a focus on traditional supervised residential continuum to a priority on supported housing is an extraordinary systems change initiative in the District of Columbia. "]

Mr. Allem said the RECEIVERSHIP is trying to address the problem of co-occurring ailments and provide integrated treatment, in order to protect consumers from receiving conflicting treatments; as for example, when addiction occurs along with other ailments. Strong support for dual diagnosis and integrated treatment was voiced.

Plans to build a new psychiatric hospital near St. Elizabeth's and the new Congress Heights Metro Station have been approved by the D.C. Council, the Mayor, and the Control Board, and $75 million for funding is included in the FY 2000 Capital Budget. The 320-bed facility would be the inpatient component of the future of CMHS. Present plans call for 225-250 beds devoted to forensic consumers, 50-75 for other adults, and 20 for children and adolescents.

Community acceptance for all plans is needed. The Employment Services Unit needs improvement, to make it more friendly and supportive to its consumers. Upon request, Mr. Allem will provide copies of the Mental Health Quarterly.

League moderator Patricia Hallman noted that prior commitments prevented Mr. Allem from remaining for a question period, but questions may be directed to his office, phone 202/364-3422.

Panelist 2: National Alliance for Mental Illness (NAMI)

Norma Melendez, a board member of NAMI-DC, commented that some think a new hospital is not a good idea; rather, mental patients should be in a full-service hospital where treatment for dual or multiple ailments can be coordinated. Funds and other resources should be directed toward comprehensive community-based services. She spoke of her own experience with mental illness, beginning at age four. She emphasized the need for education of the public and of families, to reduce stereotyped thinking about mental illness. She informed the meeting about progress in treatment which has resulted from the development of modern medicines, such as lithium. People with a mental illness have a physical disease. They are sick people, not bad people. Most can be treated successfully with medication.

Nancy Lee Head, Program Director of NAMI-DC, spoke candidly about her own long struggle with mental illness. As a young women, she was hospitalized at St. Elizabeth's just when she was about to graduate from the George Washington University; now, she is pleased to state that she is a graduate of both St. E's and G.W.U.

Ms. Head told us that DC does not have a recovery-based system. Many psychiatrists settle for no more than basic functioning, when they should aim for more. She quoted a psychiatrist (Dr. Alan Breyer of NIMH) speaking before the Medical Society several years ago: "Shame on us psychiatrists. We are the only part of the medical profession that settles for less than recovery for our patients. I cannot imagine a cardiologist or a surgeon saying they are just going to make the heart patient barely functional, or that they are just going to cut out half of the cancer. Yet we settle for our patients being barely functional and think we have done our job."

Some twenty years ago, treatment left families out. NAMI-DC, started in 1981, publishes a newsletter covering mental health issues and services in D.C. It offers free, walk-in support groups for families on Thursday evenings from 7-8:30 p.m., located at NAMI offices at 422 8th St., SE, near the Eastern Market Metro stop. The purpose of these meetings is to help families understand and assist a patient, and to understand what the system can or cannot do for them.

Ms. Head encourages families to maintain a healthy family system. For example, celebrations of birthdays, Christmas, graduations, etc. should not wait for the recovery of the family member who is ill.

In addition, NAMI offers a 12-week class to help families move on, from knowing the latest medications to dealing with their own grief and feelings. [One father burst into tears on hearing a tape of the (inner) voices which had so disturbed his son. He said, "Now I understand the pain he was experiencing."] Schizophrenia, said Ms. Head, usually hits us in the late teens, and some people recover in their 40s. When you wake up, everyone else has moved on, graduated, begun careers.

Mental illness takes a unique, individual course for each person, but too many treatment plans take a "cookie- cutter" approach. A treatment plan should be as specific and as individual as an eye-glass prescription. For more information about support meetings or classes, phone 202/546-0646.

Panelist 3: Washington Legal Clinic. Mary Ann Luby said: "to add to what Nancy said...on top of all that, you're homeless." Ms. Luby has been working with homeless people for seventeen years, and many of the homeless are struggling with mental disabilities. It is hard to connect the folks who are homeless with services, and the CMHS needs to develop ways to help them. What we need right now is not money; we need a community-based system of care, so people are not living on the street. (Recently, a friend counted 250 people sleeping on Pennsylvania Avenue.) Ms. Luby referred to a concept articulated by President Kennedy: "People in hospitals need a less restrictive environment." A good idea, but the results were not good. Many people were released from St. Elizabeth's, going from a structured environment where everything was provided to living on the street.

Regarding medication, Ms. Luby said the CMHS does not distribute the newer medicines, because it can't afford them. She said "we have a disgrace on our hands, and a large part of the blame lies with CMHS. " She said the RECEIVERSHIP is not going well. Someone needs to come in with a bulldozer (of ideas) to stimulate creativity. The RECEIVER can do dramatic things, but he has not. We need a community-based health care system.

Panelist 4: Family Advocacy and Support Association (FASA) Phyllis Morgan, President of FASA, says children are an afterthought at CMHS, and that FASA has been in conflict with Dr. Nelson since the RECEIVERSHIP began, because his attitude is that his job is to straighten out the adult programs. Ms. Morgan says "Disregard for children is criminal", and she reminds us that children will become adult.

FASA provides support and assistance to parents whose children have ADHD (Attention Deficit Hyperactive Disorder) or SED (serious emotional disturbance). FASA is currently serving some 60 children, including perhaps 30 new clients since September. It is estimated that about 700 children in the city need such services.

Ms. Morgan said services to children are hopelessly fragmented in the District of Columbia. When a child is edged out of youth services and sent back to parents, there is no transitional plan, so it is very difficult for parents to find out where to seek help. One social worker, when asked by a child and parent for guidance, said, "Oh, keep your nose clean and go back to school." The only public residential facility for children in the District of Columbia is the Hurt Home, which has a very limited capacity, so that many children in need of residential care must be sent elsewhere.

FASA made the following recommendations in a letter which was presented to Mayor Williams at a meeting of his Health Advisory Council, regarding proposals for managed care services for mental health:

"These separate proposals will set the District of Columbia back at least 25 to 30 years in the children's mental hearth field, if they propose to offer separate systems of care. Other cities are looking for ways to create a comprehensive community-based system of care that coordinates services across child- serving agencies, which include schools, social services, juvenile justice, health care, recreation, mental health, etc. as well as totally involving family members as partners in developing these systems of care. "

NOTES AND COMMENTS

Several needs were emphasized in the course of the dialogue on Mental Health Services, especially the need for public education about mental illness. The need for a community-based and coordinated system of care was a theme strongly endorsed by all panelists. The RECEIVERSHIP received criticism from the community-based panelists, but it endorses and appears to be working toward the goals they endorse — community integration and recovery-based services. However, more action showing commitment by CMHS to improving and coordinating services for children is needed.

Information about plans and projects of the RECEIVERSHIP, or copies of the CMHS Mental Health Quarterly are available by calling Mr. Johnny Allem at 202/364-2422.

The League of Women Voters of the District of Columbia extends much appreciation to Norma Melendez for her assistance in convening this panel.