In its preliminary review of the Gray's budget, the D.C. Behavioral Health Association found reductions in vital services for children:

"$900,000 reduction from DMH’s contracts for non-Medicaid reimbursed services for children.  These services may include mobile crisis response – which prevents children from being hospitalized for psychiatric emergency – and D.C. Choices, which works to prevent youth in schools and the juvenile justice system from being sent to psychiatric residential treatment centers.

$2,500,000 reduction from DMH’s funds that support specialized, non-Medicaid reimbursed mental health treatment for traumatized children through CFSA's intra-district transfer, including Choice Provider assessment, training and practice capacity funds.

There is a $3 million local-funding cap on DMH’s specialty, in-home treatment services; if this applies to Medicaid-funded services, it would translate to an overall $10.3 million reduction in treatment funds.

An additional $80.7 million reduction in Medicaid provider payments that is not further detailed, but which may further reduce Medicaid funding for mental health providers."

Shannon Hall, executive director of the D.C. Behavioral Health Association, said via email:

"D.C. already under-spends on children's mental health treatment: we spent $13 million on our children's mental health program while Vermont, which has a similiar population size, spent $72 million.  Now Mayor Gray's proposed FY2012 further reduces the mental health services that keep children out of hospitals and out of the juvenile delinquency system.  It reduces the treatment funds that help parents improve their parenting skills.  Perversely, while cutting these effective programs, Mayor Gray proposes spending significantly more on the expensive interventions that don't have the proven track record of efficacy."

Councilmember David Catania may have something to say about these cuts. This past week he announced a sweeping proposal that would address children's mental health in a comprehensive way.

Mr. Jones had been hospitalized multiple times over the years after several failed suicide attempts. He has struggled with schizophrenia and depression; according to the report, he informed St. E's staff that he had attempted suicide between 12 and 15 times. In 2009, he entered St. E's for an evaluation after picking up a criminal charge.

So what did St. E's do to help him?

Mr. Jones highlighted his suicide attempts and made them aware of his psychiatric history. Court documents stated in bold: "[d]ue to Mr. Jones's current mental condition, immediate hospitalization in an inpatient treatment facility setting is necessary in order to provide treatment. Furthermore, Mr. Jones is an imminent danger to self. While in the D.C. Superior Court cellblock awaiting transfer to the hospital and during transport to the hospital, he should be closely monitored for suicidal behavior."

Early on, St. E's staff ordered that Mr. Jones had to be "watched at all times," according to hospital records. And that he was a "very high risk for suicide." Mr. Jones continued to talk about suicide as the months passed. The only thing that changed was how the hospital monitored him. Eventually,  Mr. Jones was no longer was "watched at all times."

Then St. E's staff decided they didn't need to monitor him at all. They had transferred Mr. Jones to the D.C. Jail. Soon, D.C. Superior Court ordered Mr. Jones returned to the mental hospital with a message (again) in bold: "Mr. Jones has suicidal ideations and plans to harm himself."

When Mr. Jones returned to St. E's, he managed to find a razor blade. He then started cutting himself at 8 p.m. and didn't call for help until midnight. For those four hours, no one was watching him.

According to the ULS report, one staff member reported what they found: "Mr. Jones was sitting on his bed: both his arms were dangling at his sides and both wrists were bleeding heavily. There was a large amount of blood on the floor. He was holding a razor in his hand...I also got some sheets so we could cover the floor and get to him."

The staffer went on to report:

"As we entered the room, he took the razor, looked at us and in 'one clean swipe' he made cuts up both arms. He then squeezed his arms to force the blood out. I can still see the look on his face..."

Mr. Jones lived.

St. E's can still be a rough place. For it's roughly 300 patients last year, there were 388 physical assaults. In July and August, there were 88 assaults on patients and staff. This past year, there were also 63 reports of "abuse, neglect or exploitation" as well as 10 sexual assaults, and 342 reports of physical injury–of which 158 were the result of physical assaults.

There's more bad stats after the jump.

At St. E's last year there were seven suicide attempts and 12 deaths. University Legal Services quotes hospital officials acknowledging the violence is higher than national stats: "The patient injury rate of the Hospital in FY10...is not only significantly higher than the national public rate...but a critical increase from its FY09 patient injury rate...Patient injuries significantly increased since April 2010 and staff injuries increased since May 2010."

