Assisting the mentally ill at one-third the cost

May 10, 1994|By Laura Lippman | Laura Lippman,Sun Staff Writer

At a state mental hospital, it costs an average of $100,000 a year to keep an indigent patient. The same person could receive adequate assistance while living in the community for less than one-third of that cost under a pilot program announced yesterday by the Department of Health and Mental Hygiene.

The project, outlined at a news conference, will pay $29,000 per person, enabling 200 chronically mentally ill people to stay out of state hospitals. Another 100 patients, identified as "high cost" Medicaid recipients, also will get certain services, in hopes of cutting down their emergency room visits and hospital stays. Overall, the pilot project will cost about $6.9 million in state and federal funds, but the state ultimately should save money, Dr. Silber said, as Maryland's three mental hospitals close wards and let attrition reduce their staffs.

The funds will be unusually flexible, allowing treatment to be tailored to meet individual needs. For example, a client could receive rent assistance, in addition to psychiatric care and visits from a social worker. Or the money allocated could pay for a washing machine or a membership at the YMCA -- anything that would help the client stay out of the hospital. The assistance might even include help finding a job.

Inspired by similar approaches in Rhode Island and New York, Maryland's project also resembles the state's effort to keep children out of foster care by providing money that could be used to pay for a child's winter coat, or a week's worth of groceries.

"The flexibility of the program is what drives it," said Steve Baron, president of Baltimore Mental Health Systems, which will manage the project, allocating funds to the two providers, the Johns Hopkins Bayview Medical Center and North Baltimore Community Mental Health Service.

The program's manager, which receives a 5 percent fee for administrative costs, may keep any money saved and use the savings as incentives. For example, if the average cost per patient is $20,000 at year's end, the money left over would go to Baltimore Mental Health Systems. But if a client returns to the hospital, Baltimore Mental Health Systems would be expected to make up the difference for any care that costs more than the $29,000 allocated for the year.

"We hope this project will demonstrate that persons with severe and persistent mental illness can succeed in the community," said Health and Mental Hygiene Secretary Nelson J. Sabatini.

The 200 clients, who will volunteer for the program, must have been hospitalized for at least six months to qualify, said Dr. Stuart B. Silver, director of the state's Mental Hygiene Administration. Most are expected to live in Baltimore, near one of the two centers.

The first participant, hospitalized for nine years, has already been chosen and has found a place to live in Baltimore. This patient will be followed by others, in groups of 26 -- typically, the size of a ward. With each group of 26, the state should be able to close hospital wards, creating the savings that is expected to pay for the program.

The three hospitals -- Spring Grove in Baltimore County, Springfield in Carroll County and Crownsville in Anne Arundel County -- are expected to have an average daily inpatient population that totals almost 1,000 in the fiscal year that begins July 1.

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