An apparent shortage of psychiatric hospital beds for adolescents in Maryland has brought teen-agers from across the state to Carroll County General Hospital's psychiatric wing, even though it is not technically for teen-agers.
More than 500 patients have moved through the 12 adolescent and eight adult beds in Carroll County General's fourth-floor psychiatric unit since it opened in late July, 1991.
Teen-agers have contributed to an average daily population of 16 in the unit, a patient census that Linda Harder, the hospital's vice president for marketing, calls "tremendous, for a start-up year."
One day's stay in the unit costs $408.
Pamela J. Haines, the psychiatric unit's clinical manager, said the staff expected most of the adolescent patients to come from Carroll County. "But that hasn't been the case," she said.
Most of the adult patients have been county residents, she said, but the teen-agers have come from as far away as Garrett and Wicomico counties.
Psychiatric and psychological services are provided by Baltimore-based Glass Mental Health Centers Inc.
Statistical evidence of a shortage of hospital beds for teen-agers who need short-term psychiatric care is hard to find.
"I can't give you a 'yes' or 'no' answer," said Kery C. Hummel, the Maryland Health Planning Resources Commission's director of operations.
A psychiatric technical advisory committee is looking into statewide needs for short-term psychiatric care for adolescents and adults, he said. The committee's recommendations will go into revisions of the state's five-year health care needs plan.
Mr. Hummel said Carroll County General's certificate of need, the go-ahead from the commission, was for 20 adult psychiatric beds. But local hospital officials say they planned almost from the beginning to serve teen-agers and designed the wing to separate adults and adolescents.
The state health planning commission wouldn't criticize a hospital for using adult beds for teen-agers if it met a need, Mr. Hummel said.
"Do we as regulators come in and slap their hands and say, 'No, no?' We haven't gotten to that point. That would be almost like police," he said.
Deanna J. Dell, vice president for patient care services at Carroll County General, said the hospital began planning the psychiatric wing about four years ago in response to community needs.
Mrs. Dell said she was uncertain why the original certificate of need was for 20 adult psychiatric beds. But she said that the reallocation to give three-fifths of the beds to teen-agers was probably made during planning.
Muncie Center, at Springfield Hospital Center in Sykesville, also serves adolescents. But state government practice is to have teen-agers placed in private-sector facilities when possible.
Frederick Memorial Hospital's psychiatric unit is for adults only. "There are no [psychiatric] beds in Frederick County for teen-agers, and that's our problem," said Marguerite Wilson, the hospital's coordinator for crisis management service.
The emergency room staff at Frederick Memorial has seen 22 patients aged 17 or younger who needed psychiatric hospitalization since Jan. 1 of this year, Ms. Wilson reported. She said placements for the patients "went in all directions," to general hospitals in Howard, Montgomery and Carroll counties or to private psychiatric hospitals in Washington County and in Virginia.
Frederick County children or teen-agers without insurance were sent to Thomas Finan Center in Cumberland, she said.
Howard County General Hospital admits teen-agers needing psychiatric care, but none of the 35 beds on the unit is earmarked for adolescents. Susan Goodwin, senior vice president for nursing administration, said she hasn't seen a shortage of facilities or a large number of teen-agers needing admission to the unit.
Taylor Manor, a private psychiatric hospital in Ellicott City, halved its 40-bed adolescent unit in early 1991 to create a separate treatment facility for 9 to 12-year-olds. Hospital officials said they were getting an increasing number of pre-teens.
At Brook Lane Psychiatric Center, a private hospital in Washington County, Admissions Coordinator Kenneth Toms said he can't say definitely that there is a shortage of facilities.
"But I've been here for nine years, and the part of the program that has expanded most is the children and adolescents," he said.
Mr. Toms said he has seen the mix go from 40 beds for adults and 12 to 15 bed for teen-agers, to 30 beds for adults and 31 beds for children and adolescents.
At Carroll County General's psychiatric unit, adults stay an average of 7 to 10 days, teen-agers an average of 21 days.
"We get people here who are more at a crisis stage of their illness," said T. Carol Vitek, coordinator of rehabilitation services.
She said discharge plans for patients not ready to return home include referrals to private psychiatric hospitals.