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Proposed psych ward at AAMC would more than double inpatient beds in county

Anne Arundel Medical Center wants to add an in-patient psychiatric facility. The county's only such facility,with 14 beds,  is housed at the University of Maryland Baltimore Washington Medical Center.

About 75 people in need of the most extensive mental health care — those who are a danger to themselves or others — are admitted monthly to Baltimore Washington Medical Center.

The Glen Burnie hospital has the only inpatient psychiatric ward in Anne Arundel County. It has 14 beds. Even with 75 admitted, another 65 are transferred to hospitals outside the county for treatment, said Dwight Holmes, who oversees psychiatric services at the hospital.


"We're often faced with many patients in the emergency department that are waiting for beds to open here or at other facilities throughout the state," Holmes said.

In light of this need, Anne Arundel Medical Center in Parole announced Thursday it plans to open an inpatient facility for the mentally ill. If the state adopts the plan, this would more than double the number of inpatient beds in the county.


"There's a constant flow of patients from the emergency room into inpatient mental health programs," said Ray Hoffman, director of AAMC's Division of Mental Health and Substance Abuse.

Officials of the Annapolis-area hospital say they will submit to the state next month a letter of intent to open such a facility. They will file an application for a certificate of need in February, Hoffman said.

If approval is granted, he said, the hospital anticipates it could take years before the additional beds are in use.

"Our planning has made an assumption that 2018 is probably the earliest we could expect to open," Hoffman said.

The lack of inpatient beds is just part of a national problem regarding how communities respond to the mentally ill, said Linda Rosenberg, who heads the National Council for Behavioral Health.

The national discussion on mental illness intensified in recent years after a series of mass shootings.

"It's a problem across the nation," Rosenberg said. "Wicked problems don't have just one solution — there's a number of things you have to do."

AAMC is planning either 16 or 20 inpatient beds. In determining how many patients the proposed unit could house, the hospital is running into regulatory obstacles, Hoffman said.


Current law limits the number of Medicaid dollars the federal government provides for care in psychiatric inpatient facilities with more than 16 beds, he said.

Such facilities, including Sheppard and Enoch Pratt Hospital in Towson, are regulated differently.

Whether the new unit would be at the Parole hospital or at a new facility off-site also remains an open question, Hoffman said.

Welcome news

Holmes, of BWMC, welcomed the idea of more inpatient beds in the county.

"It benefits everyone to have as many services as possible," he said.


Jen Corbin, director of the county's Crisis Response System, said additional beds are sorely needed. Sending patients to hospitals out of the county, Corbin said, often impedes access to crucial follow-up care.

"It's about understanding the county, where people need to go to get services (and) the right fit," she said. "Having the inpatient beds (in the county) allows for a smoother transition in care."

Frequently, patients are discharged from inpatient programs out of the county without being connected to a health care provider closer to home, Corbin said.

"When they're released, it's 'Here's your two weeks worth of meds and we made you an appointment with this provider,'" she said. "A lot of times they may get a 30-day (prescription), but they don't have insurance ... how are they supposed to get their meds?"

The number of people taken by county police to hospitals for emergency psychiatric evaluations rose from 1,962 in 2012 to 2,423 last year, a 23.4 percent increase, according to statistics provided by the department.

So far this year, police have taken more than 1,960 people for emergency evaluations. Lt. Ryan Frashure, an county police spokesman, attributed the increase to heightened awareness by officers who recognize symptoms of mental illness.


But those taken by police to BWMC account for only about a third of the emergency psychiatric evaluations performed at the hospital, Holmes estimated.

Last year, hospital staff performed some 3,900 emergency evaluations. Only about half of those were determined to need inpatient care and only around 900 were ultimately admitted to BWMC's ward, Holmes said.

Once admitted, the average patient stays about five days, he said.

AAMC transfers around 1,100 people to inpatient mental health wards from its Parole emergency room each year, Hoffman estimated. But hospital staff generally perform four times that number of emergency evaluations, he said.

Overall efforts

The inpatient unit would be just one part of AAMC's effort to increase mental health services, officials said.


The hospital is planning to open a partial psychiatric unit, where patients will attend six-to-eight hour sessions, in February in leased office space on Holiday Court in Annapolis.

The facility will offer service for patients stable enough to stay at their homes during the evenings, Hoffman said. It will have the capacity to serve 12 adults and 12 children at any one time.

BWMC already has a partial hospitalization program, Holmes said.

For three years, AAMC has operated Pathways, a Riva Road facility that treats patients for substance abuse and addiction, Hoffman said.

Rosenberg said part of the issue nationally isn't just whether there is a shortage of inpatient beds but whether beds are used effectively.

"Are there people in beds that could be living in the community with the right support?" she said.


For many communities across the country, adding beds might not be the most viable option, since inpatient beds cost up to $1,000 a day.

In addition to alternative and follow-up care, many in the health care industry have focused on providing care before hospitalization is needed.

"We focus on inpatient beds, and there has to be beds, but there's lots of things we can do," said Jeff Richardson, executive director of Mosaic Community Services, a behavioral health provider that serves Baltimore and Baltimore County. "There are so many ways that we can prevent people from needing high-intensity acute care."

As part of its effort to offer mental health services across a wide spectrum, AAMC began offering a number of outpatient mental health and substance abuse services last year, Hoffman said.

"The right intervention at the right time ... can reduce utilization of the most extensive care," Hoffman said.