They arrive on the doorsteps of the aging admission building, returned from the streets, sent from emergency rooms, nursing homes and jails. They are drug addicts, mentally retarded, the elderly and criminals.
With no place left to go, they come to Spring Grove Hospital Center, the state's oldest repository for troubled minds.
"We have become society's answer for all of its problems," said ** Dr. Sharon Murphy, a psychiatrist at Spring Grove's Dayhoff admissions building. "We're the dumping ground."
While state mental hospitals have long been a catch-all, the trend has escalated during the past decade. Now, Spring Grove -- the oldest and most neglected of Maryland's 12 psychiatric hospitals -- is overwhelmed with patients whose mental illness -- often seems secondary to other problems.
With severe staffing shortages and deteriorating buildings, the hospital is one of the few in the nation that can't meet standards set by the federal government or a private commission for accreditation. On overcrowded wards, patients sleep on cots rolled into dayrooms and hallways. They spend hours slumped in chairs, with little in the way of jobs or other therapeutic activity to fill boring hours.
Increasingly, Spring Grove abandons treatment of patients, settling instead for mere supervision. Yet last year, the staff failed to closely monitor two patients who slipped away and killed themselves. To control patients, more and more often the beleaguered nurses and aides lock them in seclusion rooms or tie them to chairs. Still, the volatile mix of patients has meant frequent serious injuries to staffers and patients.
The violence has increased, said Dr. Bruce L. Regan, since he arrived as Spring Grove's superintendent four years ago. "This is a more dangerous place for patients to be," he said.
While conditions at "The Grove" are worse than at many other public mental hospitals, other institutions across the nation share its plight.
Criticized as overcrowded asylums, hospitals began shrinking and discharging patients during the 1960s and '70s. With the help of anti-psychotic drugs, many patients returned to their families. Thousands, however, became homeless, winding up on the streets or in jail. Others competed for few housing spots in communities uncomfortable with having the mentally ill live next door.
Described as "Maryland's shame"
Today, about 600 patients stay at Spring Grove's sprawling campus off Interstate 695 in Catonsville, where 2,500 lived in horrible conditions described as "Maryland's shame" by newspapers during the 1950s. Many of the 70 buildings are empty now, boarded up or used for storage. Some are rented to other community programs.
Maryland spends more per capita than most states to fund a vast network of mental hospitals and community-based programs. In an era of tight budgets, however, neither is faring well. And, as other programs like drug treatment and welfare get cut, state hospitals like Spring Grove face an influx of patients they can't begin to treat.
"When something shuts down, we get them," said Judy Parker, director of Spring Grove's extended care division.
Last fall, for example, JoAnne Epps left Great Oaks Center in Prince George's County as the state institution for the mentally retarded began cutting its population. A 34-year-old autistic woman who lived for five years at Great Oaks in a locked cottage with adults so profoundly retarded they rarely spoke, Ms. Epps was placed in a supervised apartment in Randallstown.
"No other place to go"
Since then, she has been in and out of Spring Grove because of violent outbursts and attempts to hurt herself. In July, she broke all the windows in her apartment. Soon after arriving at Spring Grove, the 340-pound woman tried to strangle her psychiatrist and cut herself with a toilet paper holder.
Within a month, Ms. Epps was stabilized on medication, but Spring Grove workers said they had no skills to deal with her mental retardation. She went to another supervised apartment last month. Hospital officials expect that she -- and others like her -- will be back.
"There's no other place with a locked door for them to go," said Dr. Regan.
Judy Parker walks down the grassy slope, past patients sleeping on the lawn or sitting and smoking cigarettes. She unlocks the double wooden doors with her key, walks inside and unlocks a screened door leading onto the wards.
"What you're gonna see in here is a real mess," said Ms. Parker.
The 39-year-old building known as Red Brick 3 once held patients who had hopes of going home within months. Now, it also houses the chronically ill, those who have little chance of leaving and demand considerable attention.
Patients here include a 47-year-old schizophrenic who has called "the Grove" home since he was 10 years old. A severely brain-damaged woman who was homeless. A handicapped young man, arrested nine years ago for attempted rape, who bounced from institution to institution. A drug addict who has destroyed his brain with PCP and cocaine.