Chestertown hospital eyed for closure

State continues efforts to reduce psychiatric facilities

Admissions on the rise

$57 million would go toward services for extremely mentally ill

June 13, 1999|By Jackie Powder | Jackie Powder,SUN STAFF

Even though admissions to Maryland's state psychiatric hospitals are on the rise, a state committee is recommending closure of an Eastern Shore facility, and the elimination of 350 inpatient beds across the state.

Still in draft form, the panel's report is part of the state's efforts to reduce the populations of eight Maryland psychiatric hospitals. While the draft recommends closing the Upper Shore Community Mental Health Center in Chestertown and cutting beds elsewhere, it suggests allocating $57 million for services that would allow for the release of the extremely mentally ill from hospitals over the next five years.

Under the proposal, housing with 24-hour supervision, crisis intervention and mobile treatment could free patients from institutions. Savings achieved through the attrition of more than 600 hospital employees who would no longer be needed could help cover the cost of community care, though an additional $35 million from the state would be required.

If the plan is adopted, about 1,100 inpatient beds for the mentally ill would be left at state psychiatric hospitals.

Thirty years ago, before deinstitutionalization of psychiatric hospitals led to the development of community-based treatment programs for the mentally ill, these facilities served an average of 7,500 patients a day. Now, many of the turn-of-the-century hospital buildings stand vacant on sprawling campuses spanning hundreds of acres. Sale of this surplus land could create money for com- munity mental health services, according to the report.

A General Assembly budget committee requested the report a year ago from the Hospital Beds Needs Assessment Committee -- made up of mental health professionals and state health officials -- to determine how to shift more hospital patients into community programs.

By recommending that the 36-bed Upper Shore Community Mental Health Center be shut down in 2001, the committee avoided a more controversial decision to close one of the "big three" psychiatric hospitals in Central Maryland.

Patients at the Chestertown facility would move to the Eastern Shore Hospital Center in Cambridge, scheduled for completion in July 2000. The report calls for the vacated Upper Shore hospital to become a treatment center -- under the oversight of another state agency -- for individuals with substance abuse problems and mental illness.

Twice in the past 12 years, other commissions reporting to the state have called for closing one of the big three hospitals -- Crownsville Hospital Center outside Annapolis, Spring Grove Hospital Center in Catonsville and Springfield Hospital Center in Sykesville -- but state health officials have backed off in the face of strong public opposition.

"Given the political realities of hospital closure, I think this is the best we can do," said committee member Herb Cromwell, executive director of the Maryland Association of Psychiatric Support Services, which represents community-based providers serving the mentally ill.

He pointed out that while hospital admissions have decreased in the state's eastern and western regions, the big three hospitals are operating at or above capacity.

"There's still a lot of pressure on these beds for use," Cromwell said.

Hospital officials say the state's goal is ambitious, given the recent increase in admissions and the severity of mental illnesses among the patients now targeted for discharge. Some of these patients have been hospitalized for decades.

"The type of patients that we're wanting to place now really do require round-the-clock supervision," said Dr. Mark Pecevich, superintendent at Spring Grove. He still praised the multiyear structure of the proposal.

"It allows time to develop resources in the community we don't have right now," he said.

That is not enough to persuade the Maryland Chapter of the National Alliance for the Mentally Ill to endorse further emptying of state hospitals.

"How can the state even think about downsizing when there hasn't been a statewide needs assessment and admissions are up?" asked Brenda K. Hohman, executive director for the alliance and a committee member.

She said the recommendations in the draft report are based in part on a partial assessment that included state hospital patients but didn't evaluate jails or homeless shelters, where many of the state's mentally ill are inappropriately warehoused.

"We agree the physical facilities need to be smaller, more efficient campuses, and we support improved community services, but we question the wisdom of reducing the number of hospital beds," Hohman said.

The report to legislators calls for reducing the average daily population at state psychiatric hospitals -- now 1,350 -- by 350 over the next five years. The goal is for 70 patients to be discharged each year.

"These 350 long-term residents are those with the greatest number of behavioral, social, legal and somatic problems," the draft states. "In many cases they have not succeeded in community placements."

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