Psychiatric patients losing their `comfortable' place

Hospital: The closing of Crownsville is causing anxiety about the effect on its residents, their families and the staff.

May 09, 2004|By Molly Knight | Molly Knight,SUN STAFF

Nearly every Sunday, Tim and Peggy Miller pack some of their six children into the car and drive an hour from their home in Waldorf to visit Tim's 59-year-old brother, Paul, at Crownsville Hospital Center in Anne Arundel County.

Before he went to Crownsville in 1991, Paul Miller - who suffers from schizophrenia - spent 30 years in and out of psychiatric hospitals, growing increasingly violent, even trying to take his life. Since being admitted to Crownsville, he has become less tortured by the hallucinations that have long haunted him.

"Crownsville has been very good to Paul," said Tim Miller.

"He's comfortable, which is all we were asking for."

This summer, the family's comfortable routine will come to an end. By July 1, the state hopes to complete the closing of the historic psychiatric hospital and transfer its 200 residents to one of the state's two remaining in-patient facilities, Spring Grove Hospital Center in Baltimore County and Springfield Hospital Center in Carroll County.

The closing will save the state $12 million in annual operating costs, $5 million of which has been earmarked for community-based programs for the mentally ill, the Department of Health and Mental Hygiene says.

Many of the hospital's employees and relatives of its patients are concerned that in a rush to cut costs, the state is failing some of the most fragile beneficiaries of its mental health system.

"What really bothers me is that the state promised this would open up more money for treatment, but no one has come forward to say, `Let us help you with Paul,'" said Tim Miller, whose brother will be moved to Springfield within two months.

Nelson J. Sabatini, the state health secretary, said the transfers will not be made without careful consideration for the well-being of every patient.

"My objective is to do it right, not fast," he said. He hopes to complete the process by the start of the 2005 fiscal year, which begins July 1.

Del. David G. Boschert, an Anne Arundel County Republican who fought to keep Crownsville open, unsuccessfully proposed delaying its closing until 2006 to allow a study of the impact of transferring patients.

Concern about stress

"In talking with the doctors, I heard that a move of this nature - out of an environment that they [the patients] feel safe in - could create a stress level that's of major concern," Boschert said. "Mental health patients are some of the most fragile in our system, and to just pick them up and transfer them is a disservice."

Dr. Gerard Gallucci, medical director of the Adult Services Community Psychiatry Program at Johns Hopkins Bayview Medical Center, said there is "valid cause for concern" over the transfers, particularly of schizophrenic patients.

"Schizophrenia, as an illness, is sometimes characterized as difficulty with change," he said. "With these patients, it can sometimes take years to develop trust in their providers, so sudden change could be problematic."

He added, however, that "for some patients, it might not be disruptive at all. ... Some patients are more resilient than we think."

Dianne Sothoron of Lexington Park in St. Mary's County said she is worried about the stress the move might cause her son, Spencer, who she said has received consistently good care since he was admitted to Crownsville in 1989 for acute paranoid schizophrenia.

Soon, he will be transferred to Springfield, adding two hours to the round trip from Sothoron's home. Traveling to visit her son, she said, will become "very difficult."

For patients such as her son, "their need for stability and order is great because they are often dealing with voices in their heads and such conflicting feelings," Sothoron said.

Asked whether the state plans to help families such as the Sothorons and the Millers, Sabatini said, "We'll look at every case and see what we can do to accommodate needs, but we can't make any guarantees."

Sheilah Davenport, acting chief executive officer of Crownsville, said, "It's something we are talking about, but we've not really come up with any good answers on this particular question."

12 years of debate

The decision to close Crownsville was made after 12 years of debate among health officials and legislators over whether the state needed three psychiatric hospitals when the number of inpatient psychiatric patients had declined significantly in recent years.

The state has no specific plans for the 1,200-acre property, 500 acres of which will be protected by a land trust, or for the nonprofit programs and agencies there, including the drug treatment programs Hope House and Second Genesis.

Also at issue is the transfer of 500 hospital employees. Although the state has promised to find jobs for them - and is trying to keep doctors with their patients - many staff members are concerned about commuting to Springfield or Spring Grove.

Some have quit in anticipation of the closing.

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