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No Care for the Homeless

State to close only public psych facility in Baltimore City

Christopher Myers
Walter P. Carter Center RN Charge Nurse Carolyn Work.

By Erin Sullivan | Posted 7/1/2009

On Oct. 1, the only publicly run acute psychiatric inpatient hospital in Baltimore City, the Walter P. Carter Center, will be closed for good.

The center is named after noted civil rights activist Walter P. Carter, who felt strongly that the city of Baltimore needed a publicly run facility that offered much-needed social, health, and community services to its poorest residents. The center was opened in its current location, at 630 W. Fayette St., in 1976, and today it is the only facility of its kind in the city, offering inpatient psychiatric treatment to indigent and uninsured residents.

"What happened was that when my dad died, the civil rights advocates at the time basically made a demand of the state that it open a facility like this one," says state Del. Jill Carter (D-41st District), Walter P. Carter's daughter. "It wasn't exactly the vision of what my dad wanted—he wanted a place for the indigent where they could basically get their lives together—but still, the history of civil rights is tied up in this center."

When the state closes it down, Baltimore will become one of just two major cities in America that does not have a public psychiatric hospital to take in poverty-stricken and uninsured individuals suffering from everything from social adjustment disorders to acute schizophrenia. (New Orleans is the only other city that does not have such a facility.) Patients being treated at the Carter Center will have to be transported to other state-run facilities outside city limits—such as Spring Grove in Catonsville or the Clifton T. Perkins Center in Jessup—and nurses at the center say that patients are already being transferred as units are downsized and closed, in preparation for Oct. 1.

"Today I have to take a couple of people off my unit," Carter Center RN charge nurse Carolyn Work says on a recent afternoon. "They are trying to downsize from three units to two units. They are trying to send them all to Spring Grove, but Spring Grove is saying they don't have any beds. But they are trying to get them over there. I think this is going to be a tougher battle then they thought. They were hoping to get them out by the end of July."

Every year during the legislative session, rumors and reports that the state is scheming to close the Carter Center—or at the very least, privatize its services—to save money arise, but then are squashed before the end of session. In 2003, for instance, a plan to privatize the center by outsourcing its management to the University of Maryland Medical System was proposed as a way to save the state money. The proposal died when University of Maryland and the state Department of Health and Mental Hygiene Administration could not come to terms about how to structure the deal. The state offered $30 million over the course of five years, and the university would have been eligible for additional money for taking in uninsured patients, but concerns were raised that there was nothing in place to stop the university from filling all of the beds with insured patients, leaving the uninsured with nowhere to go.

In 2007, rumors that the Carter Center was again facing potential closure were fervently denied by hospital administrators and state officials. At that time, Sheilah Davenport, deputy director of the Mental Hygiene Administration, which oversees the state's psychiatric facilities, told City Paper that it was just a "rumor that won't die" and that the facility was not being shuttered or moved outside city limits.

This year, however, closure of the Carter Center is not a rumor: In January 2009, a proposal was floated to move all patients out of the center to other mental-health facilities, relocate staff, and turn the center over to the University of Maryland to operate outpatient clinics—but no inpatient services. In February, Del. Carter proposed HB 1043, a bill that would prohibit the state Secretary of Health and Mental Hygiene from closing the facility. That bill was sent to the Health and Government committee, where it received an "unfavorable report" by the committee. No action was taken on the bill after that. Carter then proposed another bill, HB 1044, that would have required that the employees of the Walter P. Carter Center be offered state employment if the center was to be closed and that the state Department of Health and Mental Hygiene "ensure that specified community-based services" be offered to replace those being eliminated with the center's closure and that the University of Maryland "perform specified duties of the Walter P. Carter Center if transferred to the university." That bill was sent to committee where it quickly died.

"They do this thing in the legislature where they say we don't need the legislation because they say we're going to go ahead and do it anyway," Carter says. A letter [that Del. Pete] Hammen showed me indicates that they are going to put some things into place, more and expanded services. But it's all just best efforts—they'll do the best they can."

