Guest Host: Jim Asendio

For decades, D.C.’s Mental Health Department symbolized dysfunction in city government services. Now, the District is on the cusp of settling the long-running class action lawsuit that led to Federal Court oversight of the city’s mental health services. Kojo chats the Department’s Director about the city’s infrastructure for assisting residents with mental illness, and the multi-year progress that’s been made and is paving the way for the legal settlement.

Guests

  • Stephen Baron Director, D.C. Department of Mental Health

Transcript

  • 12:06:37

    MR. JIM ASENDIOFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your community with the world. I'm news director Jim Asendio sitting in today for Kojo. Coming up this hour, one could argue that, during the past four decades, no other agency has been as much as a symbol of dysfunction in local D.C. government than the D.C.'s Mental Health Department, which has spent 37 years under the cloud of a major lawsuit.

  • 12:07:08

    MR. JIM ASENDIOWell, that lawsuit resulted from a study that determined more than half of the 3,000 patients being treated at St. Elizabeths Hospital, the District-run facility for the mentally ill in Southeast, did not belong there. That lawsuit is close to being settled now that St. Elizabeths had been transformed into a much smaller institution, serving approximately 280 patients. At its height, St. Elizabeths served more than 3,600 patients.

  • 12:07:33

    MR. JIM ASENDIOWell, the city now treats approximately 98 percent of the District's patients in community-based health clinics. Joining us to explore the progress made within the city's mental health system and to discuss the work that's still to be done is Stephen Baron. He's director of the District of Columbia's Department of Mental Health. Welcome to "The Kojo Nnamdi Show."

  • 12:07:51

    MR. STEPHEN BARONThank you, Jim. It's a pleasure to be here.

  • 12:07:53

    ASENDIOWell, we share something in common. We've been in D.C. for about six years. I've had the good fortune of being the news director here. You had somewhat the rocky road of trying to turn around the mental health system.

  • 12:08:06

    BARONWell, I consider it a good fortune. It was a wonderful opportunity for me.

  • 12:08:10

    ASENDIONow, before we talk about the -- why the so-called Dixon case is only weeks away from settlement. Let's go back in history some time for this case. This case has been -- the lawsuit has been working its way through the court system since 1974. What was St. Elizabeths like back then, and what caused the lawsuit? Where were we, and where are we trying to go?

  • 12:08:32

    BARONLike I said, good fortune in '75 and '76, I was a social work student here in the District, and my field place in the first year was at St. Elizabeths. It was at the outpatient clinic. But where the hospital was back in the early to mid-'70s, was it was the primary source of treatment. There was not a robust community system as there was -- there is now. And also, that if someone got admitted to St. Elizabeths, they said -- they tended to stay for a very, very long time.

  • 12:09:08

    BARONSo the population at the time of the court settlement, as you said, was about 3,600. At its peak in the mid- to late '50s, it's about 7,000. It was on both sides of what is now Martin Luther King Blvd. -- Avenue. And so what happened was a group of -- a resident -- a patient -- actually, the hospital, you must add, this was a federal institution. It was operated by the federal government. A group of patients that advocates -- brought a lawsuit against the federal government, saying that people were being kept at St. Elizabeths only because there was not good community alternatives.

  • 12:09:52

    ASENDIONow, this was a case all across the country because a lot of jurisdictions, municipalities, states and all, whether they were federally operated, state operated or city government operated, they were basically warehousing mentally ill patients.

  • 12:10:06

    BARONYeah, there was a lack of community services. The real -- the institutionalization movement -- even though people tend to go back to the mid-'50s to say when the population was at its peak -- in the country -- there was about 550,000 people in state hospitals. Today, there's less than 50,000. Now, the locus of care people tend not to get their hospitalization at state hospitals, so -- but that was true, and St. Elizabeths was the District's state hospital.

  • 12:10:33

    ASENDIONow, let's talk about the study that the -- it came up with the finding that more than half the people who were being treated at St. Elizabeths should not have been there. How did that happen, and why were there?

  • 12:10:45

    BARONWell, it was really the basis for the lawsuit. And it was the advocates, and they were able to convince the court that the District was -- the federal government was in violation of the care of people. And people needed to be treated in a less restricted environment and needed to be in the community. I'm sure the -- back at that point, they did some samples of patients, and every people had a number of patients. There were nine named patients in the class-action suit who came forward and said we don't need to be here, William Dixon being one of them.

  • 12:11:20

    ASENDIONow, was it a situation that we knew what we should be doing, but we didn't have the money or the state-of-the-art in -- the study of the mentally ill wasn't there, what?

  • 12:11:31

    BARONYeah. The orientation of how you best provide service to functional to serious mental illness was just starting to move to the community. In fact, in the mid-'70s, National Institute of Mental health put out its first community support program. They really helped states develop a much stronger infrastructure to deliver community-base services.

