No Care for the Homeless: State to close only public psych facility in Baltimore City

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No Care for the Homeless

State to close only public psych facility in Baltimore City

Christopher Myers

Walter P. Carter Center RN Charge Nurse Carolyn Work.

By Erin Sullivan | Posted 6/26/2009

On Oct. 1, the only publicly run acute psychiatric inpatient hospital in Baltimore City, the Walter P. Carter Center, will be closed for good.

The center is named after noted civil rights activist Walter P. Carter, who felt strongly that the city of Baltimore needed a publicly run facility that offered much-needed social, health, and community services to its poorest residents. The center was opened in its current location, at 630 W. Fayette St., in 1976, and today it is the only facility of its kind in the city, offering inpatient psychiatric treatment to indigent and uninsured residents.

"What happened was that when my dad died, the civil rights advocates at the time basically made a demand of the state that it open a facility like this one," says state Del. Jill Carter (D-41st District), Walter P. Carter's daughter. "It wasn't exactly the vision of what my dad wanted—he wanted a place for the indigent where they could basically get their lives together—but still, the history of civil rights is tied up in this center."

When the state closes it down, Baltimore will become one of just two major cities in America that does not have a public psychiatric hospital to take in poverty-stricken and uninsured individuals suffering from everything from social adjustment disorders to acute schizophrenia. (New Orleans is the only other city that does not have such a facility.) Patients being treated at the Carter Center will have to be transported to other state-run facilities outside city limits—such as Spring Grove in Catonsville or the Clifton T. Perkins Center in Jessup—and nurses at the center say that patients are already being transferred as units are downsized and closed, in preparation for Oct. 1.

"Today I have to take a couple of people off my unit," Carter Center RN charge nurse Carolyn Work says on a recent afternoon. "They are trying to downsize from three units to two units. They are trying to send them all to Spring Grove, but Spring Grove is saying they don't have any beds. But they are trying to get them over there. I think this is going to be a tougher battle then they thought. They were hoping to get them out by the end of July."

Every year during the legislative session, rumors and reports that the state is scheming to close the Carter Center—or at the very least, privatize its services—to save money arise, but then are squashed before the end of session. In 2003, for instance, a plan to privatize the center by outsourcing its management to the University of Maryland Medical System was proposed as a way to save the state money. The proposal died when University of Maryland and the state Department of Health and Mental Hygiene Administration could not come to terms about how to structure the deal. The state offered $30 million over the course of five years, and the university would have been eligible for additional money for taking in uninsured patients, but concerns were raised that there was nothing in place to stop the university from filling all of the beds with insured patients, leaving the uninsured with nowhere to go.

In 2007, rumors that the Carter Center was again facing potential closure were fervently denied by hospital administrators and state officials. At that time, Sheilah Davenport, deputy director of the Mental Hygiene Administration, which oversees the state's psychiatric facilities, told City Paper that it was just a "rumor that won't die" and that the facility was not being shuttered or moved outside city limits.

This year, however, closure of the Carter Center is not a rumor: In January 2009, a proposal was floated to move all patients out of the center to other mental-health facilities, relocate staff, and turn the center over to the University of Maryland to operate outpatient clinics—but no inpatient services. In February, Del. Carter proposed HB 1043, a bill that would prohibit the state Secretary of Health and Mental Hygiene from closing the facility. That bill was sent to the Health and Government committee, where it received an "unfavorable report" by the committee. No action was taken on the bill after that. Carter then proposed another bill, HB 1044, that would have required that the employees of the Walter P. Carter Center be offered state employment if the center was to be closed and that the state Department of Health and Mental Hygiene "ensure that specified community-based services" be offered to replace those being eliminated with the center's closure and that the University of Maryland "perform specified duties of the Walter P. Carter Center if transferred to the university." That bill was sent to committee where it quickly died.

"They do this thing in the legislature where they say we don't need the legislation because they say we're going to go ahead and do it anyway," Carter says. A letter [that Del. Pete] Hammen showed me indicates that they are going to put some things into place, more and expanded services. But it's all just best efforts—they'll do the best they can."

Archie Wallace, CEO of the Walter P. Carter Center, says he can't comment on the closure of the center and refers calls to the state Department of Health and Mental Hygiene. John Colmers, secretary of the Department of Health and Mental Hygiene, says the proposal to close the Carter Center is part of a broader series of decisions being made about the state's mental-health facilities. He says that while inpatient services at the Carter Center—which had 34 inpatient beds just prior to closure, down from 51 earlier this year—are being eliminated, 44 more beds are being added at the Perkins Center in Jessup. Opening those beds, he says, will free up space at Spring Grove in Catonsville.

