Mental health unit expands

With an average of 245 psychiatric evaluations a month coming to Howard County General Hospital's emergency room, the need for more than two unlocked evaluation rooms was clear, said the hospital's chief psychiatrist.

"If you look at the volumes we've had recently, two rooms is completely inadequate," said Dr. Joseph Schwartz, director of psychiatry at the hospital.


A new 10-bed unit - including three locked rooms - was to open today in the emergency room at the Columbia hospital.

Construction on the 1,920-square-foot, $775,000 project began in August, and an opening ceremony was held Monday. The addition increases overall emergency room capacity from 36 to 46 beds, and the psychiatric unit will have a nurse and a security guard on duty 24 hours a day, officials said.


"I think it's good," said Donna Wells, executive director of the Howard County Mental Health Authority. "The good thing is it takes them [psychiatric patients] out of the general population of the emergency room. All the activity of the ER can be overstimulating" for patients, she said.

Howard County General, a 33-year-old community hospital that is part of the Johns Hopkins Medicine hospital system, began admitting involuntary psychiatric patients into its 20-bed in-patient unit in late 2005 as a pilot program, said Victor A. Broccolino, hospital president and chief executive officer.

Schwartz said the emergency room addition should ease congestion before people are admitted. Patients admitted typically stay about five days, though stays have lasted up to three months, Schwartz said.

Maryland's hospital emergency rooms have become bottlenecks for people suffering depression and other mental illnesses.

Pam Barclay, director of the Center for Hospital Services of the Maryland Health Care Commission, confirmed state figures showing a sharp decline in mental health treatment beds in the state that has led to patients being kept in emergency rooms for days - sometimes beyond the 30-hour limit in state law.

Beds in state psychiatric hospitals dropped from 4,390 to 1,235 - a 72 percent change - between 1972 and 2005. In private institutions, the decline was less, but still a significant 37 percent, she said.

Schwartz said psychiatric patients at Howard County General have occasionally stayed beyond that 30-hour limit because of the shortage of beds statewide, but he said emergency rooms are not often as crowded as other areas.

"Everything under our control at the hospital happens very quickly," Schwartz said. First, a patient is seen by an attending physician within 20 minutes, and a psychiatric assessment by a social worker, psychologist or psychiatrist follows within two hours.


"The 30-hour rule only applies to a very, very small set of patients," he said.

"We don't expect that locked rooms will be used very often. Most don't need a locked area," Schwartz said. "Think of it as a private, safe waiting area."

The unlocked rooms will have recliners to ease waiting, he said. The secure rooms are kept bare, so patients have less opportunity to harm themselves or others.

Schwartz is hopeful the expanded space will meet the hospital's needs for the next three to five years.

The hospital also is building a four-story tower, adding 42 beds, bringing total capacity to 229. The next project will be a 600-space garage.