A Proposal for Transferring St. Elizabeths Hospital to the District of Columbia

Pursuant to a congressional request, GAO proposed a method for transferring control of St. Elizabeths Hospital from the Department of Health and Human Services to the District of Columbia.

GAO proposed a comprehensive mental health care system for the District. Under the proposed system, primary mental health care would be shifted from St. Elizabeths to community-based programs and facilities. Three mental health districts would have responsibility for providing mental care and would each operate: (1) a community mental health center to provide outpatient, day treatment, and case management services; (2) a crisis resolution unit; and (3) mobile treatment teams. St. Elizabeths would provide: (1) long-term inpatient care; (2) intensive and rehabilitative psychiatric and psychiatric nursing care; and (3) court-ordered psychiatric care. About 700 inpatients would be transferred to community treatment settings, District-administered alcohol and drug abuse programs, and general hospitals. The proposed system would save about $22 million annually. GAO proposed implementation of the new system over a 2-year period beginning in fiscal year 1985. GAO noted that the selection of employees to operate the reduced programs at St. Elizabeths is a difficult issue and believes that Congress should balance the interests of the various groups involved. GAO also proposed that: (1) the Federal Government provide subsidies to the District during the 2-year transition period to cover the increased costs that the District would incur in operating the system; and (2) a commission be established to monitor the transfer and to report on implementation progress and problems to Congress and the District.