For more than a century, world-renowned Sheppard and Enoch Pratt Hospital has sheltered famous and not-so-famous mentally ill patients at its bucolic Towson campus -- sometimes for years.
But now, payment restrictions imposed by insurance companies and new drug treatments have emptied scores of its hospital beds, trends changing the shape of Sheppard Pratt and other psychiatric institutions around the country.
Many hospitals -- from Sheppard Pratt to Menninger in Topeka, Kan., and McLean Hospital in Belmont, Mass. -- have moved to quicker patient assessments, daytime hospitalizations and community-based clinics to meet patients' needs.
And that means big changes at Sheppard Pratt's 100-acre campus.
The hospital is reconfiguring buildings to fill vacant space and has privatized its swimming pool for community use. It has leased 2 1/2 acres of land to nearby Greater Baltimore Medical Center. And recently, the Forbush School for special-education students opened new classrooms to accommodate a growing enrollment.
The not-for-profit hospital's directors also are hiring a consultant to advise them on a comprehensive land-use plan, which is expected to be completed in six to eight months.
"It might be traumatic. It might not. It's too early to tell," says board Chairman James D. Peacock. "It doesn't mean we're moving away from Towson."
Adds Dr. Steven S. Sharfstein, president and medical director of Sheppard Pratt, "We still plan to stay here. But we don't need 100 acres here in Towson."
Many in the community are concerned about the future of the 105-year-old institution -- consistently named one of the nation's top 10 psychiatric institutions by U.S. News and World Reports -- as it adjusts to the financial realities of modern medicine.
Hoke L. Smith, president of nearby Towson State University, says, "It is in all our best interests for [Sheppard Pratt] to have a stable operation. That land is integral to our campus and GBMC."
The closest neighborhoods have not taken a position on how changes to the secluded, wooded campus would affect them, said John Dahne, president of the Ruxton-Riderwood-Lake Roland Area Improvement Association.
But the Greater Towson Council of Community Associations is watching closely.
"Sheppard Pratt has long been a recognized stabilizing factor in the neighborhood," said Justin King, the umbrella group's president. "While they maintain a low profile and don't generate a lot of publicity, they have always attempted to contribute to the well-being of the community."
The hospital began with a bequest from Quaker businessman Moses Sheppard in the mid-1850s -- a time when many mentally ill people were crowded into dank, narrow cells in almshouses and chained to floors. It occupies the former Mount Airy Farm, a once-sprawling parcel which includes two grand Victorian buildings boasting 14-foot ceilings.
But because Sheppard requested that interest -- not the principal -- from his estate be used for the ornate brick structures, the hospital did not accept its first patient, a 46-year-old woman with dementia, until 1891.
The hospital's name was changed in 1898 after Baltimore philanthropist Enoch Pratt, who also provided funds for the Enoch Pratt Free Library, left $1.6 million to the hospital with the stipulation that his name be included.
At the time, there was no Towson State University, Greater Baltimore Medical Center or St. Joseph Medical Center nearby. Those institutions bought land from Sheppard Pratt, starting around the turn of the century.
Since then such celebrities as Zelda Fitzgerald -- wife of author F. Scott Fitzgerald -- and prominent figures in sports, entertainment and politics have sought help there.
But about eight years ago changes in medical insurance began to affect the operation of the nation's psychiatric institutions. In response, many have developed a range of services in addition to inpatient stays.
"We think there are more flexible and more economical ways of providing care," said Dr. Efrain Bleiberg, Menninger's recently named president. "There is a greater reliance on outpatient and partial levels of care."
McLean, a teaching hospital of Harvard Medical School, relies on such treatments, too. It also has developed a service open 24 hours a day to immediately evaluate individuals in crisis without hospitalizing them.
"The impact of managed care has been deleterious to the best hospitals' functions," said Dr. Herbert Sacks, president-elect of the Washington-based American Psychiatric Association, a group of 40,000 psychiatrists. "The pressure has been on to reduce the length of stay."
Sacks, a child and adolescent psychiatrist at the Yale University Child Study Center, said managed care's reduced payments are leading to "drive-through psychology. . . . Judgments are not being made by psychiatrists. They're being made by lawyers and business people. It's frightful."
Other factors contributing to decreased hospital stays: improvements in medication and more aggressive management of care, a 1996 survey by the National Association of Psychiatric Health Systems showed.
"We have found that, with better drugs, people who might have stayed in the hospital for a long time now can manage their care and move to partial care," said Carole Szpak, the group's director of communications.
With such changes, the average length of stay for a Sheppard Pratt patient has plummeted from 50 days in 1990 to 14 days last year. Most patients are hospitalized for such mental illnesses as affective disorders, including depression; substance abuse; anxiety disorders and schizophrenia.
To adapt, Sheppard Pratt has been expanding off-campus, opening counseling centers in Baltimore, Harford, Anne Arundel, Howard and Kent counties as well as other outreach programs.
This fall, it opened the Jefferson School in Frederick County as a special education facility, which soon will include a residential treatment center.
And despite going from 322 to 170 hospital beds in the past decade, more than 17,000 patients -- the most ever -- were treated by the Sheppard Pratt Health System last year on- and off-campus.
"We've been very much a leader in the field, not just forced by managed care," Sharfstein said.
In the past four years, the hospital opened eight day-treatment centers, at which therapy costs about a third of inpatient stays that average around $577 a day.
And it has several initiatives aimed at helping troubled youth.
Last month, the campus's Forbush School, which is certified by the state for special education, expanded its middle school program from 36 students to 54, bringing the student body to 200.
In addition, several former offices and a one-time sitting room for geriatric patients are being converted into settings for two dozen 3- to 5-year-olds as part of the Forbush School.
The hospital also has asked permission from the state to open 48 residential treatment beds for adolescents in a building now empty. The program would provide less intensive care than the psychiatric hospital.
Meanwhile, Sheppard Pratt has been reshaping its campus.
Recently, it leased 2 1/2 acres for 40 years to GBMC for the Gilchrist Center, an inpatient hospice facility that opened in July. This summer, the hospital turned over its indoor pool, which had been closed, to a private company that is selling swim memberships.
The hospital already is leasing some office space to groups such as the Anxiety and Stress Institute of Maryland, and is negotiating to rent offices to GBMC.
And its 8 1/2 -year-old Conference Center -- the newest on-campus facility -- draws community and business members to its 200-seat auditorium, dining facilities, classrooms and offices.
Sharfstein said the center, which will bring about 20,000 visitors to the campus this year, has helped "de-stigmatize" an institution trying to shake its reputation as a "rich person's hospital."
"It's a misnomer," said Mark Eber, director of public affairs. "Fifty percent are Medicare/Medicaid patients. We have very few private pay [patients]."
Almost all patients enter the hospital through the gatehouse on Charles Street, which resembles a Swiss chalet and was designated a national historic landmark with the original two patient buildings in 1971. Area children often call the landmark archway -- actually, a double house rented to hospital employees -- the "Hansel and Gretel" house.
Judith Kremen, executive director of the Baltimore County Historical Trust, gives high marks to the hospital for becoming accessible to the community.
"What they've done is taken a historic hospital and brought the public through the gatehouse."
Pub Date: 12/16/96