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Patients wait for the Department of Mental Health to come through.
The doctor isn’t in.
That’s the news that greets the men and women who trickle into the third-floor waiting room of the city-run outpatient mental health clinic at 35 K St. NE. There are more than a dozen of them here
on a Tuesday morning, and 9 o’clock, the hour at which patients are supposed to report, has come and gone. The woman behind the counter says that the “consumers”—as D.C. Department of Mental Health employees now call them—won’t see a psychiatrist until 12:30.
“Take a seat if you can find one,” the desk clerk says to a newcomer, a man in a white ‘do-rag and a bulky jacket. He scans the room. There’s only one place left to sit—a plastic kiddie bench. He plops down on it.
The clinic is one of six community support centers run by the Department of Mental Health. It has been at 35 K St. for a year and a half; before that, it was on the grounds of St. Elizabeths Hospital.
Spending a whole morning, or longer, in the waiting room isn’t unusual for patrons. “They don’t have enough doctors,” says one patient, who says she’s been going to the clinic for a decade. She used to talk to her psychiatrist for 45 minutes, she says. Now she’s lucky if she gets 20.
According to Raymond Brown, president of the Doctors Council of the District of Columbia, the psychiatrists’ union, 17 Department of Mental Health psychiatrists retired or resigned from the department in fiscal year 2002. At the same time, 12 other psychiatry positions were left vacant. Two have since been filled, but that leaves the number of full-time psychiatrists 30 percent below what it was in 2001.
Department administrators say they plan to fill all the vacancies. In the meantime, however, Brown says psychiatrists are carrying caseloads of 300 or 400 patients—far higher than the 240-case department standard for outpatient psychiatrists. The clinic at 35 K St. has roughly 1,200 patients, agency sources say, currently served by three full-time psychiatrists and one part-timer.
Ten o’clock passes. The waiting-room occupants sit quietly, flipping through old issues of People and Time. Some clutch huge black binders with their names printed on the side. One heavyset woman sitting by the window breaks the silence, offering some unsolicited advice to the man facing her.
“You got to get a Walkman,” she says. “Then those voices don’t mess with you as much. You got to put on some funky rap—or opera.”
The man chuckles.
“Or put on some white music,” the woman adds. “If you want to live under your skin and keep your sanity, you got to give ’em something to think about.”
A few minutes later, the man slips on a pair of headphones and starts blasting rap.
Martha B. Knisley, director of the Department of Mental Health, says that the District’s mental-health system is going through “growing pains” after coming out of five years of federal receivership this past May. The long waits for a psychiatrist were a problem a year and a half ago, she says, when she took over the department.
“One of the long-standing practices in the system that predates me is that all consumers are asked to come at 9 o’clock, and the clinic operates on a first-come, first-served basis,” Knisley says. She says she aims to switch to more individualized and precise scheduling. For starters, the agency is now offering evening and weekend hours, which patients have yet to adjust to.
The department is also trying to “grow the system,” Knisley says, by offering more kinds of services, including family-preservation counseling and school-based mental-health care. In two or three years, she says, she wants the department to serve 14,000 D.C. residents, twice the number of people it does now.
But in November, Knisley announced that the department would be eliminating 235 positions—12 percent of its workforce—to trim costs. Among the positions to be cut are community-clinic staff positions, including psychologists, facilities support staff, and general medical doctors. The cutbacks, coupled with new record-keeping requirements, will further overstretch clinic resources, says Psychologists Union President Stephen Fitzgerald.
John, a regular client at 35 K St. who asks that his last name not be used, says he’s searching for a new mental-health provider because “things have gotten a lot more chaotic” at the clinic in the past few months. His longtime psychiatrist abruptly resigned five months ago, and he’s had trouble getting to see anyone since. When he tried two months ago, he says, it took three visits and several hours of waiting. Last month, he arrived for an appointment only to find there was no doctor available. “This time,” John says, “I decided just to leave and not come back.”
A little before 11, the clinic receptionist starts calling the names of people who have appointments. “If you don’t have an appointment, you have to be worked in,” the clerk announces. “Are you out of medication?” she asks one man. He nods. “I’ll put a check next to your name, then,” she says.
Another waiting-room denizen asks when the doctor is coming. “I haven’t heard from her this morning,” the clerk replies. “That means she may still be coming.”
Ten minutes later, a petite woman, bundled up in a coat and wearing sunglasses, walks in. Several patients begin to applaud.
The doctor has arrived. She smiles back at her roomful of people and says, “I see my whole day in front of me!” CP