During the course of its investigative work, the lawyers found "nurses who failed to do adequate assessments or keep adequate records of the care provided. Six of the seven individuals had serious medical conditions that were not addressed in a professional or competent way."

The lawyers also found patients who had previously been victims of rape who were repeatedly restrained by men, one well-known suicide risk who was given razor blades and had then gone to horrifically cut himself, and another patient who died shortly after being admitted into St. E's. She had a history of pulmonary embolisms, the report states, and yet when she arrived at the mental hospital, she wasn't given any meds for her condition. "There were no records of nurses at St. Elizabeths monitoring her for symptoms of this disorder or any suggestion that St. Elizabeths was even aware of this problem," the report states.

The report goes on to cite a Department of Justice letter sent to a D.C. Assistant Attorney General dated Jan. 5, 2011 which addresses staff alleged indifference toward patients. The letter states: "Although some staff demonstrated and verbalized a caring attitude toward individuals, others were entirely disengaged, often milling back and forth between work areas and areas where individuals were sitting."

The Hospitals own assessment report dated Oct. 7, 2010, the lawyers found, provides zero mentions of the violent attacks as well as very little attention toward staff training.

We will have more on this report in subsequent posts. To read the lawyers' report in its entirety, go here.

Today, the Washington Post chronicled Jared Loughner's journey from IHOP-loving Normal to alleged Killer. The AP wrote its own Loughner bio with shitty poetry. These stories were your typical five-days-since-Tragedy  stockpile of reporting, fast-paced Dateline-esque narrative, and limp attempts at explaining mental illness (From WaPo: "And then Jared Loughner slipped into a world of fantasy that was no online game.")

We've all read this story before. As a reporter, I've done this story many, many times over the years.

There was the case of Osman Abdullahi.

There was the case of David Kerstetter.

There was the case of Seung Hui Cho. And before Cho, William Charles Morva attempted to terrorize the Virginia Tech campus.

And there was the case of Kyle Hulbert.

These were just the young men I wrote about since 2001. Young men who suffered through mental breakdowns or moments of crisis without adequate government interventions, who ran out of meds, who ended up in an unregulated group home, who got ignored. Kerstetter didn't hurt anybody before he was killed by police in his own bathroom. These are just the infamous cases of alleged police breakdowns, murder, and massacre. What about the kids no one reads about?

A new study by the Rand corporation found that 60 percent of D.C. adults diagnosed with depression and enrolled in a medicaid managed care organization did not receive treatment. That same study found that 72 percent of D.C. children with depression also went without treatment. Another recent report noted that even kids who enter into our juvenile-justice system do receive adequate mental-health treatment.

What are we going to do about those kids?

*file photo by Darrow Montgomery.

Ellington, a Department of Mental Health administrator, suggested the city may in fact be hurting Jumiya. On August 20, 2009, she seemed to sum up Jumiya's dilemma:

"The effort to get her to a residential has placed her at risk in the community and not helped with engaging her in the treatment process. She has decreased her trust in the public system and the belief that we can help meet her needs. We have an opportunity to meet her where she is and truly provide her with a team that will persist in supporting her and her family until things bet better."

Every child-welfare worker might agree on the sentiment. But that doesn't mean they are willing to follow it. A few weeks ago, Ellington resigned from her post at the Department of Mental Health. Now, who does Jumiya have that will get her needs?

You can read the city's first on-the-record response to Jumiya's story here.

During last week's oversight hearing on the Department of Mental Health, there was an opportunity for Councilmember David Catania to fire up his inner prosecutor and start asking some tough questions about what happened on the morning of Nov. 6.

On that morning, two police officers responded to David Kerstetter's Logan Circle home. The two cops knew that Kerstetter was mentally-ill and that he was in crisis. The officers did not quite know what to do. They waited outside his home for roughly a half hour. They called their supervisor. They tried calling Kerstetter's therapist.

The officers should have called DMH's mobile crisis response team. Instead, they went inside Kerstetter's home. Kerstetter ended up being shot multiple times and died. He allegedly came at the officers with a knife and a struggle ensued. [The evidence casts serious doubt on that narrative]. While a standard MOU had yet to be signed between DMH and D.C. Police, the existence of the mobile crisis team was known all the way up to the highest levels of the police department.

