Maryland's top health official proposed yesterday to shrink the state's mental health system by closing the 90-year-old Crownsville Hospital Center in Anne Arundel County and privatizing the Walter P. Carter Center in downtown Baltimore.
Shutting Crownsville would force the state to relocate its 200 patients to other facilities and could prompt about 150 layoffs, according to a report by Health Secretary Nelson J. Sabatini.
It would also save $5.3 million per year for a state facing an $800 million shortfall next budget year.
And it might free up money to help support community mental health care, state officials and mental health advocates said.
The report, prepared at the request of state lawmakers, represents the first major statement by Gov. Robert L. Ehrlich Jr.'s administration on how it would reshape Maryland's psychiatric hospital system.
Decades ago, the state would institutionalize mental health patients for life inside massive facilities. But with advances in medicine and the growth of community mental health facilities, the average patient stay has dropped to less than half a year.
The huge facilities remain, but with far fewer patients.
"Does it make sense to run three facilities that are basically designed for the techniques of the last century?" Sabatini asked.
Closing the Carter Center could also save money, Sabatini said, though a figure is not provided in the report. Carter is a 50-bed facility on Fayette Street where patients receive immediate short-term care and are either transferred to other hospitals or released.
While many people voiced initial support for the plan yesterday, it will face some opposition.
Del. David G. Boschert, a Republican who represents Crownsville, said he plans to organize large community meetings and fight the new plan.
"I'm obviously very concerned about the recommendation, but I do look at it only as that, a recommendation," he said.
The General Assembly had asked the Department of Health and Mental Hygiene for a report on how best to consolidate the state's mental health facilities, particularly its three largest centers. To many in Annapolis, closing one emerged as an attractive option over paying to renovate them.
The newest building at Crownsville is nearly 50 years old, and the hospital has been seeking $98 million in capital funding for rehabilitation.
"We're trying to get more bang for our buck," said Del. John Adams Hurson, a Montgomery County Democrat who is the chairman of the House Health and Government Operations Committee.
"But the driving force here is not money. The driving force is that you can sometimes get better service in the community if the dollars follow those patients into the community."
Suggesting closure is not a new idea.
Twice in the past 15 years, state task forces recommended shutting one of the so-called big three hospitals - Crownsville, Spring Grove Hospital Center in Catonsville and Springfield Hospital Center in Sykesville.
Each time, the plans were scuttled by residents near the hospitals, unions and local politicians.
"I think we're a little bit further than in the past," said Del. Van T. Mitchell, a Charles County Democrat whose subcommittee requested the report.
Although state officials don't need the legislature's permission to close Crownsville, Sabatini said he will not move forward without the backing of lawmakers. The next legislative session begins in January.
The state weighed closing each one of the big three, though it came down to choosing Crownsville over the Catonsville center.
Anne Arundel County Executive Janet S. Owens said she has questions about the future of the patients, the staff, the asbestos-filled buildings and the tenants leasing land there.
"I'm very concerned about Crownsville," she said. "That may sound mild. I am deeply concerned."
The Maryland Classified Employees Association also issued a statement yesterday urging the state to offer early retirement plans for affected employees.
The report concedes that moving patients could be disruptive to their care and could make it harder for relatives to visit. But mental health advocates were not complaining yesterday - as long as the expected savings go toward mental health care.
"If we can save money by consolidating, we need it," said Linda Raines, executive director of the Mental Health Association of Maryland, "because we have people out there who aren't getting care, that need it."
Eight adult facilities, including the big three, and three adolescent treatment centers constitute the state mental health system. Nearly half its patients are from the criminal justice system; the other half are uninsured individuals who were committed by psychiatrists.
The state system's capacity has dwindled during the past 21 years to 1,204 beds from 4,390, the report states. It is full, and the capacity would remain the same after the proposed changes, Sabatini said.
But despite the dwindling number of patients, the state has closed only Highland Health Psychiatric Unit in Baltimore.
Instead, the facilities shrank within their sprawling campuses. Crownsville, which was a 2,719-person asylum in 1955, has devolved into a 200-bed hospital on a 633-acre campus with vacant buildings.
Construction of Crownsville, initially named the Hospital for the Negro Insane, started in 1910. It was built by the people it was intended to serve.
Some buildings leased
Several buildings are leased to nonprofit tenants. Across the campus there are remnants of how large the institution was: the chapel that was once a potato barn, a former hospital livestock barn and the unused 150-gallon vat in the hospital kitchen.
Closing Crownsville and relocating the patients would take about a year, the report estimates. Of its 200 patients, 180 would remain in the Baltimore area. The others would be moved to a state facility in Allegany County.
Its closure could result in 147 full-time nonclinical employees, such as maintenance workers and dieticians, losing their jobs. The state would prefer to move medical staff with the patients, but the report notes that there is no guarantee they would agree to move.
Even though closing the Catonsville center would save $3 million more per year, the state opted for Crownsville because fewer patients would be moved, fewer employees could lose their jobs and the Catonsville location has better access to public transportation.
Use of land
The land in Crownsville would first be offered to other state agencies, then to Anne Arundel's government.
If the Carter Center were privatized, the state would require guarantees that it could place patients there. Sabatini said he would expect that employees could remain at the facility and will push for no layoffs at Carter or Crownsville.
Sabatini said the report also suggests exploring privatization of the state's three juvenile residential treatment centers, including one near the Baltimore National Cemetery.