  • 12:11:52

    ASENDIONow, where do you stand on that? You said you were a student, you know, in the '70s here at St. Elizabeths. And over the past 30, 40 years, has the thinking changed? Have we progressed?

  • 12:12:06

    BARONVery much so. Very much so. State hospitals is probably our most restricted form of treatment. There's been a tremendous increase in both the medications, the commitment and our ability to provide the wide range of services individuals need in the community. There are services that are offered now routinely in public mental health systems that were not available back then and came out because of the commitment to move people responsibly into the community.

  • 12:12:37

    BARONNow, I'm not naive and know this has not been without its bumps in the roads, and, very unfortunately, we're dealing with a large number of folks in the criminal justice system with mental illness. But that we do know what works. We have a body of literature. There's evidence-based practices. There's a whole number of initiatives to expand the range of services, and the District has done that.

  • 12:13:01

    ASENDIONow, let's go back to '74 when you were, you know, studying here. When you have so many different agencies or jurisdictions with dogs in the fight, going from status quo to where you want to go is difficult at best, this must have been a gargantuan task trying to turn this aircraft carrier.

  • 12:13:22

    BARONWell, yeah, it's tough. But what you really need -- and the District has done that, and the District did that beginning the 2000, 2001 when they established the Department of Mental Health as a single state agency. We were part of the commission -- the Department of Human Services, and it's very important that there's a single point of authority and responsibility to drive the system and move the system forward.

  • 12:13:47

    BARONAnd the District did that. In 2001, there was enabling legislation that that created the Department of Mental Health. And by 2003, we had moved out of court receivership that the District -- there was a court monitor who still is in place and will go away in mid-February, we hope. And -- but the system, they were able to identify 19 well-defined exit criteria that that would indicate that the system had made progress. And we -- and these 19 exit criteria are very consistent with the direction we wanted to take the public mental health system.

  • 12:14:25

    ASENDIONow, you somewhat described it as bumps in the road, but if you go back a little bit when the District took over and it really struggled to move to this community-based modem of -- mode of dealing with these patients so much so that the District was put in receivership, what happened there? Was it that you're having more difficulty, the department is having more difficultly to making the transition, or wasn't as fast as the, you know, the court overseer has wanted it to be?

  • 12:14:55

    BARONYou know, not being here is a disadvantage. Probably '97, '98, the District was put in receivership, and that meant that the court ran the department. And so the court hired a director who was accountable to the court to begin to shape the department. I think they really struggled. They went back and forth. And it wasn't until -- there was a transitional receiver, and then the beginning of the enabling legislation and the 19 exit criteria that the department was able to see the direction.

  • 12:15:33

    BARONThe exit -- the court -- the agreement that established the department addressed a number of things. One was the need to build a robust community-based system, have a robust psychiatric emergency response system, have a new and improved St. Elizabeths Hospital, to have inpatient care take place in community hospitals, not in the state hospital, all things we've been able to do.

  • 12:16:00

    ASENDIOWe're speaking with Stephen Baron. He's the director of D.C.'s Department of Mental Health. You can join us by calling 1-800-433-8850. You can email us at kojo@wamu.org, or you can get in touch us with us through our Facebook page or by sending us a tweet to @kojoshow. Now, Mr. Baron, you've been in the system a long time, and I know when you look at a lot of municipal departments, and particularly in D.C., it seems that we have a lot of turnover.

  • 12:16:32

    ASENDIOWe have a lot of transition, new administrations come in and out. Have you, over the six years that you've been able to be here, been able to have consistency moving toward that goal?

  • 12:16:43

    BARONYeah. I feel we've had a great deal of stability and growth in the department. We have a great staff. People are very focused. We have great partnerships with both the executive. We've had wonderful support from Mayor Gray and Mayor Fenty previously. The council has been wonderful. You know, council chair -- the health councilman, Catania, has been a big supporter of the department, understands the direction we want to go.

  • 12:17:10

    BARONWe've had the executive legislative support. We've had strong support from our own staff. And our provider network has grown and has responded extremely well. They've been very, very strong partners. As you move out of providing direct service yourself, which we've had done as District government, we only provide about 10 percent of the direct service. And a couple years ago, it was 40 percent.

  • 12:17:34

    BARONYour private providers are your public mental health systems. So we have to, one, support them and, two, hold them accountable, and it's been a very, very good partnership.

  • 12:17:43

    ASENDIOIn the time that you've been in the field, have you seen a shift in the public's attitude? Because I know when the deinstitutionalization process began, there was a lot of NIMB, not in my backyard.

  • 12:17:55

    BARONYeah.

  • 12:17:55

    ASENDIOWe don't want a -- we love the concept of community-based facilities. We like to see them all throughout our area, but, please, not on my block or not in my neighborhood.

