Summary: Current levels of planning, coordination and interaction among the National Institute of Mental Health (NIMH), St. Elizabeth's Hospital, and the District of Columbia Government have failed to produce an integrated mental health care system for the District. Too many patients who could have been treated at an alternate facility are being treated at St. Elizabeth's. As long as patients remain on the rolls of St. Elizabeth's, the District community mental health centers do not take an active roll in providing treatment. St. Elizabeth's has informally served as the "catch all" institution for the District when alternate facilities are not available, and many patients' mental status would likely improve if they were placed in an alternate facility or deteriorate if they were not placed. Of 1,284 patients identified as not needing the level of care provided at the hospital, 848 were still in St. Elizabeth's as of January 31, 1977. Its accreditation was removed in 1975. The hospital is currently planning construction improvements, but there has been minimal participation by District officials in determining construction needs. There is a lack of communication across clinical division lines, discharge planning seems weak, and patient followup work is lacking. The hospital does not have a management system that adequately integrates the complex management areas of budget, planning, evaluation and personnel. The organizations involved in mental health care delivery in the District should jointly develop a coordinated plan for the provision of mental health services.
