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baltimoresun.com

Maryland's public psychiatric hospitals are broken

10:30 AM EDT, March 11, 2013

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Your article about the dangerous conditions at Spring Grove Hospital was an accurate description of what has been happening in our public psychiatric hospitals ("At mental facility, staffers besieged," March 3).

I was a staff psychiatrist at Spring Grove Hospital for 25 years until June 2013, when the state Department of Health and Mental Hygiene decided to close the two assisted living units on the hospital grounds. This was an unfortunate decision since those units served as chronic care for many patients who could not get community placements.

Most of our patients were forensic cases who already had been adjudicated as "not criminally responsible" or "not competent and not dangerous." Because of that, the courts had no say about where and when we discharged such patients into community housing.

Your article correctly pointed out that the mental health courts have changed the patient population at state psychiatric hospitals in such a way that they have now become "forensic" hospitals. None of the remaining state psychiatric hospitals are free to take voluntary or even civilly committed patients unless a judge commits them from the bench.

Consequently, dozens of patients languish in emergency rooms and jails, waiting to get into a state psychiatric hospital. Basically, judges in the mental health courts have used the pre-trial status of defendants to detain them indefinitely at state hospitals.

The judges will not allow the defendants to go to trial, even after an evaluation has been done, if they aren't satisfied with the aftercare plans. That means that most defendants must have unrealistic aftercare plans, such as supervised housing that does not exist. So they wait in the hospital despite not needing that level of care.

Mental health courts have become an instrument of social engineering from the bench. What is overlooked are the right to a speedy trial of the psychiatric patient-defendants.

When my unit closed, I was offered a position as a ward, psychiatrist but I chose to retire rather that put myself at risk of being attacked by a patient. The judges bear responsibility for the dangerous conditions at Spring Grove, as well as for the unavailability of hospital care for the many non-forensic indigent patients who no longer can get into state psychiatric hospitals.

Rochelle Herman, Silver Spring

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