Barbara Peckham remembers when she used to cook Thanksgiving dinner for 17 people. These days, she's happy to master a simple recipe for tuna noodle casserole.
About eight years ago, the 48-year-old Springfield Hospital Center patient began losing her confidence in the kitchen as her manic-depressive illness became more serious.
After 10 weeks in a Springfield program that reacquaints longtime patients with daily living skills recently, she began to rediscover the pleasures of cooking.
"It's made me realize I haven't lost the talents I thought I lost," said Ms. Peckham, who most recently entered the Sykesville hospital in October. "I was so sick at one point that I couldn't cook for my family. I'd stand in the kitchen and go in circles."
Since 1987, Springfield's Home Arts program has been helping patients like Ms. Peckham be more independent -- teaching them to cook, clean, shop and manage money. Preparing the severely mentally ill for life outside institutions was a new concept when the Home Arts program was developed.
"This program was on the cutting edge of demonstrating that psychiatric patients with severe mental illness were capable of managing their own home in a safe and effective manner," said Carole Hays, Springfield's director of rehabilitation services.
Springfield staff members have given presentations on the Home Arts program at occupational therapy conferences, and psychiatric hospitals in Oregon and Kansas have incorporated elements of Springfield's life skills course, Ms. Hays said.
According to the most recent data on the program from 1991, 67 percent of the 144 patients who participated in the course during a four-year period remained in the community for two years before being readmitted to a hospital or institutional setting.
"With the severely mentally ill, that's a pretty good rate," Ms. Hays said. "Mental illness is a chronic disease; it doesn't go away."
With increased emphasis on moving the mentally ill from hospitals to outpatient settings or group homes, mental health officials say that life skills programs are critical to a patient's successful discharge.
"A patient might not use safety precautions in the kitchen or know how to plan a shopping list because they have difficulty thinking in the future," said Donna Lucke, an occupational therapist at the Adult Day Hospital of the Sheppard and Enoch Pratt Health System. "Until they learn these activities of daily living, they're never going to be self-sufficient."
The classroom for Home Arts patients is a fully furnished, turn-of-the-century white house on Springfield's grounds. There patients learn to plan menus, cook meals and keep house. They also take weekly field trips to grocery stores, fast-food restaurants or malls to become more familiar with life beyond a hospital ward.
Springfield patients referred to the program usually are long-term hospital patients or those who, because of their illnesses, never have developed independent living skills. The most common diagnoses of participants are schizophrenia, manic depression and mood disorders.
"Many of these patients are dependent on the provision of the most simple services," said Dr. Sherrill Cheeks, Springfield's clinical director. "Everything in the hospital is so structured."
Springfield officials say that leaving the setting of the hospital ward to go to the Home Arts house helps patients leave behind their passive, dependent behaviors.
"The patients become owners of it, in a sense," Ms. Hays said of the house, which at one time was a home for Springfield physicians.
At the conclusion of the Home Arts program, therapists determine what type of living arrangement suits each patient. That might mean living independently with a roommate or in supervised housing where residents may be expected to make their own meals.
"We don't want them just to sit quietly and be taken care of," Dr. Cheeks said. "We want them to function independently to their highest capacity. "
At a recent Home Arts session, four students gathered in the house kitchen to make tuna noodle casserole, corn muffins, a vegetable medley and peaches with whipped topping.
"I keep reading the same thing over again," said Ms. Peckham, who volunteered to make the casserole. After studying the recipe for a few minutes, she began chopping an onion.
One woman chopped cauliflower and carrots. Another prepared the corn muffin mix.
The student in charge of getting the dessert ready stood alone in a corner waiting to be told what to do.
Therapist Pam Cushman helped William (who asked that his real name not be used) with each step. She pointed to the correct line in a measuring cup as he poured milk into it and showed him how to use a mixer and can opener.
Following Ms. Cushman's instructions, William, 43, methodically counted four peach slices into each dessert bowl and put whipped topping on them.
Opening a can of peaches may not seem like a significant accomplishment, but it's a big step for William, who has been in and out of psychiatric hospitals for 20 years.
"When he first started [in Home Arts], he would just sit on the side and talk to himself, muttering," said Terry Buccheri, an occupational therapist at Springfield.
On their community trips, Home Arts students test their skills.
At Weis market in Owings Mills, some students had no trouble locating the items on their grocery list. Others needed more direction.
William, who was looking for Parmesan cheese, confused the product with macaroni and cheese. He eventually found the Parmesan, but selected the smallest size.
After some prompting from Ms. Cushman -- "Which would be the better value?" -- he selected a larger jar of Parmesan cheese.
"You have to be able to see they can make some improvements," Ms. Hays said. "With some people, that may mean they're capable of going to the store and not getting lost."
Ms. Peckham, who recently completed the Home Arts program, said she hopes to move into a supervised group house in Montgomery County where she can share in meal preparation and housekeeping.
"This has made me realize, 'You can do it,' " she said. " 'You've been sick, but you can do it.' "