  • 12:18:04

    BARONRight. These are ongoing struggles. I think fed laws have helped protect individuals with serious mental illness, the Federal Housing Act and so on. And I -- but the public is quite sympathetic. It's unusual that you don't meet somebody who doesn't have a family member, relative or somebody they know with a serious mental illness.

  • 12:18:28

    ASENDIONow, we have a call from Talib in Washington, D.C. Go ahead, Talib. You're on the air.

  • 12:18:34

    TALIBThank you. And I want to salute Director Baron. We worked together, and I know that he is really committed. And I'd like to ask the director or relate to him that I've experienced a number of mental health providers who are really so frustrated because of the amount of paperwork required to secure reimbursement for their services. Many of them are actually considering shutting their doors. And I know one who has shut their doors. And this mental health provider was specifically working with young people and particularly families.

  • 12:19:06

    TALIBAnd at a time where we're increasing -- or we're seeing increased demand for mental health services, what are you and what is the District doing to make sure that we have an abundant and a robust supply of clinical social workers and psychologists who are available to deal and help our families cope with the increasing challenges that our families face, which, as you say and point out, often lead to an increase in criminal activity and incarceration, particularly of our young people?

  • 12:19:41

    BARONThanks, Talib. Good hearing from you. You know, the administrative challenges that -- based on the numerous funding streams can be difficult. We've internally created a committee to look at administrative burden to see what we put in place originally that doesn't need to be put in place. What we can do, to simplify the processes from the time a provider applies to be a member of our DMH network to while they are a provider.

  • 12:20:12

    BARONSo it is something we're aware of and something we're trying to adjust, and we've solicited within the provider network ideas and suggestions. And we're always open to hearing them. And I think the latter part of the question of workforce development is critically important, and we have to figure out a way to really attract people into this field and help them stay in the field.

  • 12:20:38

    ASENDIOWhen you survey the list of providers, and then you overlay that with the economy, the national economy, and what we're expecting in the D.C. region to take the hits in terms of cutbacks in federal government, are you looking at a dire situation or a challenging situation?

  • 12:20:56

    BARONWell, all I can tell you is the number of people served in the District's public mental health system has increased over the last three years, probably from 15-, 16,000 to about 20,000. There's a variety of reasons. It's not all just increased demand. And I think access to our system is one of the challenges. We're always trying to streamline to make it easier for people to access the system. And if you allow me, I do have an 800 -- a 24-hour seven number that we'd like to give out to the audience, and people should always feel free to call.

  • 12:21:32

    BARONThese folks can help figure out if we're the right place for you or if you have insurance that requires another venue or whatever. But it's 1-888-793-4357. That's 1-888-793-4357. That's our access helpline, and we have someone -- it's covered 24/7.

  • 12:21:56

    ASENDIOAnd in case you couldn't write that down, we'll have that up on the kojoshow.org website also.

  • 12:22:01

    BARONThank you.

  • 12:22:03

    ASENDIOIf someone can't remember the number, if they call the 311 D.C. number, would they be able to be referred?

  • 12:22:07

    BARONYes, that's right. Yeah. Just ask the access helpline, Department of Mental Health.

  • 12:22:11

    ASENDIOLet's talk about Saint Elizabeths Hospital. It sort of played a starring role in this dispute. But the city just opened a new Saint Elizabeths under your watch last year. I know there's a difference. They are serving about 280 patients versus 3,600, or more than 500 more recently. How -- do you just look at the number of people you're serving and cut that or saying people can be served in another area?

  • 12:22:39

    BARONIt's basically people can be served in other areas. The primary place an individual experiences -- receives services if they need psychiatric inpatient care across the county is in general hospital psych units. Even involuntary and voluntary patient psychiatry, you can be admitted to an inpatient unit involuntarily.

  • 12:23:02

    BARONAnd with the -- and Saint Elizabeths Hospital, up until probably 2004 or 2005, was exclusively the acute care admission for involuntary patients as well as the long-term care. State hospitals need to provide intermediate and long-term care. And the community -- people should be able to resolve their crisis in the community.

  • 12:23:25

    ASENDIOOkay. We'll be back and continue our conversation after a short break. We're speaking with Stephen Baron, head of the D.C. Department of Mental Health. Stay tuned.

  • 12:25:21

    ASENDIOWelcome back. I'm WAMU news director Jim Asendio, sitting in for Kojo Nnamdi today. We're talking with Stephen Baron about D.C.'s Department of Mental Health. He's the top guy in charge over there. Now, first of all, when we look at old Saint Elizabeths Hospital, the conditions there were the subject of a federal -- Justice Department investigation, until as recently as 2007, what was that investigation about?

