State studies escape policy Mentally ill patients assessed

August 31, 1993|By Deidre Nerreau McCabe | Deidre Nerreau McCabe,Staff Writer

When 20 professionals from throughout the state met at Crownsville Hospital Center yesterday to review escape policies for mentally ill patients, their mission was to hammer out new procedures in the wake of a patient death last month.

But finding solutions, they discovered, won't be easy.

State police and hospital security guards, responsible for searching for escaped patients, talked about manpower shortages limiting their ability to launch active searches.

And hospital staff focused on the need to protect patients' rights, questioning whether aggressive searches are needed every time a patient wanders off.

"We have to [screen] patients to determine if there's really a risk," said David Helsel, clinical director of Spring Grove Hospital Center in Catonsville.

"We've worked hard for patients' rights," he said, adding that he opposed strict security and higher fences in the name of protecting patients. "To be clinically effective, we've got to allow some risk."

But advocates for the mentally ill question the level of supervision and manner of searching for patients that led to the death of George F. Berry III, 30, last month. His decomposing body was found on the hottest days of the year in woods less than 1 1/2 miles from Crownsville Hospital Center.

Mr. Berry, who apparently died of heat exhaustion and dehydration after jumping a 5-foot fence, wandered by himself once he left hospital grounds.

When mental health advocates learned no one actively searched for him despite the extreme heat and his fragile medical state -- his mother, Joanah Berry, said he was on three anti-psychotic medications -- they called for immediate changes in hospital search policies.

"The bottom line is the safety of the patient, not whether all the paperwork is filled out properly," said Marguerite Bridge, president of the Maryland Alliance for the Mentally Ill. AMI has called for changes in state policy to require more aggressive searches, better supervision of patients, immediate notification of family members and more secure facilities.

But Paul Lurz, chief of social work at Crownsville, said he worried the recent tragedy might prompt an overreaction. "I hope we're not going to see more fences at Crownsville," he said.

"Unless we throw up 22-foot fences, people will [get out]," said Alice Shannon, acting clinical director of Clifton T. Perkins Hospital Center, Maryland's hospital for the criminally mentally ill.

Mr. Lurz suggested that increased supervision and better evaluation of patients' ability to care for themselves if they escape would be far preferable to returning to more prison-like hospital settings.

If a patient is considered high-risk, he said, "We could pull in more resources to search."

In the fiscal year ending June 30, almost 500 patients from Maryland's nine psychiatric hospitals wandered off, escaped or did not return from overnight passes to visit family, state health department spokesmen said.

Most are found by hospital security guards on the grounds or nearby roads, end up at relatives' homes or return by themselves, hospital staff said. But unless patients are court-ordered to a facility for criminal activity, state police do not actively search for them. County police don't search either, because psychiatric hospitals are state facilities.

For involuntarily committed patients who are not court-ordered, search policies don't go far enough, mental health advocates said.

"We search a lot harder if they're a risk to others than we do if they are a risk to themselves," Dr. Bridge said. "In a sense, they are penalized if they haven't committed a crime."

Members of the search policy task force -- which was called by

Crownsville's new superintendent, Haroon R. Ansari -- will meet twice more before drafting a plan for policy changes.

Dr. Ansari said he hopes to give a final report to the state's Mental Hygiene Administration within 90 days.

Whether the proposals can be achieved through state policy or will require new laws regarding the care of the mentally ill is not known.

Dr. Stuart Silver, director of the state Mental Hygiene Administration, said he applauded Dr. Ansari's efforts to improve the policies and expects that changes recommended by the task force will be adopted statewide.

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