When Dr. Steven S. Sharfstein came to the Sheppard and Enoch Pratt Hospital 30 years ago as medical director, the Towson facility had 320 beds filled with patients who spent many months or even years getting treatment.
That was how mental health care was delivered back then.
As Sharfstein prepares to step down July 1 as president and CEO at what is now called Sheppard Pratt Health System, his 25-year term at the institution's helm has paralleled the evolution in how mental health is treated, funded and administered nationally.
During his time on the job, the hospital took steps to survive and provide care to many more people with depression, substance abuse, autism, eating disorders, post-traumatic stress disorder and other mental health conditions.
"We're no longer in the hospital business, but the mental health business," Sharfstein said Wednesday ahead of a presentation on his tenure to staff on the sprawling main campus just north of Baltimore. "Many people we treat would have had long stays in that bygone era. In my public health point of view, they are better served getting treatment near where they live and work."
Sheppard Pratt has become a nationally recognized leader in behavioral health. It is the state's largest health care provider, serving some 70,000 people a year in more than three dozen locations, including community facilities and special schools.
A newer but smaller, state-of-the-art central hospital opened in 2005. Funding that once came largely from private insurance now comes more from public health and education sources. A budget that was $35 million with a $30 million endowment three decades ago is now $366 million with a $150 million endowment.
Sharfstein said overcoming financial hurdles was not pain-free. When insurers adopted managed care in the 1980s and balked at long hospital stays, psychiatric hospitals suffered or went out of business. Sheppard Pratt went deep into debt, and not long after Sharfstein became CEO, the organization laid off some 150 of about 900 employees.
Instead of scaling back, Sharfstein and the hospital's board decided to expand. Sharfstein went to donors and the General Assembly for help, eventually winning business from the state. Maryland largely got out of the business of running psychiatric hospitals for those outside the criminal justice system and instead sent patients to private hospitals, including Sheppard Pratt.
"He has done so much for all Marylanders," said state Health Secretary Van T. Mitchell.
Sharfstein said there have been other positive changes generally when it comes to mental health care.
"Mental health is now considered part of the human condition," he said, comparing it to any other disease that patients can be treated for in a doctor's office or clinic.
Access to care is expanding after passage of the Affordable Care Act of 2010. Ongoing research aims to bring new and more effective medications to manage mental health disorders. Sheppard Pratt now supports in-house research and last year entered into a partnership with the Lieber Institute for Brain Development in East Baltimore.
Sharfstein said a remaining challenge is countering the fear and stigma associated with mental health disorders. Just a few years ago, Sharfstein faced fierce opposition from the nearby neighborhood of Ruxton that opposed a group home for those leaving The Retreat, its inpatient service for wealthier patients.
As president of the American Psychiatric Association, Sharfstein went on NBC's "Today" show in 2005 to respond to Tom Cruise's widely publicized rant against the field of psychiatry and actress Brooke Shields' use of antidepressants for postpartum depression. Sharfstein won a bit of fame when he quipped, "Mr. Cruise may be a halfway-decent actor, but when he starts to play doctor, he's being totally irresponsible."
The top job at Sheppard Pratt will now fall to Dr. Harsh K. Trivedi, 40, CEO of Vanderbilt Psychiatric Hospital. He will become its sixth president and CEO in 125 years. In a phone interview from Tennessee, Trivedi said he agreed perceptions remain a top concern but added that there is growing understanding that people can live productive lives with treatment.
"I still see stigma," he said. "But I see more people being open to wanting help."
Trivedi said he hopes to continue Sharfstein's legacy by remaining "a trusted source of information for folks about what is real in the field, what people can expect to get from treatment and where they can turn."
For his part, Sharfstein plans to continue seeing patients part time in one of Sheppard Pratt's community centers.