The human and economic costs of failing to make needed improvements are substantial and, according to a new report, among the many problems persons with behavioral disorders face is a revolving door of incarceration, treatment, relapse or decompensation, and re-incarceration, often for minor, non-dangerous offenses.
The new report, “Improving Mental Services and Outcomes for All: the D.C. Department of Behavioral Health and the Justice System,” was released by the Office of the District of Columbia Office Auditor on Feb. 26. The Council for Court Excellence provided the 191-page document to address the D.C.’s Department of Behavioral Health (DBH) and its interactions with the criminal justice system.
The authors said it’s based on a tremendous amount of research conducted over the past 18 months that analyzed how DBH interacts with justice-involved consumers and the effectiveness of those interactions.
Research included nearly 60 interviews, totaling more than 150 hours, with DBH staff, stakeholders, community behavioral health providers, leading academic experts and current and former senior officials of forensic departments of other mental health agencies from around the country.
It also included focus groups with consumers, advocates and providers, surveys of those groups, a review of forensic behavioral health practices in other jurisdictions, analysis of D.C. law and municipal regulations, and a thorough review of DBH internal documents and data.
“As explained in detail in the report, we found that DBH has many areas for improvement, not only in its direct interactions with justice-involved consumers, but also department-wide,” wrote attorneys Michael Hays and Barry Coburn, the report’s co-chairs. “DBH’s shortcomings have several bases — structural deficiencies related to the agency’s organizational hierarchy; leadership issues that hinder progress and do not foster healthy work environments; inconsistent and inadequate funding support for community providers; inadequate and ineffective data tracking and management; and poor strategic vision.
“While we found that much of its staff are passionate about their work and are dedicated to improving the agency’s operations, we also found that DBH has much room for improvement,” the co-chairs wrote. “We hope that this report will provide impetus toward such further improvement.”
Among the key findings in the report were that professionals without proper training are looked upon to decide whether suspected criminals are competent to stand trial. They also found that patients are being unnecessarily held at the public psychiatric hospital.
Researchers discovered that department fell short in its basic obligation to evaluate the mental fitness of defendants. It said the department should do more to make sure they get treatment and resources such as housing to help them stay out of the criminal justice system.
“There’s this revolving door of incarceration, treatment and relapse and re-incarceration for often minor and nonviolent offenses,” Hays said. “The costs in human misery and economic costs to D.C. government are substantial.”
Researchers have also urged Mayor Muriel Bowser to do more to scrutinize DBH Director Tanya Royster and Nicole Johnson, who oversaw forensic psychologists who evaluate defendants.
The report also found that turnover has been high and, in some instances, evaluators responsible for figuring out whether suspects could assist in their legal defenses didn’t understand basics about the legal system.
It also found that there are long wait lists for housing and those deemed competent to stand trial are stuck at St. Elizabeths Psychiatric Hospital in Southeast because of delays.
The report recommends that the D.C. Council mandate forensics training and board certifications for the evaluators.
“This is the kind of thing you can’t just ignore and hope it goes away,” said At-Large D.C. Council Member David Grosso. “It has not gotten better. It’s gotten worse,”
Ward 7 Councilman Vince Gray, who chairs the council’s health committee, said he’s especially concerned about the direction of the District’s behavioral health system.
“This thorough and thoughtful audit report outlines 25 findings and 77 recommendations,” Gray said, noting that neither Royster nor anyone at DBH contested the findings of the report. “It paints a picture of an agency that is failing in its core mission of serving District residents with mental health and substance abuse issues, especially those people who have mental health problems and are involved with the criminal justice system.”
The councilman highlighted the report’s detailed deficiencies throughout DBH focusing on areas such as inadequate training and clinical experience for psychologists and psychiatrists in forensic services, waiting list and length of stay irregularities at St. Elizabeth’s; a lack of institutional support for Core Services Agencies; and a pattern of inappropriate hiring decisions and promotions.
“It is clear from the report that forensic sciences at the Department of Behavioral Health are in disarray and the agency has failed to support a network of Core Services Agencies that are the front-line services providers,” Gray said. “This agency is responsible for caring for the needs of some of the District’s most vulnerable residents, and it has been moving in the wrong direction each of the last three years. Part of those failures are certainly attributable to a lack of budgetary support from the Mayor, but there are also management failures that point directly at Dr. Royster.”