  • 12:25:48

    BARONSure. In 2005, Department of Justice came into Saint Elizabeths and did a full site visit and found the hospital and the department and the District in violation of CRIPA, Civil Rights of Institutionalized Persons Act. And we entered in September -- June of '07, we entered into a settlement agreement with Department of Justice, and I'm pleased to say it has been tremendous progress at the hospital. And we are on course to have that settlement agreement be resolved within, hopefully, by September of '12.

  • 12:26:26

    ASENDIONow, you -- there were certain conditions for all of that. Talk about those.

  • 12:26:29

    BARONOkay. One was the environment. We built a new hospital. That was the easiest, but it was all around how individual recovery -- we have our treatment plans rewritten, the coverage of psychiatrist, coverage of nursing, discharge planning, quality of life at the hospital, civil rights of patients. And they were broken into various components. So there's about 220 areas identified by the Department of Justice.

  • 12:27:02

    BARONAnd the hospital has made tremendous progress. There's nothing not in compliance right now, and everything is either in fully or partial compliance. And we're confident we're going to -- we've modified the agreement with justice. And we're confident that our leadership there, Dr. Kennedy and his staff, will continue moving this in the positive direction it's going.

  • 12:27:23

    ASENDIONow, the kind of things that you're talking about, I mean, to me it's somewhat stupefying that, you know, you could have all of those conditions, negative conditions, build up. What was the cause? Did we -- I mean, when you talk to people in D.C. government and people, particularly, in the mental health field, you have very passionate people who are very well committed and all. Was it a matter of resources? We just weren't connecting the dots? What happened?

  • 12:27:46

    BARONIt's combination. I don't think it's -- I think we really want to stay focused on the present and our future direction, which is much -- which is very positive.

  • 12:27:56

    ASENDIOBut you don't want to repeat the past.

  • 12:27:57

    BARONWe don't want to repeat the past. We understood one of the lessons -- one of the values of this Department of Justice settlement agreement has been that we've been able to really focus on the forward moving in making these positive changes.

  • 12:28:11

    ASENDIONow, we have an email from Sarah about medication, in a time warp sort of way, "Medication developed decades after the Dixon case was begun and seems to have made the settlement possible." Another time warp, she said she was once in a jury pool that was asked to stand up if anyone there had worked at St. Elizabeth, and more than half of the people stood up. Is that a common situation?

  • 12:28:32

    BARONYes. It's very -- I find it very positive. There's a wonderful legacy. It's very hard to go places in the District and not meeting somebody who either worked there, had a family member who worked there that had a connection. The medication is interesting. Well, medications really hit the country in the mid- to late '50s with the original antipsychotic medicines, the Thorazines, the Haldols. Well, what happened in the late '80s and through the '90s is what we call the new atypical meds. And one of our 19 exit criteria was to ensure that 70 percent of outpatients were getting the state-of-the-art medicine.

  • 12:29:09

    BARONSo the agreement on the Dixon case addressed medication. It addressed range of services to make sure we had best services available, including housing, supported employment, assorted community treatment. It looked at making sure we were serving enough people through penetration, that there was a reasonable number of people, District residents, getting services in the community who should, and then looking at the connectedness from people leaving an inpatient facility to get services in the community.

  • 12:29:45

    BARONBut for the email question, medication is part of the treatment. But studies have shown medication alone is not enough for many people, for some people, yes. The best is combination of services and medication.

  • 12:30:02

    ASENDIOYes. I also spoke about so many people in D.C. having some sort of connection to St. Elizabeth. Has that helped your job, your responsibility to turn it around?

  • 12:30:10

    BARONWell, I think, you're always running across people who have a very warm spot for the hospital. Even when it was large, I mean, it was just a very valuable institution. At its peak, St. Elizabeths was the pinnacle of public psychiatry in this country, and we really want to go back to those days.

  • 12:30:29

    ASENDIODo any of the current economic conditions or the expected federal budget cutback, are they going to affect St. Elizabeth? I know there was supposed to be so much development over there and changing around. Is that going to come to a screeching halt?

  • 12:30:43

    BARONOkay. That doesn't affect the hospital. The District or the west side of the campus is the Homeland Security that the federal government is putting up. There is a lot of development plan for the east side of the campus. And there are a number of buildings caught up in the federal budget, but that's not a Department of Mental Health issue.

  • 12:31:03

    ASENDIOOkay. Have you or anyone close to you received services from D.C.'s Mental Health Department? And what did you make of the care that was available through the city? Do you have any experience with St. Elizabeth? Please join us by calling 1-800-433-8850. Or you can email us at kojo@wamu.org. Or you can get in touch with us through our Facebook page or by sending us a tweet to @kojoshow.

  • 12:31:27

    ASENDIOAgain, the number is 1-800-433-8850. Our email address is kojo, K-O-J-O, @wamu.org. Mr. Baron, some of the District's other departments and agencies are under constant, almost microscopic investigation. People follow every move when it comes to the school system. One Washington Post editorial writer has written enough columns about the juvenile justice system to fill an encyclopedia.

