For 87 days, Mark Wheatley has been locked in a psychiatric ward at Johns Hopkins Hospital. The Baltimore man was ready to leave two months ago, but no person, no agency would take him: In addition to having a psychiatric problem, he is also mentally retarded.
While waiting for a home, Wheatley, 29, endured the taunts of other patients, who were troubled mentally but of normal intelligence. He was restrained and shut in seclusion rooms. He had to watch everyone else go home.
Today, Wheatley, who has a mental age of 5, may finally leave. But physicians know there will be another Mark Wheatley soon enough.
Up to a third of the people with developmental disabilities also suffer from a psychiatric condition, experts say.
When patients such as Wheatley, who has emotional and behavioral disorders, get out of control, they often land in emergency rooms and are admitted to inpatient psychiatric units. But when they're ready to be discharged, families or group homes often can't or won't take them back. Asked for help, state agencies charged with taking care of this special population point to each other.
"This is a tremendous unmet need, and what state agencies do is play hot potato," said Dr. Michael J. Kaminsky, clinical director of the Hopkins' Department of Psychiatry and Behavioral Sciences. "Mark was abandoned."
Maryland is considered among the most progressive states for its policies regarding the disabled. Officials say they routinely work together on these complicated cases and that it takes a long time -- a minimum of two months -- to set up a home for someone such as Wheatley.
For years, experts say this troubled population has been misdiagnosed and underserved. And even though they are starting to get more attention, experts say a lack of political will and infighting between agencies has left many in bad situations.
"No one speaks up for the dually diagnosed," said Ohio State Professor Stephen Reiss, who runs the Nisonger Center, a research facility for mental retardation and developmental disabilities. "They must be one of the most powerless groups in the country."
Doctors say these people often end up stranded in private wards, at the cost of about $1,000 a day. Hopkins physicians see several a month, and at the University of Maryland Medical Center, psychiatrists deal with the same issue.
"It's very common to have problems with this," said Dr. Johannes Dalmasy, UM medical director of adult inpatient services.
"Our usual tendency -- unless they're in our emergency room, and we have no option but to take them -- is to be very careful about taking someone who is dually diagnosed, precisely because even if we can stabilize them, then there's the issue of, where is he going to go now?" Dalmasy said.
Not only do these patients block spots from those who truly need psychiatric services, but they are forced to live with psychotic patients whose conditions make their own worse.
Nonstop yelling
In Wheatley's case, doctors said that other patients sometimes deliberately incited him. Other times, they would set him off without meaning to. One person suffering from manic depression, for instance, yelled nonstop 22 hours a day for several days, which agitated Wheatley. Such episodes forced physicians to medicate him heavily, restrain him in a vest and lock him in a seclusion room.
During his nearly three-month stay in Room 313, Wheatley did every possible art project with the hospital's occupational therapist at least three times. He watched other patients coming and going. (Most leave within 10 to 12 days.) At least once a week, he confronted a staff member with the question: "When am I going to go home?"
Dr. Adam Kaplin, a psychiatrist who has been overseeing Wheatley's care, said he never had a good answer for him.
"I just felt awful. The system truly fails these people," Kaplin said. For weeks, he and Hopkins social workers trying to find a place for Wheatley were directed back and forth between two state agencies, the Developmental Disabilities Administration and the Mental Hygiene Administration.
Officials say they have been working together on the case but defended the amount of time it has taken to handle Wheatley's situation. They said they needed to pick a provider, locate a home or apartment, sign a lease, and hire and train staff. And then, the state agency must approve the funding, they said.
"The expectation is that we can just move mountains the next day," said Oscar Morgan, MHA's director. "Sometimes we can. Sometimes we can't."
State officials say they are seeing more cases like Wheatley's, and Morgan said they are exploring the possibility of creating temporary placements, so these patients can be discharged from hospitals and have somewhere to stay while waiting for a home.
The two state health agencies have put together a task force to address inappropriate placements of people with these dual diagnoses. Recommendations are expected early next year.
