The underfunding for forensic psychiatric hospital beds detailed in the Sept. 29 article "Judge holds Maryland officials in contempt, orders them to open dozens of psychiatric beds," (Oct. 29) is another example of the state's long-standing failure to prioritize services and timely treatment for the most seriously ill. Maryland has closed so many state hospital beds that a 2016 report by the Treatment Advocacy Center found Maryland has only 31 percent of the psychiatric hospital beds generally accepted as needed.
According to the contempt order, "Admissions [to state hospitals] from the community … occurs rarely if ever." Since community hospitals largely provide only short-term care, this constitutes a denial of appropriate treatment to those requiring longer term care, and a shift of costs to the community. Desperate family members sometimes press criminal charges against a loved one as the only chance to obtain needed longer treatment and prevent harm to self or others. These policies have also created a shortage of community hospital beds. Those needing longer-term care now cycle repeatedly in and out of short-term community hospitalizations.
The state's plan to place forensic patients in community hospitals will only make the bed shortage there worse and increase emergency room back-ups. Instead, more state hospital beds for both forensic and community patients would help. The state has exacerbated the crisis by refusing to prioritize state-wide community services for the most severely ill. Services needing state-wide implementation include long-term case management, Mobile Crisis Services, Assertive Community Treatment, and law enforcement de-escalation training. Helpful legislation would include a need-for- treatment standard for involuntary hospitalization for those who lack insight and cannot care for themselves, and establishing an evidence based Assisted Outpatient Treatment Program.
Prioritizing spending on treatment and services for those with severe illness would save lives and reduce hospitalizations and incarcerations and ultimately costs.
The writer is the director of Parents for Care.
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