  • 12:31:52

    ASENDIOBut sometimes, when it comes to the mental health system, people only pay attention when there is either a violent or tragic news demands their attention. Why do you think that is? Is there some sort of, I don't know, a mental block that many people have when it comes to mental illness or dealing with these kinds of things?

  • 12:32:09

    BARONWell, I heard your question in a different way. I'm going to throw it back to you as the news guy. Why won't they -- why won't we get covers? We'll say The Post covered the settlement very, very nicely. There's a nice editorial about the progress, a nice coverage. But, you know, it's hard to get good coverage of good things. Now, we'll say -- also with The Post, we put up a mobile crisis service. And The Post was very interested in that, and they covered it.

  • 12:32:37

    BARONIt's been the health professionals who respond to citizens who may be having a psychiatric crisis. They respond in the community, going to their homes, going to restaurants or wherever. And we'll hopefully stabilize the situation. Post went out -- went with the team and covered it. It was a very well done story. But a lot of the work, you know, it's just the important -- doing the important good work. And I really can't answer that. I mean, people -- unfortunately, there's been some sad horror stories.

  • 12:33:12

    BARONThere's a famous case in New York where a fellow pushed a woman in front of the subway train, and that -- and who had tried to receive treatment. And that actually spurred New York to do a lot of positive changes.

  • 12:33:27

    ASENDIONow, you talk about those special impact teams and how -- the way -- the modus operandi has changed. Over the years that you have been here, you know, what other kinds of things -- is it more getting the word out that mental illness isn't illness and we should deal with it just like any other disease or any other, you know, medical situation that we do have?

  • 12:33:49

    BARONYeah. We've -- I think that's a very strong analogy. For some people, it's a chronic illness. Just like, for some people, diabetes is a chronic illness and people need to stay on their insulin, people need to stay on their psychiatric medicines. But we really have tried to focus to improve access. One of the reasons for the mobile crisis team was to be able -- I have always felt the backbone of a public system, its exposure -- its ability to respond to individuals in a psychiatric crisis in a very, very timely passion.

  • 12:34:24

    BARONPeople can't say, we'll hold that to Tuesday at 3:30. They need to be seen immediately. And we put a number of things in place to enable that. The mobile crisis team has one. We have one for adults, one for children. We have a walk-in clinic at 35 K Street Northeast. People can walk in with that without a scheduled appointment. They see between 15 and 20 people a day.

  • 12:34:49

    BARONAnd we have the CPEP, the Comprehensive Psychiatric Emergency Program, which is basically a standalone psychiatric emergency center that receives folks brought by the police and also some walk-ins. We're looking at what we can offer on -- to prevent unnecessary hospitalization. The ideal situation, if someone is connected with a provider, that that crisis gets resolved within that provider environment.

  • 12:35:19

    ASENDIOSince so much of, you know, the dealings the department would be, in some way, interacting with other city department, particularly police department, because if the first person -- someone's going to call is 911 and the police is going to -- the police will be responding, how has that relationship go on between your department and the police in terms of getting them to understand what they're dealing with, and it's not just that -- maybe the end result might be a criminal act, but it's spurred on by mental illness?

  • 12:35:47

    BARONSuperbly. Thank you for asking that question. In March of -- April of '09, we put -- there's -- let me just back up. I'll put it in context. There's a national program called CIT, crisis intervention team, that grew out of the Memphis Police Department to help train first responders to respond to individuals -- experiences psychiatric crisis who come to the attention of the police. The intervention really has this called the decrease officer injury, decrease civilian injury and get somebody involved in the right service system.

  • 12:36:22

    BARONWorking very closely with MPD, we have created the District's version of CIT. We call it CIO, crisis intervention officer. And since April of '09, we've trained over 330 MPD officers, a handful of Metro police, Georgetown police, Housing Authority police, to respond individuals with a mental illness. And the training is a 40-hour week training. Officers are very enthused. Chief Lanier is a major, major supporter of this. In addition, we're part of the annual -- and the cadet training, we do 16 hours.

  • 12:37:00

    BARONI think we do three days with the cadets -- we're involved there. And then when people have their refresher, 40-hour refresher courses a year, there's a mental health component. So our relationship with MPD is very good. The mobile crisis team is all the time talking with them.

  • 12:37:17

    ASENDIONow, I know the schools play such an important role in so many things in the life of the District. Do you have programs with the public school system where you have -- either speakers go out and speak to the administrators or the guidance counselors and perhaps the students?

  • 12:37:33

    BARONYeah. We are embedded in, probably -- I think it's 54 public -- well, it was between public and charter, predominantly public schools, 50 -- maybe 56 and 11 charter. And so we actually have DMH staff who were at the school, working closely with the school principal and the school staff to doing both health education, delivering a number of innovative interventions and then doing good clinical services for the youngsters.

