ANNAPOLIS – When Sandra Solomon’s mentally ill son wound up in jail, he had to wait for weeks in the Anne Arundel County Detention Center for an evaluation at Crownsville Hospital Center, and he wound up in isolation, lost 20 pounds and did not receive medication for his psychiatric problems.
His condition deteriorated and he was eventually admitted to Crownsville, which is set to close July 1 in the latest move to consolidate the state’s mental health care services to help offset a $31 million deficit in the Mental Hygiene Administration budget.
Solomon, who recently founded the Preserve Crownsville group, said the facility’s closure will mean even lengthier treatment delays for patients like her son.
Delegate David Boschert, R-Anne Arundel, seems to agree the hospital should remain open. He introduced an emergency bill Thursday to delay the closure until mid-2006 so a thorough analysis can be done to justify it.
“I feel that this is such an important issue that we should not rush through it in such a hasty manner,” Boschert said. “(The patients) deserve a voice, and I’m going to be their voice if no one else is.”
But with growing Medicaid costs and use, Department of Health and Mental Hygiene Secretary Nelson Sabatini said Crownsville must close to plug the budget gap.
The department is plagued with inefficiencies in service authorization and eligibility standards enforcement, according to analysis by the Department of Legislative Services, but it’s worked to improve them over the past year.
“We need to make some aggressive, fundamental changes in how services are delivered,” Sabatini said at a recent Mental Hygiene Administration budget hearing, agreeing with the analysis.
The state plans to invest $5 million in community services for outpatient treatment and crisis services with money from the closure, a move designed to get people treated before they need hospitalization or enter the justice system, Sabatini said.
Gov. Robert Ehrlich included a $54 million bailout in his 2005 budget for the department’s deficits dating back to the 2003 fiscal year.
If the Mental Hygiene Administration cannot show an ability to live within its budget this year, Sabatini said he will have to consider alternatives like providing mental health services through managed care organizations.
“Get your act together or do something differently,” Sabatini said, interpreting the department’s budget analysis. “I agree with that.”
Consolidation plans include moving Crownsville’s 200 beds to Springfield Hospital Center in Sykesville and Spring Grove Hospital Center in Catonsville after a total $900,000 renovation of the facilities to accommodate the new patients.
Plans to privatize 48 forensic beds at Walter P. Carter Center in Baltimore through the University of Maryland Medical System were scrapped recently in favor of building a new wing at the Clifton T. Perkins Hospital Center.
Two weeks ago, the university system withdrew its partnership, citing ongoing unresolved issues. That left the department with a $10 million hole where it expected cost savings.
Sabatini won’t pursue a partnership with the system for next year, saying he would need a “reliable and trustworthy” business partner to complete the transaction.
To cut costs by $7 million this year, the administration changed payment plans for mental health services from a fee-for-service to a monthly rate system, which pays a set amount per patient to a provider regardless of the number of services that patient receives each month.
Community providers are facing a $20 million hit as a result of the cost-cutting measure, said Herb Cromwell, executive director of Community Behavioral Health Association of Maryland.
“Nonprofit providers . . . will do everything they can to stay in business,” Cromwell said.
A task force created last year to study access to mental health services in the state has not produced recommendations, and won’t until well after Crownsville is expected to close.
Kathleen Loughran, chairwoman of the task force and an associate commissioner with the Maryland Insurance Administration, presented an interim report to lawmakers in January that identified systemic barriers to accessing mental health care.
The final report will be submitted in December, but will cover a period of transition for the system with consolidation and cost-cutting measures taking place through the spring and summer.
Patient’s families, Crownsville employees and several non-profit organizations who are tenants at the facility are still protesting the hospital’s closure. Many hope Boschert’s bill will pass.
Commuting time for employees, possible unemployment for nonclinical staff and the burden of getting to other hospitals concerned the groups.
Solomon’s son, meanwhile, has recovered and is working in the community. – 30 – CNS-2-26-04