In September 2011, federal Judge Thomas F. Hogan preliminarily approved a settlement agreement between the District and Dixon Plaintiff’s Counsel as fair and reasonable. This ruling moves the District closer to the end of this longstanding litigation and 37 years of court oversight of its public mental health system.
As required in a class action suit, the Judge also set a time period for public comment or objections to the settlement from any Dixon class member. The District mailed notice of the settlement [PDF] to all enrollees for public mental health services and sent the notice to advocacy groups, homeless shelters and community providers for posting. The notice gave information about the terms of settlement and the procedures to follow to send comments to Judge Hogan before December 31, 2011. Judge Hogan reviewed all public comments submitted by the public and held a fairness hearing on February 16, 2012. Judge Hogan issued an order [PDF] dismissing the case with prejudice.
Under the terms of the settlement, the District commits to adding 300 affordable housing units, expanding job-readiness services for adults with mental illness to help them get and keep a job, and increasing treatment services with proven records of good outcomes at home and in the community instead of out-of-home placements for children.
Background
Under the terms of a lawsuit dating back to 1974 when Saint Elizabeths Hospital was managed by the federal government, the Department of Mental Health under the oversight of a Court Monitor is required to meet 19 performance measures—called the "Dixon Exit Criteria". The Court held that the District had violated the Ervin Act by failing to provide community-based alternatives to Saint Elizabeths for people with mental illness who could be treated in less-restrictive environments.
Motion to Dismiss Dixon Lawsuit
When the lawsuit was filed, more than 3,600 patients were at the Hospital. Today, the DMH has shifted primary treatment from the Hospital to community based mental health providers—reducing the population to around 270 patients. More than 98% of the residents who use the public mental health system are treated in the community.
In September 2009, the District Government filed a motion to dismiss [PDF] the Dixon lawsuit and return full management authority of the Department of Mental Health to local officials.The District maintains that the public mental health system now provides treatment in the least restrictive environment through a broad range of community based services and support, including housing and supportive employment; thus, the original Ervin Act violation of unnecessary hospitalization has been remedied. Further, the District has complied or substantially complied with the conditions of the Dixon Exit Criteria.
Court Monitor Reports and District Status Reports
The Court Monitor is required by the Court Order to prepare and submit an annual monitoring plan to the parties for approval and to submit bi-annual reports on monitoring activities to the Court. The District also submits periodic status reports to the Court.
Annual Community Service Review
DMH conducts an annual review of its services to adults, children and youth called the community service review (CSR). The annual reviews—conducted by an independent review team—collect data through interviews with consumers and families, caretakers and staff as well as document reviews. DMH uses a stratified random sample of sufficient number to provide statistical levels of confidence.
The consumer Service review covers seven areas:
- community living
- life skills
- health and development
- treatment
- family support
- systems capacity for prevention and early intervention
- service system capacity
The Dixon Court Required Performance Level is an aggregate score of 80% for positive system performance for the children and youth who are sampled and reviewed.
Adult Community Service Review (Exit Criterion #3)
Children/Youth Community Service Review (Exit Criterion #4)
Origin of Dixon Lawsuit
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 [PDF].
In 2000, the US District Court appointed a Transitional Receiver [PDF] 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 [PDF]. 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 [PDF] 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 [PDF] adopted on December 12, 2003.