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Dixon Case
Because of a lawsuit dating back to 1974 when Saint Elizabeths Hospital was managed by the federal government, the Department of Mental Health (DMH) is required to report regularly to the US District Court on its progress in providing community based treatment alternatives to hospitalization for people with mental illness. The Court held that the District had violated the Ervin Act by failing to provide community-based alternatives to Saint Elizabeths Hospital for people with mental illness who could be treated in less-restrictive environments. At that time, more than 3,600 patients were in the Hospital. Under the terms of the lawsuit, now known as Dixon et al v. Fenty et al, the Court required the District under the oversight of a court monitor to meet 19 defined performance measures—called the "Dixon Exit Criteria"*—that define the minimum standard for an effective public mental health system.
On September 4, 2009, the Fenty Administration filed a motion to dismiss* the Dixon lawsuit, remove court monitoring and return full management authority to local officials. The District asserts that in the three decades since court oversight was imposed, the public mental health service delivery system has been transformed. Further, in light of the recent Supreme Court decision in Horne v. Flores, the motion argues that continued enforcement of the Court’s consent decree is not only unnecessary but also improper.
Today, the Department of Mental Health has shifted primary treatment from the Hospital to community based mental health providers. The Hospital population has been reduced from thousands to less than 400 patients—with a 77% decrease from 2003 alone. In fact, more than 98% of the people who use the public mental health system are treated in the community. The District’s motion asks that the lawsuit be dismissed since the original Ervin Act violation of unnecessary hospitalization has been remedied.
Moreover, the District maintains that it has complied or substantially complied with the conditions of the 2003 Consent Decree and has built a mental health system that provides treatment in the least restrictive environment through a broad range of community based services and support, including housing and supportive employment. The motion argues that the Supreme Court observed in its Horne decision that district courts are empowered to modify or vacate consent decrees based on changed circumstances.
Background of Dixon et al. v. Fenty et al.
In 1974, a lawsuit was filed against the federal government and District government on behalf of a class of individuals civilly committed to Saint Elizabeths Hospital, demanding community based treatment alternatives to hospitalization. The class included former, current and future patients. Because the lead plaintiff was William Dixon, the case is referred to as the “Dixon case.”
On October 1, 1987, operational responsibility for Saint Elizabeths Hospital officially was transferred from the federal government to the District government. As a result of the transfer, the District government became the sole defendant in the Dixon case. In 1996, the Dixon plaintiffs filed a motion in the US District Court, requesting the appointment of a receiver to operate the District’s public mental health system. This motion was granted in 1997*.
In 2000, the US District Court appointed a Transitional Receiver* to work with the District and the plaintiffs’ counsel on a plan to transition the daily operation of the public mental health system. On April 2, 2001, the US District Court adopted the Final Court Ordered Plan*. The Final Court Ordered Plan required the District to enact legislation establishing the Department of Mental Health as a cabinet-level agency reporting directly to the Mayor. It also set forth requirements for the organization and functions of the newly created department, including a requirement to construct a replacement for Saint Elizabeths Hospital.
On May 23, 2002, the US District Court issued a consent order* that terminated the receivership, adopted agreed upon Exit Criteria and appointed Dennis Jones, who had served as the Transitional Receiver as the new Court Monitor. While the Consent Order identified the Exit Criteria, it did not specify performance targets or measurement criteria. After negotiations, the District Government, the Court Monitor and the Dixon plaintiffs reached agreement about operational definitions, the measurement methods and performance levels required for each of the 19 Exit Criteria. The terms of the agreement were approved by the US District Court and memorialized in a Consent Order* adopted on December 12, 2003.
Court Monitor Reports and District Status Reports
The May 23, 2002 Consent Order requires the Court Monitor to prepare and submit an annual monitoring plan to the parties for approval. The Court Monitor visits DMH regularly throughout the year and meets with DMH employees and stakeholders to conduct monitoring. The Court Monitor also is required to submit bi-annual reports on monitoring activities to the Court. The Court Monitor began filing bi-annual reports in January 2003. As outlined in Exit Criterion #3 and Exit Criterion #4, DMH conducts an annual review of its services to adults, children and youth called the community service review (CSR). In addition, the District submits periodic status reports to the District Court about issues identified by the Court Monitor as critical.
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