So I waited for Kerstetter's name to be invoked. And I waited for Catania to ask some tough questions. Instead, Catania played it safe and gentle.

When the subject of mobile crisis and police-DMH cooperation came up, Catania offered this limp assessment:

“You don’t always get it right," he said.  "You got to have to have those systems willing to back each other up…That’s part of the beauty here. I’m very pleased with the collaboration going on there.”

“Everything isn’t neat in a crisis,” Catania went on to say. So much for deep insight.

David Kerstetter was never mentioned. Maybe he came up later in the hearing. I'm still watching the hours of testimony. But that moment would have been the moment to start asking some tough questions about the morning of November 6.

At last week's hearing on the Department of Mental Health, Councilmember David Catania revealed the cost to house one person for one year at St. Elizabeths.

Guess how much?

About $280,000 per year.

"That is an enormous amount of money," Catania said in what has to be the understatement of the day. There are so many reasons the money isn't worth it. University Legal Services has found plenty of reasons.

Catania referred to these services at St. Es as "inferior" compared to a private facility and by paying these huge fees we've "cheated everybody."

But opponents to the proposal say private clinics are not as well staffed and can close without notice.

The Post writes:

"Critics of the District's plan to transfer 4,000 clients say that the staffs at the public clinics are better paid, are better trained and tend to stay on the job longer than at private clinics. Those critics — clients, psychiatrists, caseworkers and union leaders representing workers who stand to lose their jobs — have a vested interest in keeping the clinics open. But others, such as Ken Duckworth, medical director for the National Alliance on Mental Health, also raise similar concerns.

'Outpatient mental health is notoriously difficult to fund,' Duckworth said. 'The clinics soon realize that doctors are expensive and want fewer of them. Doctors get overwhelmed and say, 'I didn't come here for this.' '"

But DMH was basically told to make the move:

"A court monitor requested that within three years the city determine whether private providers could do the same work. Last year, an audit commissioned by the city concluded that private clinics were more cash-efficient than public clinics and could do the job if the city helped them build their staff and facilities."

We addressed the private takeover of group homes in the story of Osman Abdullahi's death.

As I documented in this week's cover story on Osman Abdullahi's death, the problems at 830 7th Street NE were vast. Abdullahi was left without meds in a house without heat and very little food. There was the thinnest of safety nets for Abdullahi and his fellow tenants. After the shooting, the building's manager Mark Spence simply shut the home down. Without the proper notification or going through Landlord-Tenant Court, he kicked everyone out and locked the doors. Last Friday, I reported that city officials still aren't sure where the tenants ended up.

An unlicensed home means simply that the tenants are left in particularly vulnerable positions. But one former Spence tenant did fight his eviction. He took Spence to court.

After the Department of Mental Health in 2003 ordered its staff and service providers from ever placing its people in Spence's homes, Spence continued to operate unabated. One tenant took him to court.

In December 2003, Lawrence Winston filed a wrongful eviction civil suit against Spence. He sought a temporary restraining order and $6,000 in damages. He alleged that Spence had not only evicted him without notice but took all of his belongings (TV, sofa, other electronic equipment).

Winston wrote to the court: "I don't know where anything is. I have no food, clothes, or place to stay for me or my son."

A Superior Court judge granted Winston the restraining order and then extended it–ordering Spence to allow Winston to return to his apartment and give him back his possessions. The judge wrote that Spence "is not to harass plaintiff in any manner" and that Winston's personal property must be returned by January 30, 2004.

I asked Spence about Winston. He says Winston was referred to him by a church. He claims that Winston didn't pay rent. "He's a get-over artist," Spence says. "I didn't have any of his stuff. I never had his stuff. He did that to just say something to go down to civil court. He didn't have nothing but a bag when he came [to me]....He's a con artist. I felt played."

On June 14, 2004, Winston filed a motion against Spence for contempt. Spence still hadn't returned his things. On August 6, a judge found Spence in contempt.

A few years later, a landlord sued Spence for more than $7,000 in unpaid rent over an apartment he had given to a mentally-ill man. The landlord refused comment for this piece (they had another case against Spence as well).

"They no longer wanted those clients in the apartment," Spence says. "They wanted to remove the clients so that's what they did. They were paid up in full. That was just their way of going to court."

