Smaller hospitals for mentally ill

April 07, 1999|By Brenda K. Hohman and Carolyn C. Knight

A SUN article published March 14 concerning the future of state mental hospitals, many of which are empty, accurately portrayed the deteriorated conditions of such facilities.

Unfortunately, the article revealed a bias toward closing such hospitals and failed to adequately explore the many reasons that people may need that level of care.

The article framed the choice as one of keeping the 200-plus acre campuses or closing them down. That is a false choice.

The third, and better, option is to maintain small, reasonably modern regional hospitals on small properties. It is very unwise to envision one central hospital with 1,000 beds.

The National Association of State Mental Health Directors has determined that the optimum size for a psychiatric hospital is 250 beds. This provides for quality care and efficient operation. It does not preclude the use of smaller facilities in geographically isolated regions.

Part of community

Regional hospitals provide the greatest accessibility to patients and their families, as well as the opportunity for close collaboration with other community programs. In essence, the regional hospital is part of, not separate from, a community of caring programs and services for people with such illnesses as schizophrenia, bipolar disorder and major depression.

We must also challenge the assertion that community-based care is in all cases dramatically less expensive than hospital care. After all, hospital costs include housing, food, 24-hour nursing care, medication, professional services (medical, dental and eye care) and diagnostics, all for about $330 per day.

Over the past 20 years, community-based programs have absorbed thousands of people who are mildly to moderately mentally ill. People who remain hospitalized are very sick and, typically, have failed to adapt to community-based programs. Many have never responded to any of the available drug treatments, have repeatedly stopped treatment or have significant additional medical problems.

Those who fail such programs go back to the hospital, to the streets or to jail. The state's Mental Hygiene Administration is studying the cost of such care and is planning to release 100 of the more difficult-to-place patients. The estimate is that it will cost about $80,000 per year to adequately care for one of these patients outside the hospital.

The cost of inpatient care could be reduced greatly by selling surrounding hospital grounds and getting rid of unused buildings -- but keeping the hospitals.

Also, proceeds from the sale of such properties should go for services for the mentally ill as is required under state law. This has not happened. We were alarmed to read in The Sun that Gov. Parris N. Glendening has given 550 acres of the Crownsville Hospital Center outside Annapolis to the local community.

While we do not begrudge the community green space to benefit its citizens, we are concerned that Maryland is giving away land that could be sold.

On the map accompanying the story, it was misleading to show Clifton T. Perkins Hospital Center as simply another redundant centrally located facility, with no mention of its special mission. It is a facility for people who have committed crimes and are either not yet competent to stand trial or have been found not criminally responsible due to their mental illness.

Court control

Finally, up to 30 percent of the population in each of the other hospitals consists of patients under the control of the criminal courts. This effectively reduces beds available for general psychiatric care.

Families are not the obstructionists we were portrayed to be in the discussion over the future of such hospitals. But we are experienced with these problems and we are pragmatic. We are huge proponents of comprehensive community-based care for our loved ones who have brain disorders.

In the past 18 months, the board of directors of the National Alliance for the Mentally Ill of Maryland toured six of Maryland's eight psychiatric hospitals. We serve on the Governor's Work Group on Hospital Bed Needs and have studied the issue carefully.

We support Maryland's efforts to have psychiatric inpatient services easily accessible to people across the state. It is abundantly clear that we can do this, and do it in a way that is cost effective for Maryland's taxpayers.

Brenda K. Hohman is executive director and Carolyn C. Knight is president of the National Alliance for the Mentally Ill of Maryland, a statewide volunteer advocacy support organization for families and consumers.

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