  • 12:38:04

    ASENDIONow, we have an email from Karen in D.C. Its subject is finding treatment for people who need help. The question is to you. "When there's someone in your neighborhood who seems to be suffering from a severe mental illness, as there is on my block, who do you recommend a resident contact if people begin to feel unsafe around that person? This person -- this is a person who some people on my block feel so unsafe around that it makes it difficult for people to even interact with him, but it seems clear that he could benefit from treatment whether it's available from the city or elsewhere."

  • 12:38:32

    BARONYes. What we like to do in those sorts of cases -- that number gave out, 1-888-793-4357, explain the situation to the caller. There's a very good chance they're going to refer it to our mobile crisis team. And I hope the mobile crisis team would then contact the person who made the call just to get the information. We can't -- we can receive information, but all sorts of, you know, confidentiality once we begin services. We may not be able to share it back, but we can receive information.

  • 12:39:06

    BARONWe want to hear with you -- from you what you see as the main problem and also who you know who has any sort of relationship with the individual. So don't hesitate to call that number. Explain the situation and say, would it be a case for the mobile crisis team.

  • 12:39:23

    ASENDIOWhen you look at what's been able to be accomplished over the -- you know, the past few decades, why -- or if the city is in a better position to manage these community-based facilities in terms of manage to care to these community-based facilities, are they more up to speed than they were before? Are they more prevalent now or what?

  • 12:39:44

    BARONWell, that's a very interesting question. It's hard to compare a time -- we weren't here. We spent a lot of time building, working with the providers, providing training to -- we have a wonderful staff at the Department of Mental Health that -- from the folks who support the providers to the folks who offer all sorts of training to -- we've also expanded the range of services. So there's a service called assertive community treatment act. It is designed -- it's been well researched.

  • 12:40:18

    BARONIt's been designed for individuals who have been non-compliant with treatment. It has the ability to go out in the home. It is quite mobile. It's made up of teams of doctors, social workers, nurses. They manage with very low case loads, and we've expanded act greatly in the District.

  • 12:40:36

    ASENDIOAnd the wheels are in motion right now. But a few more things need to happen before the Dixon case is settled. What are the next steps that your department has to take from here? And it's my understanding that there's a comment period that will last until February.

  • 12:40:49

    BARONYes, very much so. Let me just go back to the agreement amendment. We negotiated this agreement with the plaintiff's lawyers, the court monitor and the District -- our lawyers from the District, and it's a very thoughtful agreement. We had made significant progress that we have satisfied 15 of the 19 exit criteria. So we -- so everyone realized we were working from the position of strength, everybody involved. This is not a bad -- a weak department.

  • 12:41:23

    BARONSo while we did that, we looked at four areas where we -- the four areas we have met and focused on those four areas. And so the agreement looks at that. The agreement also provided resources to expand affordable housing, which is a tremendous need for individuals with serious mental illness. Over the life of the agreement, we have expanded by 200 units.

  • 12:41:50

    BARONThe agreement is once this thing is settled by Feb. 16 at the final hearing, we will then be out of federal court oversight and have an agreement with the plaintiff's lawyers to address these four areas of housing, supported employment, services to youth and making sure people get connected to community providers upon discharge from an inpatient -- an involuntary inpatient service.

  • 12:42:18

    ASENDIOLet's talk about the connection between the Department of Mental Health and Department of Youth Rehabilitation Services since it both deals -- in some ways, they perform with young people and people who are in sort of crisis situations. Is there an embedded component there? Or do you work with the court system and DYRS?

  • 12:42:39

    BARONWe work with the court system. We have a court assessment system. We work with DYRS. One of the goals of the agreement is to reduce the number of District youth and the days they spent in out-of-home placement psychiatric residential treatment facilities. And DYRS is part of our strategy to do this. DYRS also transfers money to us. And we've created these innovative wraparound services with DYRS. So they have become a full partner.

  • 12:43:11

    BARONI also want to make sure I answer your previous question about the deadlines. So part of the agreement was also to send out letters to anybody in our system. Twenty-six thousand letters have gone out to people who were registered in our system. About 300 letters went out to shelters and mental health providers. And there's a comment period. It ends Dec. 31, 2011. All that information is on our website, dmh.dc.gov. And you can get all the information. And then the judge will have a final hearing Feb. 16.

  • 12:43:48

    ASENDIOOkay. You're listening to "The Kojo Nnamdi Show." I'm WAMU news director Jim Asendio, sitting in for Kojo today. We'll continue with our conversation about the District's Department of Mental Health and its Director Stephen Baron. We'll continue that in a moment, so, please, stay with us.