On January 26, Osman Abdullahi was gunned down by D.C. Police after an altercation inside his unlicensed group home. The home, located at 830 7th Street NE, had no heat, very little food, and no supervision. Abdullahi wasn't taking his medication at the time. The home's manager Mark Spence has a long history with troubled group homes. We published a cover story on Spence's activities and Abdullahi this week.

Within a few days of the incident, Spence effectively shutdown his group home. The lights were turned off. The doors were locked. A mysterious notice to "correct" or "vacate" was placed on the door.

The Department of Consumer and Regulatory Affairs told me they have no record of posting such a notice on the door of 830 7th Street NE. The notice cited overcrowding as an issue. Spence had 30 days to correct the overcrowding problem or face some kind of fine or eviction. I saw the notice. The notice did not have DCRA letterhead or a name and phone number of an inspector who made the determination.

I asked Spence about the note. He told me the building's owner could have posted it. He added that he had cleared everyone out of the building. This is a clear violation of landlord-tenant regs. No one stopped Mr. Spence from ignoring the law.

The Office of the D.C. Long-Term Care Ombudsman Program has had frequent encounters with Spence’s work, dating to 1999, according to Jerry Kasunic, the office’s current director.

Today, Kasunic met with the Department of Mental Health. He had one question for the department: Where did the residents of 830 7th Street NE go?

The department's answer: We don't know.

Kasunic sounded frustrated on the phone. "I don't know where they went," he says. "I want to make sure they have support services that they need whether its medical, psychiatric, any kind of coaching and counseling."

Kasunic had just gotten back from his meeting with DMH officials. He says he hopes to have information on the residents within a week or two.

"The longer the people are without the proper support systems the better the chance that someone is going to relapse and end up in an ER room or a psych unit," Kasunic says. "They need the proper case management."

If Spence was a licensed provider, the residents of 830 7th Street would have been given a 21-day notice of eviction, counseling before the 21-day notice, and a proper transfer to another facility or group home.

Instead, the residents were just dumped. “No one is stepping up to the plate to find these people,” Kasunic says.

Look at it. Go ahead and stare. This is what a District group house looks like. This is the scene from the Jan. 26th police shooting death of Osman Abdullahi. He had been suffering from schizophrenia. He had been living at this group home, located at 830 7th St. NE, since Nov. 1.

The Department of Mental Health has repeatedly stressed that this was not technically a group home. It was not one of their own. It had not been licensed as one. It didn't get a handy acronym that I won't even bother explaining. It didn't have the proper paperwork. But it was a group home. Many of its tenants were mentally ill. [All five I talked to or researched had been in the system]. All were unsupervised. This house had a history, a backstory. Abdullahi had a story, too. We first wrote about the incident later that night. I get to expand on my reporting for this week's cover.

While DMH gets to breathe a sigh of relief that this wasn't one of their own homes, its people were still inside. Its people were living without food, without heat, without meds, without supervision. So take a look at where some D.C. residents were living. Who's going to prevent this from happening again? Who's going to make sure there's someone competent watching over our most vulnerable? While DMH is investigating the house, the big question is: Did any of their people ever do a site visit, ever actually come to the house?

More pictures after the jump.

The kitchen sink as of January 27.

The freezer.

The cupboards.

I will be posting more pictures of 830 7th St. NE throughout the week.

The incident happened shortly before 11 a.m. While there was some back and forth over whether the home was a group home, it is a rooming house that does include people who are mentally ill. One former resident I interviewed said that he had been referred to the house by a psych facility. "This is supposed to be a community residential facility," said the former resident of his one-time 7th Street home.

Tonight, the home was empty except for two residents. The former resident was on the scene as well. He talked about the man who had been shot and killed by police. He knew him as "Osmond." Police released his name a few hours ago. His name is Osman A. Abdullahi. He was 36. The former resident said that Osman could be delusional, that he talked often about people out to get him. Some of Osman's enemies were from Alaska. "I would say he was schizophrenic," said the resident. "He talked about people coming to get him."

A month ago, he says, he saw Osman laying on his bed. "He had a butcher knife under [the] covers," he recalled. "He was worried about his roommates. He said the roommates were talking in their sleep about him."

