Psychiatric Hospitals

BEIJING - A labor organizer who tried to form an independent trade union has been released from a psychiatric hospital where he was involuntarily committed by police late last year after speaking with American newspaper reporters. Cao Maobing, who worked in a state-owned silk mill in eastern China's Jiangsu province, was quietly released July 10 after spending more than six months in the No. 4 Psychiatric Hospital in the city of Yancheng. "This is a great thing," said Li Qiang, head of the New York-based workers' rights group China Labor Watch, referring to Cao's release.

The state's hospital rate-setting commission approved yesterday a 19.2 percent increase for Taylor Manor and began a contentious debate on setting statewide hospital rates for next year. Taylor Manor, an Ellicott City psychiatric hospital, had said it was in danger of closing without an increase. Even with the rate increase approved yesterday, which applies to commercial insurers, the hospital's future is uncertain unless the state also raises Medicaid rates, said Dr. Bruce Taylor, the hospital's chief executive.

THEY ARE AN underclass we'd rather ignore: the mentally ill with little or no income. There are more out there than you think in Maryland -- 75,000 deeply troubled people. State mental facilities are filled. So are psychiatric wards in community hospitals. Neighborhood clinics are bulging. And yet the state has done such an abysmal job of supporting community treatment centers that the system is on the verge of collapse. In September, Corner Clinic, an Annapolis-based mental health group serving 2,000 people in Glen Burnie, Annapolis, the Eastern Shore and St. Mary's County, closed its doors.

Double-digit inflation is returning in health care - one national study published last month predicted an 11 percent average increase in health premiums for this year - but health care providers say they are caught in a money crunch. Doctors are worried that insurers are not paying them adequate rates. This year, "the big question is whether we start to see physicians telling bottom-dwelling HMOs to take a hike," said T. Michael Preston, executive director of the state medical society.

Maryland regulators granted Taylor Manor a 19 percent emergency rate increase yesterday - less than the 93-year-old Ellicott City psychiatric hospital wanted but enough to keep it open pending a more thorough review early next year. The temporary increase falls short of the 29.7 percent the hospital said it needed to prevent its closure. But state officials determined that it, combined with potential changes in how Medicaid reimburses hospitals, may boost Taylor Manor's 2001 revenue just enough to keep it in business.

Noting low reimbursement levels and cumbersome paperwork, Taylor Manor, a psychiatric hospital in Ellicott City, announced yesterday that it will stop taking Medicare patients at the end of the month. Medicare pays about $100 less than the $600-a-day rate set by state regulators and paid by commercial insurers, and even the $600 level is about $100-a-day less than it costs to deliver care, said Dr. Bruce T. Taylor, chief executive and medical director of the Taylor Health System. "It's supposed to be fair, but it isn't" he said.

TREATING MENTALLY ill patients has changed dramatically since the gothic red-brick structures known as A and B were built on the grounds of Sheppard and Enoch Pratt Hospital. With their spires, deeply pitched slate roofs and dramatic bay windows, these buildings are among Baltimore's architectural treasures. But current psychiatric practices have made them obsolete. There is no need for spacious rooms with 14-foot ceilings and fireplaces that were intended for months, sometimes years, of treatment.

The two most elegant and prestigious buildings in Towson are known simply as A and B.No fancy names were necessary for the identical twins perched atop a wooded ridge at Sheppard and Enoch Pratt Hospital. With their six-story towers, lattice-work balconies and majestic bay windows, they spoke for themselves. One was built for men, the other for women. Both were hailed as part of the movement toward more humane treatment of the mentally ill in 1891.Those days are long past.In the world of managed health care, the 14-foot ceilings, Tiffany stained-glass windows and cozy sun rooms no longer fit.Over the next few years, officials at Sheppard Pratt plan to build a more modern facility on the west side of the sprawling 100-acre campus -- closing two of the nation's oldest buildings still in use at a mental institution.

The Glendening administration's plan to keep all eight of Maryland's psychiatric hospitals open -- but with fewer patients and staff -- got a favorable reception from a legislative committee yesterday.Mental health advocates who have pushed to close some of the hospitals endorsed the proposal, which would shift resources to community-based programs as the hospitals are downsized.The General Assembly directed the state Mental Hygiene Administration last year to review its facilities and develop a plan for downsizing, consolidating or closing some of the state-run psychiatric hospitals.