  • 12:45:40

    ASENDIOI'm WAMU news director Jim Asendio, sitting in for Kojo Nnamdi. I'm talking with Stephen Baron. He's the director of D.C.'s Department of Mental Health. And we're talking about the state of affairs at the Department of Mental Health, particularly with the Dixon case winding down and D.C. getting its house in order as it relates to the treatment of -- and the services provided for people with mental illnesses here in the District of Columbia. Well, the -- we were talking about the department's relationship with DYRS, the Department of Youth Rehabilitation Services. Continue that.

  • 12:46:13

    BARONYeah. You know, one of the things that we see that is critically important is that we have strong collaborative relationships with a number of departments including DYRS. We have a very strong arm with CFSA, the Child Family Services Administration. Housing and Community Development is a strong partner. We've developed almost 300 new units of housing. Separate from the Dixon decree, strong relationship with the Department of Human Services, the schools, MPD, very important.

  • 12:46:43

    BARONSo we really much value the relationship with DYRS. We think for some of the youth who are struggling with mental health conditions, we are in a very good place to help them and really tie them into the range of services that we've been focusing on. And when I say -- talk about expanding the range of services, it's really to be able to organize your service system. So services are individualized and can be adjusted based on that individual's need, so one size doesn't fit all. So DYRS is a strong partner with us in that.

  • 12:47:17

    ASENDIOWe have an email from Sam about partnerships with the Department of Addiction Recovery Prevention Administration. (sic) It says "Are there any plans for DMH to encourage more partnership with the Addiction Recovery Preventions Administrations, APRA, especially around consumers with a dual disorder mental health and substance abuse?"

  • 12:47:35

    BARONYeah. It's one of the biggest challenges in the field. APRA is part of Department of Health. And in fact, we have an agreement with the Department of Health for APRA that we operate what's called an urgent care clinic at Superior Court. Very unique that, at the courthouse, there is an outpatient clinic. And just this past year, our staff and APRA staff working together have expanded the urgent care clinics, so it's the first -- it's our first real behavioral health clinic.

  • 12:48:06

    BARONOur office of accountability and leadership at APRA have meeting, trying to take a look at what we can do to make or to certify our providers so they are certified as co-occurring competent, come up with a description of the service of reimbursement rate to really try and stimulate the development of more services for co-occurring folks. We know, depending on the setting, that anywhere from 30 to 60 percent of folks in our system will have a co-occurring substance abuse mental health needs. So it is an area that we continue to focus on and discuss.

  • 12:48:47

    ASENDIOAnd we have this email from someone who didn't want to give their name. It says, "My mother suffered from mental illness, and, at one point, she was committed to a public treatment facility albeit in a different city. I don't think, however, she or my family ever got over the stigma of her being institutionalized. She eventually got better and eventually found herself living seamless in society. But it was hard knowing what the people would talk about the time she spent quote, 'in the loony bin.' I know people were saying it, even though they never said it to anybody's face in my family."

  • 12:49:15

    BARONYeah. Yeah. That's sad, but, unfortunately, it is true. If you talk to -- there's a whole movement of consumers or people with lived experience who self-identify as folks recovering from mental illness, and it's probably the number one issue they will talk about. I think, as a society, we've done better. I think there's more understanding, but, clearly, we're not there yet.

  • 12:49:41

    BARONAnd one of the -- there's been a lot of changes since the early '80s. And a couple of the major changes have come directly from peers, people who have recovered, and that's the consumer movement. And then the family movement, National Alliance on Mental Illness, which is throughout the country, is a very strong group of family members that provide support. And I really encourage anybody who is either doing -- having a lived experience or dealing with a family member to use the resources of NAMI or consumer movements.

  • 12:50:18

    BARONWe are really trying to promote the use of people with lived experience in our system. We know they have a tremendous and unique value to bring to the people. We just had our first class of what we call peer specialists, graduated 11 folks with -- or 10 folks with lived experience, who went through a -- three weeks of classroom experience, 80 hours of practicum experience, sat in the exam, passed the exam. A number of them are being hired by providers. So there's a much more of a recognition that people with lived experience have something to add, but it's -- it doesn't offset the stigma issues.

  • 12:51:00

    ASENDIOThis to our listeners, have you ever tried to seek out help for someone with mental illness who didn't feel they needed it? And how did you resolve that situation? If you have any answers to those or any others, you could call us at 1-800-433-8850. Again, that's 1-800-433-8850. Or you can email us at kojo@wamu.org. Or you can get in touch with us through our Facebook page or by sending us a tweet to @kojoshow.

  • 12:51:29

    ASENDIOWe have another email, this one from Steve, about housing. He spoke about the need to increase housing and what you've been doing underneath the settlement. Also, in addition to the settlement, he says, "People with serious mental illness have a variety of needs or rate along a continuum, ranging from inpatient care at one end to occasional visits with a doctor for therapy and medication management on the other.