This morning, Osman, attacked one of his roommates, a senior citizen, someone the two current residents referred to only as "Lewis." Grant Osborne, 57, a resident at the 7th Street home, says he woke up this morning to Osman standing in the doorway with a knife. He was fuming about his same old problem: People were out to get him. They were coming for him. Osborne didn't understand. The shades were drawn.

Osborne remembers the police breaking down the door. He heard the police ask Osman multiple times to drop his weapon. He says he heard one shot.

Osborne is speaking from his stoop. He is dressed in sweat pants, a sweat shirt and jacket. He is wearing a knitcap. It is 6:15 p.m. Soon two members of the Department of Mental Health's mobile crisis unit show up at the stoop. They offer to talk to Osborne and another resident. They want to talk inside where it is supposedly warm.

When they open the door to 730 8th Street, it is immediately apparent that inside will not work. There is blood in the foyer. It has pooled and congealed in spots. In one area, there is a small squiggle of bloody flesh.

Blood splatter or blood smears are on the lower right corner of the wall. Mobile Crisis calls it in. They want to see about getting this cleaned up. "There's still blood on the floor," one tells the authorities. "Nobody's here except for the people that live here."

"There is blood in the hallway," she tells the police during a second call. "This is a biohazard." It is 6:45 p.m. Police say they are done with the crime scene. It isn't their job to clean up the blood. A police cruiser soon passes by. And then another.

The carpet is drenched with blood and fluids. It's not quite a carpet. It looks like the foam layer that comes with the carpet. The foam is duct taped to the floor and stairs. In the kitchen, the sink is stopped up. The garbage disposal switch does nothing. Also, Osborne says one of the bathrooms is "messed up."

The former resident says he had to move because his bedroom had a mold problem. The former resident eventually leaves. He says he is headed for a niece's house in Maryland. He carries with him a loaded down garbage bag. If anyone needs him, he says, he will be at a local psych facility in the morning.

It is freezing inside 830 7th Street. Osborne says sometimes the heat comes on. Sometimes it's just cold. Upstairs there is a blood stain in the hall.

There is no one there to supervise the men. There is no one there to make sure the heat works, to clean up all the blood on the floor. Mobile Crisis makes a call to the proprietor–Mark Spence of an organization called "Hope Finders." Mobile Crisis has to leave a message.The men say they haven't seen him in a while.

I later reach Spence. He says that he has yet to visit his property since the shooting death of Osmond. "I wasn't down there," he says. "I know all about it. I really don't have any comment."

Osborne says he has been living at 830 7th Street for no more than a year. When he first arrived, he says, "everything was brand new." He doesn't know how many group homes or rooming houses he's lived in. There was one in Baltimore. There was a stay at the Psychiatric Institute of Washington. Now, there is uncertainty.

The two employees from Mobile Crisis do not think it is a good idea for Osborne to stay at 830 7th Street. They bring up the blood.

Osborne is prepared to leave, he says. He agrees to get in their van and find other shelter options. He tells one of the employees that he left all of his clothes and belongings in his first-floor room. But that he doesn't care. The employee assures him that he can get more clothes. All he carries with him to the van is a small, half-filled plastic bag. His nose is running. His sweat pants have seen better days. But his tan work boots look new. Osborne takes a seat in the far back corner of the van.

Osborne just stares out the window and takes in the car's heat.

There is one resident left at 830 7th Street NE. He tells mobile crisis that he doesn't want to go with them in their van. There is not much else mobile crisis can do. The resident quietly closes the door, walks back across the blood, and on inside.

The stations will be parked along the parade route, at Union Station and at RFK Stadium. Not sure why RFK. Maybe that's where the buses will be idling. The spots along the parade route or near the parade route include one at L'Enfant Plaza, two on the south side of Pennsylvania Avenue, and two on the north side of Pennsylvania Avenue.

"The teams will provide emergency care to people who are experiencing a crisis who need stabilization and will transport involuntarily to [be evaluated] if necessary.  The teams also will do screenings and/or referrals," writes Phyllis Jones, DMH's spokesperson in an e-mail.

It is possible, Jones says, that team members will be out roving the crowds checking for people who are in distress. They aren't just going to wait for you to visit one of its tents.

Also, the mobile crisis response teams will be taking calls. Starting January 17, they will have five teams of two staffers working from 9 a.m. to 1 a.m.