"The majority of the patients who are in the Walter P. Carter Center inpatient unit today are forensic patients," Colmers says. "They are criminally involved. Those are not patients that we can or should place into private facilities. They will be served in—and they come not just from Baltimore city, but other jurisdictions as well—they will be served in one of the other state facilities: Spring Grove, Springfield, or Perkins."

Civilly committed patients, he says, can also be treated at Spring Grove or Springfield, but the state is also planning to buy private beds at Bon Secours, Shepherd Pratt, and other private hospitals.

The state pays millions of dollars per year for those private hospital beds, and according to a letter written to state delegates by Dr. Steve Whitefield, a psychiatrist who used to work at the Carter Center, the state "is not getting its money's worth" because private hospitals can pick and choose which patients to admit: "They cherry pick for the patients whose care will cost them the least to provide, and do not provide a safety net and best practices type of care that state hospitals provide the uninsured."

Colmers says that the millions paid for private beds is actually a "cost saver" for the state, because the state negotiates the price via a rate-setting system and stays in private hospitals are usually "a little bit shorter" than at public ones. Colmers says that the vast majority of mental health services are provided in community settings, not hospitals, and Baltimore already has a strong public and private mental-health infrastructure in place.

Work says she's "outraged" at the state's short-sightedness in this situation. She says that the Carter Center is the only place willing to keep acute psych patients long enough to stabilize them and get them on a steady medication regimen before release. Private facilities, she says, usually release people in a matter of days.

"[Patients] can usually be here from one to three months," she says. "And when they get treatment like that, they can get back to being on meds and their chances of making it on the outside are much, much greater. If you have to send them to the University of Maryland clinic or to Bon Secours, or any place like that, the length of stay is so short. If you're a paranoid schizophrenic, the first few days you are here, you probably don't even want to take your medication at all. So if you're released, you're not going to make it. So it becomes a revolving door thing."

Not only is that detrimental to the patient, says John Burleigh, who was also a civil rights activist and friend of Walter P. Carter's, it's detrimental to the community. The Carter Center, he says, was created to address the unmet needs of minorities and low-income individuals in the city during a time when "many were being released from institutions, during the movement of deinstitutionalizing the mentally ill." Many of those patients, he recalls, had few resources and ended up out on the streets. Because of their mental illnesses, these untreated patients would do things that were "socially unacceptable" and would end up incarcerated.

"It was found that these people were being misdirected and mistreated because they were ill, not criminals," Burleigh recalls. "There was a growing need and awareness of that unmet need."

Meetings were held with the Community Health Council, the Congress of Racial Equality, and professional health care providers to come up with a plan that would address the need for mental health care for the poor and minorities. "Through negotiations, we were able to bring to fruition an institute to address those needs," he says. "The Walter P. Carter Center."

Burleigh says that people should be aware of how the closure of the center will affect the community if replacement services are not in place when it's gone. "We should not be shortsighted in reducing resources to the community that provides for unmet needs, that provides funding for unmet needs, in lower-income and minority communities," he says. "It exacerbates the increase of social problems and deteriorates the quality of life for the community at large."

Colmers does not agree that the state is backing away from its commitment to provide mental-health services to poor and minority communities.

"Our commitment to mental-health needs in Baltimore city and to eliminating health disparities, including health disparities in mental health, is profound," he says. "We are profoundly committed to addressing those issues, even in these economic times, to be sure that services are available to people."

To that end, he says, the state will work closely with the University of Maryland to establish more outpatient services to absorb the mental-health needs of the community. Carter says the plan, from her perspective, seems "kind of murky" and she hopes the state is able to make sure that "the largest jurisdiction [in the state] with the greatest mental health needs in the state has some type of facility people can go to. Especially people without any money or any insurance."

Email Erin Sullivan

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Tags: Walter P. Carter Center, mental health

Stephen Pohl

5 comments.

Member since 6/26/2009

This is right on the mark:"John Burleigh, who was also a civil rights activist and friend of Walter P. Carter’s, it’s detrimental to the community. The Carter Center, he says, was created to address the unmet needs of minorities and low-income individuals in the city during a time when “many were being released from institutions, during the movement of deinstitutionalizing the mentally ill.” Many of those patients, he recalls, had few resources and ended up out on the streets. Because of their mental illnesses, these untreated patients would do things that were “socially unacceptable” and would end up incarcerated."

I was a Baltimore police officer at the time when deinstutionlization was taking place as a result of court decisions at the time, which said peole could not be held unless they were a danger to themselves or others. That usually translated to tgrying or succeeding in killing themselves or otheres, whic usually falls under Mr. Burleigh's euphemism of "socially unacceptable."

The theory at the time was that things would change to "community based mental health. In Irvington, where I worked at the tiime, that meant a house off Frederick Rd, where the patients would come and meds would be dispensed. As you might guess, one of the problems with the mentally ill is that they don't like or want to take there meds. I never saw anyone go in or out of the community health office. I did have to arrest a number of former Spring Grove patients who did "socially unacceptabl." My friend, Timothy Ridenour, was murdered in October 1976 by one such patient he was attempting to arrest.

