St. Elizabeths Hospital and District of Columbia Are Improving Their Mental Health Services

HRD-78-31: Published: Sep 27, 1978. Publicly Released: Sep 27, 1978.

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St. Elizabeths Hospital is operated by the Department of Health, Education, and Welfare (HEW), but efforts have been made to transfer its administration to the District of Columbia. Its accreditation was taken away in 1975. Currently, it is the subject of a lawsuit to provide alternative facilities for patients who do not need the level of care provided at the hospital. Mental health services in the District are also provided by three mental health centers operated by the District's Mental Health Administration and by several private facilities.

There has been a lack of effective joint planning, coordination, and agreement on how best to provide mental health services to District residents, which has resulted in overlaps and gaps in services. Inadequacies in services result from the failure of the District to provide adequate resources, reorganizations, and program cutbacks. Improvements at St. Elizabeths are needed in central admissions, treatment programs, outplacement services, work schedules, medical records management, industrial and recreational therapies, and medical and surgical services. A higher than necessary level of care was being provided at some facilities for many patients who could have been cared for in nursing or foster care homes if adequate facilities were available. The National Institute of Mental Health planned to request $75 to $100 million to regain accreditation for the hospital and to provide better housing for patients. Planned programs exceeded what was needed to regain accreditation, and plans have been subsequently revised. St. Elizabeths did not have an effective system for information gathering, planning, evaluating, budgeting, staffing, and training because of inadequate implementation of a decentralized management system and inefficient use of committees for making management decisions.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Mayor of the District should: direct the community mental health centers to evaluate patients' needs and establish programs based on needs, direct the Emergency Mental Health Services and Combined Adult Inpatient Services units to establish followup procedures for discharged patients, and provide resources to the community mental health centers' partial hospitalization programs. The Secretary of HEW should require the superintendent of St. Elizabeths to: provide guidelines for staff use, make appropriate staffing changes, organize and monitor patient treatment plans, plan and evaluate outpatient programs, simplify the medical records system, develop admission criteria, perform cost-benefit analyses of services, establish criteria for identifying patients ready for outplacement, and work with the District to resolve outplacement problems. The Secretary should also require actions to improve the management system and administrative services at St. Elizabeths.

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