Archie Wallace, CEO of the Walter P. Carter Center, says he can't comment on the closure of the center and refers calls to the state Department of Health and Mental Hygiene. John Colmers, secretary of the Department of Health and Mental Hygiene, says the proposal to close the Carter Center is part of a broader series of decisions being made about the state's mental-health facilities. He says that while inpatient services at the Carter Center—which had 34 inpatient beds just prior to closure, down from 51 earlier this year—are being eliminated, 44 more beds are being added at the Perkins Center in Jessup. Opening those beds, he says, will free up space at Spring Grove in Catonsville.

"The majority of the patients who are in the Walter P. Carter Center inpatient unit today are forensic patients," Colmers says. "They are criminally involved. Those are not patients that we can or should place into private facilities. They will be served in—and they come not just from Baltimore city, but other jurisdictions as well—they will be served in one of the other state facilities: Spring Grove, Springfield, or Perkins."

Civilly committed patients, he says, can also be treated at Spring Grove or Springfield, but the state is also planning to buy private beds at Bon Secours, Shepherd Pratt, and other private hospitals.

The state pays millions of dollars per year for those private hospital beds, and according to a letter written to state delegates by Dr. Steve Whitefield, a psychiatrist who used to work at the Carter Center, the state "is not getting its money's worth" because private hospitals can pick and choose which patients to admit: "They cherry pick for the patients whose care will cost them the least to provide, and do not provide a safety net and best practices type of care that state hospitals provide the uninsured."

Colmers says that the millions paid for private beds is actually a "cost saver" for the state, because the state negotiates the price via a rate-setting system and stays in private hospitals are usually "a little bit shorter" than at public ones. Colmers says that the vast majority of mental health services are provided in community settings, not hospitals, and Baltimore already has a strong public and private mental-health infrastructure in place.

Work says she's "outraged" at the state's short-sightedness in this situation. She says that the Carter Center is the only place willing to keep acute psych patients long enough to stabilize them and get them on a steady medication regimen before release. Private facilities, she says, usually release people in a matter of days.

"[Patients] can usually be here from one to three months," she says. "And when they get treatment like that, they can get back to being on meds and their chances of making it on the outside are much, much greater. If you have to send them to the University of Maryland clinic or to Bon Secours, or any place like that, the length of stay is so short. If you're a paranoid schizophrenic, the first few days you are here, you probably don't even want to take your medication at all. So if you're released, you're not going to make it. So it becomes a revolving door thing."

Not only is that detrimental to the patient, says John Burleigh, who was also a civil rights activist and friend of Walter P. Carter's, it's detrimental to the community. The Carter Center, he says, was created to address the unmet needs of minorities and low-income individuals in the city during a time when "many were being released from institutions, during the movement of deinstitutionalizing the mentally ill." Many of those patients, he recalls, had few resources and ended up out on the streets. Because of their mental illnesses, these untreated patients would do things that were "socially unacceptable" and would end up incarcerated.

"It was found that these people were being misdirected and mistreated because they were ill, not criminals," Burleigh recalls. "There was a growing need and awareness of that unmet need."

Meetings were held with the Community Health Council, the Congress of Racial Equality, and professional health care providers to come up with a plan that would address the need for mental health care for the poor and minorities. "Through negotiations, we were able to bring to fruition an institute to address those needs," he says. "The Walter P. Carter Center."

Burleigh says that people should be aware of how the closure of the center will affect the community if replacement services are not in place when it's gone. "We should not be shortsighted in reducing resources to the community that provides for unmet needs, that provides funding for unmet needs, in lower-income and minority communities," he says. "It exacerbates the increase of social problems and deteriorates the quality of life for the community at large."

Colmers does not agree that the state is backing away from its commitment to provide mental-health services to poor and minority communities.

"Our commitment to mental-health needs in Baltimore city and to eliminating health disparities, including health disparities in mental health, is profound," he says. "We are profoundly committed to addressing those issues, even in these economic times, to be sure that services are available to people."

To that end, he says, the state will work closely with the University of Maryland to establish more outpatient services to absorb the mental-health needs of the community. Carter says the plan, from her perspective, seems "kind of murky" and she hopes the state is able to make sure that "the largest jurisdiction [in the state] with the greatest mental health needs in the state has some type of facility people can go to. Especially people without any money or any insurance."

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Tags: Walter P. Carter Center, mental health

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