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As Trusted Mental Health Clinics Prepare to Close, Some Clients Cry Out

A group of the city's mental health clients cried out to D.C. Council members from the steps of City Hall yesterday, asking them to reconsider a plan to close six public clinics, lay off dozens of health care workers they trust, and send clients to get treatment at private clinics from doctors they distrust.

The D.C. Department of Health began taking steps to close its Community Service Agency (CSA) clinics by March 2010 and enter into contracts with about 30 private clinics, saving an estimated $14 million a year. About 4,000 clients are affected.

Organizers said the demonstration was a chance to give visibility and voice to clients who oppose the change. About 75 people participated, organizers said. The estimate could not be confirmed.

"I trust all of my providers" at CSA, said Sylvia Adegoke, 55. After suffering what she called "a terrible breakdown" years ago, Adegoke said a CSA psychiatrist brought her out of the dark when she was afraid to leave her bedroom.

Adegoke's faith in public clinics is so strong that she refuses to attend meet-and-greet events held by the health department to introduce clients to staff members at private clinics.

Mental health officials say the concern is unfounded. Private clinics in the District, such as the Green Door, have been around for more than 40 years, far longer than CSA and the Department of Mental Health, which were created under court order in 2001, they say. Moreover, 64 percent of the city's mental health clients already seek treatment at private clinics under contract with the mental health department.

States and cities have turned to private mental health care with mixed results. In North Carolina, the process was disastrous. Clients who were once treated at state facilities wound up causing a ruckus in emergency rooms. Sheriffs complained of being overwhelmed by calls to arrest unruly mental health clients.

But in south Florida, a private company greatly improved on the public system with careful therapy and a state of the art facility, so much so that nonprofit mental health interest groups that criticized the move to privatize now praise it.

Fair or not, negative views of private care echo among public clients in the District, presenting a sticky problem for the health department and perhaps D.C. citizens in general, said Vanessa Dixon, a representative of a coalition of union groups that organized the march. Dixon and others said upset, insecure and distrusting clients have skipped psychiatric appointments and gone without their medicine.

Alfred Wilson Jr. and Leavon Reeves, both of whom attended yesterday's demonstration, have. "I refuse to go."

Wilson, 47, said many clients view private clinics the way he does. Nine years ago he climbed out a window during a business trip in Paris and threatened to jump. At private clinics, doctors insisted on treating him with medication for six years. Finally he turned to CSA clinics, where he said his bipolar disorder was diagnosed and he was treated with psychoterapy.

"The thing about private hospitals and privatization is this: it's just a job, it's just money," Wilson said. "That's the starting point. They are there one day, gone the next."

Like Wilson, Reeves, 51, goes to the 35 K Street facility for treatment of post traumatic stress disorder that originated when he was a jail guard.

"Too many private agencies I went to made me feel like they didn't hear what I was saying," Reeves said. He was scheduled to meet with representatives from private clinics on Thursday. "But they already know I don't want to deal with a private facility. There's no trust. They're just trying to line their pockets."

Darryl Fears

By Darryl Fears  |  April 8, 2009; 7:00 AM ET
Categories:  City Life  
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The article by Daryl Fears might leave the reader with the mistaken impression that public mental health clinics in DC are of recent vintage. This is not the case. Clinics at St. Elizabeths Hospital and the District Government predate the Green Door and all other contract providers by decades. I came to work at St. Elizabeths in 1971 and retired for the DC Department of Mental Health last May. One psychiatrist that I worked with has continued to provide services at DC Government outpatient clinics since the middle 1960's. She was employed first at the Area B Community Mental Health Center at DC General and moved to its new location at 35 K Street NE in 2001.

I agree with those who demonstrated this week. The closure of the DC Government mental health clinics will be a significant step backwards for those who need psychiatric outpatient services in DC.

Posted by: sfitzgerus | April 9, 2009 6:07 PM | Report abuse

Privatization of DC's mental health clinics is both costly, chaotic and harmful to the consumers and patients that rely on city services.

Entering the 35 K St clinic at the consumer fair in early march, what seemed to be a hundred people crammed into hallways and a small room where five private providers passed out brochures advertising their mental health services. People were worried and confused; it was crowded and chaotic-- there was barely room to breathe and people were pushing each other to get through the door and to get a chance to sign up to recieve care. One company, community connections, ran out of brochures.

People were being forced to sign away their rights and "voluntarily" move to a private provider. Health clinic staff kept asking, did you choose a place yet? One woman asked me how many tables were inside the room as she waited in the hall. I said 5 or 6. Out of a possible 26 groups that one can choose from supposedly only 6 showed up to the consumer "choice" fair. Another woman said she was just collecting info and wasn't going to sign anything before she thought it through, despite the enormous pressure to sign away her rights to public services. On June 1st, in a move of dubious legality, the Department of Mental Health plans on assigning all patients a private provider, no matter if they are on the other side of town or don't provide the services the patient needs.

That isn't right, and this isn't a smooth transition to the private sector. The city hired a consulting firm to say it was ok to privatize, that the private sector could handle all the new patients, and that the city would save money. However, in a paper by the private provders themselves, the District of Columbia Behavioral Health Association, they say that the private sector will need significant support to quickly build capacity to care for thousands of new patients. They don't have capacity currently, and they've asked for increased reimbursement rates, big subsidies, and even giving away public clinics to the private agencies. Not only are the long term cost savings that the consulting firm KPMG alleges not been looked at by an independent audit, but privatization will cost millions of dollars more than maintaining the public system, just when DC has a major budget crisis. Meanwhile, the most vulnerable fall through the cracks in an ill conceived and rushed transition to privatization.

Posted by: dlb6 | April 10, 2009 7:42 PM | Report abuse

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