That time was the beginning of the visible and intractable problem of homelessness in Baltimore.

Posted 6.26.2009 11:57 PM

Stephen Pohl

5 comments.

Member since 6/26/2009

Never post anything at midnight without spell checking.

This is right on the mark: "John Burleigh, who was also a civil rights activist and friend of Walter P. Carter’s, it’s detrimental to the community. The Carter Center, he says, was created to address the unmet needs of minorities and low-income individuals in the city during a time when “many were being released from institutions, during the movement of deinstitutionalizing the mentally ill.” Many of those patients, he recalls, had few resources and ended up out on the streets. Because of their mental illnesses, these untreated patients would do things that were “socially unacceptable” and would end up incarcerated."

I was a Baltimore police officer at the time when deinstitutionalization was taking place as a result of court decisions, which said mentally ill people could not be held unless they were a danger to themselves or others. That usually translated to trying or succeeding in killing themselves or others, which usually falls under Mr. Burleigh's euphemism of "socially unacceptable" things.

The theory was that treatment would be provided at "community mental health centers.” In Irvington, where I worked, that meant a house off Frederick Rd, where the patients could come and meds would be dispensed and I presume, the patients counseled. As you might guess, one of the problems with the mentally ill is that they don't like or want to take their meds. I never saw anyone go in or out of the community health office. I did arrest a number of former Spring Grove patients who did "socially unacceptable" things. My friend, Timothy Ridenour, was murdered in October 1975 by one such patient he was attempting to arrest.

That time was the beginning of the visible and intractable problem of homelessness in Baltimore.

Posted 6.27.2009 12:37 AM

Katherine Ramey

3 comments.

Member since 6/27/2009

I am an employee of the Carter Center. The staff are not being placed like they say they are. The clients will be picked up by the private sector But the private hospitals only keep clients up to a week. Some medications take two weeks to have an effect. We also find housing and placements for the clients where the private hospitals wont. We also deal with agitated clients where the private hospitals will put them out on the street. My uncle Timothy Ridenour was shot buy one such patient. I have had clients say the only reason they committed crimes was to have a place to eat and sleep. That they were hungry. The crime rate will continue to raise if there is no place for the mentally ill to go.

Posted 6.27.2009 11:13 AM

Katherine Ramey

3 comments.

Member since 6/27/2009

I also want to say thank you Stephen Pohl for submitting your comment. The things you said are so true.

Posted 6.27.2009 11:22 AM

Charles

416 comments.

Member since 1/11/2007

If I remember right, wasn't it the ACLU who brought the lawsuits that made those institutions force those with mental health problems out onto the street? Of course, the ACLU believes it did it to "protect" those poor people, but failed to realized the consequences of that action.

Posted 6.27.2009 8:54 PM

Katherine Ramey

3 comments.

Member since 6/27/2009

I agree they were trying to protect the rights of the clients in the institutions. But not looking at the long term effect it has on the community along with their out on the street with the right to refuse medications. Even that is an injustice for them to wonder the street sick. It bothers me to see clients on the street who need help but refuse to go get the help. Now their will be less places for them to go for help. Also we want tourist to come to visit but who wants to come visit went you got somebody up in your face asking no demanding you give them some change.

Posted 6.28.2009 12:22 PM

Kay Bhagat

1 comments.

Member since 7/1/2009

I am a civil rights attorney who works in the Adult Mental Health Unit at the Maryland Disability Law Center (MDLC). MDLC is the federally-mandated Protection and Advocacy agency for the state of Maryland, charged with defending and advancing the rights of persons with disabilities. Along with Maryland mental health and civil rights advocates as well as mental health consumer organizations, MDLC strongly supported the closure of the Carter Center. The Carter Center is both a costly and structurally unsafe building that holds Marylanders in the most restrictive setting.

The State's Mental Hygiene Administration (MHA)'s budget – with the closure of Carter Center – already allocates over $292 million, nearly one-third of its entire budget, to institutions. Although Maryland’s psychiatric institutions are the most expensive forms of treatment, they serve only 3.4% of Marylanders in the Public Mental Health System (PMHS)--and in the most restrictive setting. Most individuals in psychiatric facilities could be served in the community and could avoid costly repeat hospital admissions if adequate community services were available. Despite our knowledge that comprehensive community-based services are effective in preventing hospitalizations, those services are chronically under-funded and create a strain on other parts of the overall care system. We agree with Delegate Jill Carter's call for the State to ensure that adequate community resources are available.

