DISTURBING CHANGES AT ST. E'S

"THE STRONG HOSPITAL . . . IS BEING DISMANTLED."

Last fall, as the District took over St. Elizabeths Hospital, there was hope that this world-renowned institution would combine with community mental health services to improve treatment for the usually forgotten, often homeless mentally ill of our city. With its links to the National Institute of Mental Health, many psychiatric techniques have been developed at St. Elizabeths, including psychodrama and dance therapy. By coordinating and integrating hospital and community health services, patients could be transferred from the hospital to a community mental health center without a break in treatment.

But in the past seven months, the mental health system has fallen far short of this promise. Patients are being discharged without structured programs, and there is no provision for continued consultation between the hospital and community care providers. Today, if a discharged patient has a relapse, he or she must go to the unfamiliar grounds of D.C. General Hospital because the St. Elizabeths admission room has been closed. For those assigned to private mental health providers, contract terms require that they not be sent back to St. Elizabeths -- no matter what their condition. Instead, they are being sent in large numbers to the Washington Hospital Center, which cannot handle the large increase in mental patient admissions. When mental patients get sick, they should be able to go back to the doctors who treated them and with whom they have an established relationship -- just like the rest of us when we get sick.

The strong hospital, essential to a sound mental health system, is being dismantled. Admission wards are overcrowded because of a failure to acknowledge the number of patients needing beds. Consequently, shelters have had to provide what treatment they can for mentally ill persons discharged after a few hours of examination. In effect, shelters are providing nursing care for psychotic patients. Recently, Mitch Snyder said he has noticed the impact at his shelter since the District took over St. Elizabeths Hospital.

We hope that Mayor Barry's decision to fill 400 staff vacancies at St. Elizabeths will reverse the curtailment of hospital services. However, we are opposed to cutbacks in youth services. We think it is absurd to claim that a cutback of more than one-third in the Youth Services budget would not require any program cuts.

There are disturbing signs of change at St. Elizabeths. The Mental Health Commission's proposal to the Joint Accreditation Committee to cut out long-term services and retain only a small acute-care hospital will severely undermine the medical preeminence of St. Elizabeths. Once gone, the unique psychiatric medical team will be hard to rebuild. Indeed, one of the strengths of St. Elizabeths Hospital has been the variety of treatment techniques available under one roof. Given the imprecise nature of mental illness, having a variety of approaches is very important.

The mayor is intent on selling off the West Campus of St. Elizabeths. He has offered The Point and its "unparalleled view" of the city to developers. This land belongs by right to the mentally ill. We could build a wonderful Capital City Community where the mentally ill could live and work with friends and caring people.

The lawyers of the Mental Health Law Project say this is "ghettoization." They say they will fight clusters of mentally ill living together. In fact, they are making arbitrary judgments about how men and women should live. Instead, we should be looking at the individual's needs and wants. In many instances, discharged mental patients can live more comfortably in a community of their peers, whose shared experiences give support and companionship.

Advocates such as Erna Steinbruck and Merion Kane are asking the question: "Where is the moral outrage in Washington?" How can we do nothing when we see young women lying in dangerous alleys, prey to beatings and rape? Why don't we do something for people sitting alone on park benches, obsessed with terrifying voices? Why do we walk a wide path to avoid these people instead of finding ways to help them?

Dr. John Dluhy, president-elect of the Washington Psychiatric Society, at a Friends of St. Elizabeths meeting this spring, called for religious and moral commitment to end the conditions under which the homeless, including the homeless mentally ill, are living in our city. We need here the same kind of moral outrage from churches and synagogues that they mobilized to try to end bloodshed in Central America.

Last week at the Martin Luther King Library, I asked people to join a campaign to save St. Elizabeths Hospital and to follow in the footsteps of Martin Luther King Jr. and say no to injustice. And say it as often as is necessary to get the job done. -- Hanna Schussheim is president of Friends of St. Elizabeths.

Articles appear as they were originally printed in The Washington Post and may not include subsequent corrections.