Closing of home for mentally ill criticized Some say state plan to deinstitutionalize is costly, disruptive

December 01, 1998|By Mary Gail Hare | Mary Gail Hare,SUN STAFF

For Robert Spalding, home is a two-story brick house on the grounds of a state mental hospital in Sykesville. There, he and several dozen other mentally ill residents have formed deep friendships in the past decade, celebrating one another's birthdays, planting chrysanthemums and decorating the walls with bright posters.

"This is better than any place I have ever been and I have been through a slew of them," said Spalding, who at 31 is the youngest of 40 residents of Freedom House at Springfield Hospital Center.

The state is closing the home, saying that its lifestyle is too restrictive, even for its long-term residents. The state, as part of its effort to deinstitutionalize mental hospitals, will begin moving the residents of Freedom House into the community in about six months.

Doctors, family members and residents question the decision, calling it costly and disruptive.

"These people have been deinstitutionalized already," said Frederick K. Schilling Jr., 77, whose 50-year-old autistic son has lived at Freedom House since 1990. "This program is good for taxpayers."

Any program at a state institution is too restrictive, state officials say, although many Freedom House residents have failed at the same community programs the state has in mind for them.

"I don't know what to expect when I get out there," said Spalding. "I have been before and it didn't work. I need the structure and the support I have here."

Like the other residents, Fred Schilling III is free to move around the campus or call for transportation to malls and restaurants. He also works at Goodwill Industries doing sorting and packaging.

"Fred may be stabilized, but he is still mentally ill," said his father. "You see people like him wandering the streets. The state is trying to relieve itself of responsibility by pushing these people off into the community."

Schilling's son, who has been in state hospitals for 30 years, has written to Gov. Parris N. Glendening.

"Please relent and keep it open," Fred Schilling III wrote Oct. 27. "It would mean a lot to me and the other residents there." As of Nov. 23, he had received no reply.

The younger Schilling's time at Freedom House, which overlooks tree-covered hills in southern Carroll County, has been "the most creative, innovative way to handle chronic mentally ill people," his father said. "Fred loves it there and has bonded with the other residents."

The elder Schilling said he is reaching the end of his days. He would like his son to remain where he feels most at home and where he receives good care.

Dr. Marcio V. Pinheiro, a staff psychiatrist who helped establish Freedom House in 1989, estimates that about one-third of the patients who go to Springfield need the kind of long-term residential care that Freedom House offers. "There is a core of patients who need the community of a state hospital," he said.

Peace at last

Ending a successful program is neither fiscally prudent nor in the residents' best interests, he said.

"At Freedom House, they finally found a place where they could live their lives in peace without the threat of being pushed here and there for administrative reasons," Pinheiro said.

"They have gone through all kinds of treatments and attempts at community placements until they moved here and retired from being patients," he said. "It is the only place in the hospital where patients don't bug you about leaving."

Springfield, a 102-year-old hospital that cared for nearly 1,000 patients at its peak, has about 350. Freedom House residents, whose average age is in the mid-50s, are not included in that number.

Freedom House provides the least-costly level of care -- $43,800 a year per resident -- at the hospital, said Dr. Sherrill C. Cheeks, clinical director at Springfield. Programs for the hospital's more acutely ill cost about $70,000 per patient per year.

Community care costs

Community-care program costs range from $40,000 to $70,000 a year, said Tim Santoni, deputy director for the Mental Hygiene Administration.

"The basic principle is to treat a patient in the least restrictive environment that provides safety and quality of life," said Cheeks. "The Department of Health and Mental Hygiene has said Freedom House is not the least restrictive environment. Basically, these people could live in the community, given the appropriate setting."

Pinheiro said the state might be bowing to pressure from community services groups that "are forever pushing to get patients out of the hospital."

"Too many believe everybody can be treated out there," Pinheiro said. "But a lot of those at Freedom House will not make it and will be back at the hospital -- maybe as many as two-thirds."

Rules of the house

Residents of Freedom House must abide by rules of behavior and take responsibility for themselves and their rooms. They take out the trash and do their laundry.

They fill their days. A few, like Schilling, have jobs. Others go to area senior centers. One woman is taking English lessons on campus.

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