Tampabay: Hospital's closing worries advocates

TAMPA -- When state inspectors walked into Oakland Manor assisted living facility last year, they were surprised to find the basement floor covered with more than two inches of sewage.

Inspectors found feces in a hallway and on the bathroom floor of the home, which houses 24 people, most of them mentally ill. And those weren't the only problems.

One resident said he had not received his Prozac for five days. Throughout the rambling home on Nebraska Avenue, "all of the mattresses were dirty, most of the beds did not have sheets and dirty clothes were strewn over most of the rooms," inspectors wrote.

Owners Rory and Lisa McCarthy say they are spending money and working hard to fix the home and create a loving, family-style atmosphere inside. "I feel we're providing a great service to people," Rory McCarthy said. "Unfortunately it's in a 105-year-old building."

Oakland Manor is one tiny piece of Florida's community mental health system, but its troubles point to a big worry.

One year from now, Florida plans to close G. Pierce Wood in Arcadia, the state mental hospital that serves the Tampa Bay area and the rest of Southwest Florida. Some patients will go to other state hospitals. But more than 200 will leave for smaller facilities, including assisted living facilities or ALFs, in Tampa, St. Petersburg, Fort Myers and elsewhere.

Even advocates who have long called for closing the hospital because of poor care there now worry that it is shutting down too fast. They say the state's ambitious plan to spend more than $30-million building up smaller community-based programs may not be complete by April 2002. And the hospital plans to stop taking new patients in July, meaning the community-based programs already will be filling faster than normal. "I'm not convinced that the timing will be proper. It takes a while to build residential services," said Thomas Riggs, chief executive officer for Directions for Mental Health in northern Pinellas County.

Like Riggs, Marsha Lewis Brown, executive director of Northside Mental Health Center in Hillsborough County, supports closing the hospital. But she, too, says, "I have a concern whether or not we'll have online all the services I believe are necessary."

The overall goal is to get people into smaller, local centers such as those operated by St. Petersburg-based Boley Centers for Behavioral Health Care, which has received nationwide recognition for the services it provides to people with serious and chronic mental illnesses such as schizophrenia.

But if the state hasn't expanded space in local centers by the time the hospital empties, it raises the prospect that people who need intense supervision and care will end up in facilities such as ALFs, which are for people who need less oversight.

If that happens, residents could "do something disruptive in the neighborhood, and the next thing you know, the poor soul is in jail," said Paula Hays, Boley's president and chief executive officer.

It may sound like a scenario you've heard before: A state mental hospital shuts down. Patients are released, with no good plan for giving them care. Many wind up homeless or jailed, as sick as they ever were, or worse.

Opponents of the hospital's closing say just such problems are ahead, the inevitable result of closing a hospital for people so ill that some of them hear voices or mutilate themselves.

Florida officials vow the G. Pierce Wood closing will be different. And many advocates for the mentally ill say there's no reason it shouldn't be, because they strongly believe they can provide better care for patients in smaller settings that are closer to home and allow people more independence.

"It's not rocket science, as they say. It simply takes adequate funding of services in the community," said Hays, who said Boley already provides residential care for people with serious and chronic mental illnesses.

These same advocates, who have complained for years about Florida's paltry funding of services for the mentally ill compared with other states, say they are generally impressed with the state's plans to spend more than $26-million on community mental health programs within G. Pierce Wood's service area. Gov. Jeb Bush's proposed budget has called for:

$9.4-million for "assertive community treatment" teams throughout the hospital's service region -- teams of doctors, nurses and other professionals who monitor, assist and give medical treatment to the mentally ill, whether they are living in supervised homes or their own houses.

$2.2-million for creating "crisis stabilization units," for people in crisis, for up to 21 people at a time.

$4.6-million short-term residential facilities that will serve up to 100 people at a time.

$2.7-million for group homes for 216 people.

$2.1-million in housing assistance.

Riggs said the governor's budget and the Department of Children and Families have been "very, very reasonable in terms of asking the Legislature to support the funding of the services that will be necessary in order to do a good job."

But he noted that those figures could change as the Legislature passes its budget, so the final amounts aren't yet known.

He also worries that potential hospital patients already are being diverted from G. Pierce Wood and "that is creating a significant strain on an existing, already strained service delivery system."

"I am concerned about the July 1 date. I don't think that is realistic," he said, referring to when the hospital will stop accepting new patients.

DCF spokeswoman Ginnene Elster said "the community development plan is on schedule, and we are moving ahead, assuming that we'll get the necessary funds to complete the plan."

She said that wherever possible, the state will purchase bed space in existing facilities. That explains how the state can accommodate so many patients in community settings so quickly.

"How could they build a group home in that amount of time? We're not planning on building a group home," Elster said. She did say it was possible the state would have to look into renovating or expanding facilities in areas where there isn't enough room. "If there is a need, then that will have to be addressed in that district."

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