Clinics' closings prompt concerns

Shortage may worsen for psychiatric care in city, county facilities

`Expect ... more problems'

October 15, 2001|By Joan Jacobson | Joan Jacobson,SUN STAFF

Behind the locked door, the new inpatient psychiatric unit at Northwest Hospital Center is freshly painted in soothing hues of blues and greens. Patients in the 12-bed unit pace the hallway or sit quietly by tables in the dining area.

Though they suffer from serious mental illnesses, they are lucky to be here.

The unit has been open for two months and has turned away potential patients.

The demand for care at the small unit is symptomatic of the broader need for more hospital beds for the mentally ill in Maryland, said Dr. Samuel Adler, chief of psychiatry for Northwest and Sinai hospitals and Levindale Hebrew Geriatric Center.

"It's a 30-year history of deinstitutionalization," he said, referring to the movement to transfer the mentally ill from long-term institutions to community settings.

Though statistics show a high occupancy rate statewide, beds for psychiatric care are available, according to the Maryland Department of Health and Mental Hygiene.

In Baltimore City and Baltimore County, 356 licensed beds are available at traditional hospitals for acute - or short-term - psychiatric care. From July 1, 2000, to June 30, 77 percent were occupied, said Pam Barclay, deputy director of health resources at the Maryland Health Care Commission.

At Northwest, on Old Court Road in Randallstown, patients stay an average of six days, but could stay for several weeks, said Dr. Anthony G. Massey, medical director for psychiatric programs at Northwest.

Patients go there with severe conditions, including schizophrenia or manic depression, that have become hard to manage. They may have become a threat to themselves or others.

"We are geared to stabilize a crisis - from unsafe to safe," Massey said. "To be in this unit, you need to have a locked door and nurses 24 hours a day."

The days are structured with group therapy. Patients learn coping skills and are educated about their diseases and addictions to drugs or alcohol.

With 12 beds for psychiatric patients, the hospital has had to find beds at other hospitals, such as Sinai, for the patients they turn away, Massey said.

The shortage of beds in northwest Baltimore County appears to be worsening. Sheppard Pratt Health System is closing two outpatient clinics - one at St. Agnes HealthCare that serves 700 to 900 patients, and another in Randallstown, about a half-mile north of Northwest Hospital, that serves 900 patients.

The Randallstown clinic closed Friday. The St. Agnes clinic will close by the end of next month, said Bonnie Katz, vice president for business development at Sheppard Pratt.

Katz said the clinics are "prohibitively expensive to operate" because "you need an army of people" to work with health insurance companies and managed care organizations.

Even when treatments are approved, insurance payments don't cover the salaries of doctors, nurses and administrative staff, she said.

At Northwest Hospital, staff members are concerned that patients from the closing outpatient clinics may show up at the hospital.

"Somebody who might go to an outpatient program might [instead] go to the emergency room," Adler said. "I would expect it to create more problems."

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