January 27, 2009

What's going on with DC's DMH? (Part 1)

DC's Department of Mental Health is undergoing some big changes. Here at Beyond Bread, we will do our best to cover the changes and bring light to the effects that they're having on the District residents who need these services. (Through our Representative Payee program, we help 800 people receive their disability benefits -- many of whom will be affected by the DMH changes.)

But first, the basics...

DC DMH currently provides direct mental health services to about 4,000 severely mentally ill individuals from 4 different locations throughout the District. Typically you hear these locations referred to collectively as "the DC CSA" (Community Services Agency). These services are described as "wrap-around, community-based" services--assistance with daily living like making doctor appointments, day programs, case management, etc.

While the DC CSA has been doing a reasonably good job caring for the needs of the severely mentally ill, there is very little capacity for those who need less comprehensive care. Those who need to meet regularly with a therapist, those who suffer from mild depression or anxiety who could benefit from an anti-depressant, or those in need of group counseling are at a real disadvantage with our current system. There just isn't capacity for these types of basic (but important) office-based services.

Thankfully, DC realizes that this is a problem and is working to diversify the public mental health system. The centerpiece of their plan is to close the DC CSA and use the savings to expand capacity in the private sector so that DMH could go from being both provider and overseer to just being the overseer. See this recent Washington Post article on the matter, and Kathryn Baer's Poverty and Policy blog where she recently wrote about the history of the DC CSA and the implications of the proposed closure.

This redefinition is necessary to improve the quality of services provided in the District and to improve the efficiency of mental health funding. I think Kathryn's right that the restructuring will ultimately be for the better, expanding the access to these services to thousands of people who currently are underserved, but that doesn't mean it will be easy.

In the midst of the transition, thousands of people who need guidance and stability hang in the balance. It's going to take a lot of coordination and commitment to make sure nobody falls through the cracks.

DMH finally released its implementation plan for the transition - so stay tuned to this blog for a run-down of the plan and a look ahead to the coming year.


Stephen said...

I am a clinical psychologist who worked from 1995 to May 2008 at the DC CSA. Your comment about what is missing at the DC CSA is wide of the mark. It is precisely the services that you say will be needed that will be lost by the closure of the DC CSA. Myself and my colleagus provided individual psychotherapy and group psychotherapy. A number of consumers came exclusively for these services. Others needed primarily medication and were seen by our psychiatrists to obtain these services. Such coverage was largely absent at private clinics due to the sallary level of psychiatrists. It was the private clinics that delivered less of these forms of interventions. The DC CSA received the vast majority of referrals from probation officers and others in the criminal justice system. These consumers primarily receive the sevices you say are needed. The closure of the DC CSA will lead to an outcome you do not favor.

Valentine said...

Stephen, thank you for your thoughtful, thorough response. I would like to clarify my post further--I did not mean to imply that the services you and your colleagues provided at the DC CSA were not important or needed, nor did I mean to imply that they were not being provided. What I was trying to convey is that the DC mental health system is lacking capacity for office-based services for those who are not severely mentally ill. Especially for patients who receive health insurance through the DC Healthcare Alliance, the current system is not robust enough to provide all the care DC residents need.

I agree with your point that capacity is currently lacking in the private clinics as well due to salary constraints. This blog post is meant to be one in a series--it is a very complex system with too many complex problems to tackle in one blog post.

With that in mind, I would also like to clarify that I do not believe that the closure of the DC CSA will bring about the mental health system DC needs. More accurately, I hope that with careful oversight and reallocation of funds, the closure of the DC CSA (and subsequent redefinition of DMH strictly as an oversight authority rather than a dual overseer/provider) will be one step in a long process to improve DC's public mental health system. The post I am currently writing is about the Implementation plan that DMH released and after that I hope to dig deeper into potential concerns, obstacles, etc.

Perhaps you would be interested helping us further unpack this issue for our readers?