If the Carter Center was not closed, there would be a $5 million cut to community services –which would end up being a $10 million cut – as community services are paid through Medicaid and receive a federal match. This enormous cut to community services would be devastating to Marylanders with psychiatric disabilities. With even less community services, individuals with psychiatric disabilities would not receive the outpatient care necessary to remain in the community. Many Marylanders who rely on community services would be more apt to experience a crisis, and end up in a restrictive and costly inpatient setting. This would place a greater financial strain on the State, while also depriving Marylanders of their right to remain in the least restrictive setting.

The closure of Carter Center eliminates a decrepit facility and prevents further cuts from community services.

Posted 7.1.2009 5:00 PM

Stephen Pohl

5 comments.

Member since 6/26/2009

Here is a link to an article in The Washington Post about how deinstitutionalzation is not working in fairfax County, VA.

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/27/AR2009072702248.html?hpid=topnews

Posted 7.28.2009 2:35 PM

Elaine Carroll

2 comments.

Member since 7/24/2009

I am the State Network Coordinator for On Our Own of Maryland, Inc. (OOOMD), the statewide mental health consumer education and advocacy organization dedicated to promoting equality in all aspects of society for people who receive mental health services. OOOMD is dedicated to developing alternative, recovery-based mental health initiatives that allow individuals to live healthy lives to their fullest potential. We have a combined membership of over 1,400 mental health consumers and supporters and represent 23 consumer-operated Wellness and Recovery Centers throughout in the state. Last year OOOMD touched over 5,500 persons with mental health disabilities within the community through peer-run services.

OOOMD fully supported the closure of the Carter Center for the same reasons mention by Ms. Bhagat. It is much more cost effective, recovery oriented, and consumer driven to allow people with mental health disabilities the opportunity to live beyond hospital stabilization. It is important to note who supported the closure of the Carter center becuase many who did are consumers themselves.

Posted 7.28.2009 3:44 PM

ProfessorIrene

1 comments.

Member since 7/29/2009

For all those who cry the loss of Carter Center ---- are you sad because you received good psychological therapy at Carter? Are you sad because you personally improved your mental health while at Carter? ..... waiting..... waiting...

No I suspect you are sad because 1) You like your state benefited job. 2) You like the thought of people with mental illness being locked out of sight so you don't have to deal with them in the community. 3) You are a well meaning loved one who was at a loss of what to do with your family or friend and Carter seemed like a good, affordable option. 4.) You are brainwashed into believing that an antiquated model of institutionalization and medication/sedation is what is "BEST" for patients.

None of those are good reasons to lock people away at places like Carter. I personally have visited every single menatl health facility in Maryland as a part of a previous job. I was shocked and horrified by the conditions and lack of care at these wretched places. If you have never visited there, you should. People are overmedicated, neglected, abused and deprived of therapeutic opprtunites.

I think most people envision group therapy or individual therapy sessions... not true. Most people never see a psychologist -- in fact that is considered a priviledge that people have to "earn." People spend their entire life sitting in a dayroom watching television with 50 other people. You also have "earn" the right to breath fresh air, receive pysical therapy, exercise, go to church or read books. Whatever you personally think would be therapeutic for you if you should have a mental illness is NOT offered at these institutions.

While there are some exceptional staff people in these institutions who strive every day to give the very best care they can to patients, there are also others who do no do their best. Many staff people ignore the patients because they are apathetic, undertrained or simply cruel. I personally know of patients who were left to die lying on the floor because staff considered them to "whine" too much. Simple medical issues like a broken leg or choking on birthday cake became the causes of death because staff failed to take action because the victims "were just attention seeking."

The amazing thing about this is that the cost to put people in these places is around $200-300,000 per patient per year. You could send people around the world on a luxory cruise ship for that cost. And I promise you people would feel a whole lot better and be treated better.

So what to do? You cannot just release most people with a serious mental illness into the community without a support system. (Everyone needs support systems - by the way -- not just people with a mental illness. Support systems are what make us human.) The GREAT news is that Maryland has some of the very best community based support systems in the country. We have caring people in community settings who administer medications, provide therapy, finance housing, supervise employment opportunities and help people with activities of daily living. A prime examples are the Southern Maryland Community Network or Project Plase. I personally know several people who have gone through these programs after long institutionalizations who are now thriving in the community with jobs and friends and hobbies and all the other things that define us as human beings. And if cost matters to you.... the average cost per person per year is $20-40,000. And the state already finances these positions so jobs could be transfered from isntitutional settings to community settings. The quality of the staff's life increases in community settings too because the rates of patient on staff abuse is dramatically reduced, job satisfaction increases, and job growth opportunities increases.

At a time when we are looking at health care reform and budget defiicits why not start with the idea that the best care for people with mental illness is in the community and the best way to reduce budget expenditures for people with mental illness is in the community. Plus ---- ITS JUST THE RIGHT THING TO DO!!!

Posted 7.29.2009 10:11 AM