  • 12:51:49

    ASENDIO"To successfully live in the community, people often require varying supportive services in a supervised residential setting. Would you comment on the role that the presence or absence of such supported housing plays in your work, promoting community-based mental health services?"

  • 12:52:02

    BARONYes. Be glad to. And I'd like to divide this into a couple of camps. We use the word supported housing usually when the individual owns the lease, and their tenancy in the house is based on them complying with the lease. Up until that -- there are other options. In the District, we have about 223 people living in what we call contracted community residential facilities. They're basically group homes run by providers, and they offer 24-hour on-site supervision.

  • 12:52:33

    BARONWe also have what's called supported independent living, where providers are funded to provide drop-in services. And then there's a whole group of private owners, private individuals who operate about 450 supervised housing slots, and they provide supervision when the individual is there. The emailer is absolutely correct. Things need to be individualized. The service system -- particularly for folks who have supported housing or living in their own place -- needs to be titrated or regulated depending on their need.

  • 12:53:08

    BARONSome people may only need to see their doctor once a month, once a week. Other people may need the services of a sort of community treatment team, as I described earlier, that can come by their residence three to five days a week for a while, while they stabilize and can adjust to living. It's a very interesting dichotomy 'cause most folks with serious mental illness desire to live alone, not all 'cause I don't want to say everybody, but people want their own space. And it's very hard in a group living to get your own space.

  • 12:53:40

    BARONSo the real challenge is getting the system to support the individual to meet their needs. The individual who needs to see their doc once a week or once a month is one level. The individual who needs a team to drop in a couple of times a week is another level. And we're trying to build our system in the District to have the whole range of services.

  • 12:53:59

    ASENDIOThough some people are cheering the announced settlement as a major symbolic victory for the city, a victory for home rule in D.C. government, others are saying that the progress that paved the way for the settlement is overstated. You listed many of the things the department has done.

  • 12:54:13

    ASENDIOThis letter was sent to the Washington Post by the executive director of the Treatment Advocacy Center, says, "As long as people are too ill to access community health care are left to live -- and, too often, die -- in torment on the streets, in jails or in squalor, and until the District's court-ordered outpatient treatment law to get them into treatment is actively used, celebration of the District's mental health care achievements is premature." Your reaction to that.

  • 12:54:36

    BARONWell, first of all, we think the settlement agreement is a recognition of tremendous progress. It is not a recognition of a job completed. We know there are major challenges. We believe we've created a system to respond to those kinds of concerns. Court oversight was not value-added to help move the system to whatever next level we need to do.

  • 12:55:02

    BARONAnd I would totally disagree with the writer, that it does -- while there are many challenges in our system and in any public system around the country, I would totally disagree that this settlement agreement is not a recognition of progress made and more challenges to be overcome. And we're really up for that. I think this department can easily take it to the next level with the support that we've already had -- the executive, legislative and the provider -- with an outstanding staff all coming together, and the consumers. We really value the voice of those who use the service.

  • 12:55:42

    ASENDIOLet's go to Jennifer in Columbia, Md. You're on "The Kojo Nnamdi Show."

  • 12:55:46

    JENNIFERYes. I'd like to just ask a question related to the stigma factor that -- how do we help or educate the public, especially the public servants, to be more understanding or to be more behaving appropriately to the people with the disability? For example, bus drivers -- I had experience of a close friend, who had a disability and -- of mental illness and was given a bus pass. But the bus driver refused to let him on the bus and said, you don't look like you have disability, and asked for identification, medical assistance card. At the end, she still didn't let him on.

  • 12:56:37

    ASENDIOOkay. So what about training of bus operators and other public servants?

  • 12:56:41

    BARONI think these are things we are more than willing to take on. That's another group. We have started a program that started in New Zealand and Australia called Mental Health First Aid, where we educate the general public about what mental illness is, how treatment works, how people can recover and how best to respond. And I was thrilled that some of our initial attendees were librarians.

  • 12:57:08

    BARONAnd we really do -- the caller is absolutely right. We do have to reach the general population. We are doing something with Metro in the District around suicide prevention, and I'm sure we will get into some of those areas, too.

  • 12:57:22

    ASENDIOOkay. And, once again, we're coming to a close. You got about a minute left. Give the number again.

  • 12:57:27

    BARONSure. 1-888-793-4357, and that's our -- actually, DMH's access helpline. Stay with them. If -- tell them what your needs are, and they'll sort it out for you.

  • 12:57:43

    ASENDIOOr you can call 311, the District of Columbia's main number. They can refer you to Department of Mental Health.

  • 12:57:46

    BARONRight. Right.

  • 12:57:48

    ASENDIOWell, thank you very much, Director Stephen Baron, of D.C.'s Department of Mental Health. I'm News Director Jim Asendio, sitting in on "The Kojo Nnamdi Show" today. Thanks for listening.

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