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Position on Hospitals
 

NAMI of Maryland  believes that hospitals are one stage of a continuum of care for persons with serious psychiatric disorders.  While it is our hope that, of those afflicted with psychiatric disorders, as many as possible can live in the community, we believe it is clear as a matter of appropriate treatment and existing law that persons who must have continuing close care or need to stabilize acute psychiatric symptoms should be able to have recourse to hospitals. These institutions also provide important and necessary service to persons who must be hospitalized because of a court order or inability to live successfully in the community.  

NAMI of Maryland has a role to play in advocating for adequate services in public and private hospitals and in monitoring the quality of the services provided. We advocate the following:

1. The welfare of the patient is the most important consideration, whether the patient is in a hospital or in the community. The patient shall receive the best treatment and quality of care available.

2. The Olmstead decision of the Supreme Court of the United States, interpreting the Americans with Disabilities Act (“ADA”), should be fully and carefully implemented by the State of Maryland. The State is required under Olmstead to provide community-based treatment for persons with mental disabilities when the State’s treatment professionals determine that such placement is appropriate, the affected persons do not oppose such treatment, and the placement can be reasonably accommodated, “taking into account the resources available to the State and the needs of others with mental disabilities.”  In implementing Olmstead’s conclusions, other clarifying statements in the Court’s Opinion must also be carefully considered: that the ADA “is not reasonably read to impel States to phase out institutions, placing patients in need of close care at risk” -  that some individuals may need institutional care from time to time “to stabilize acute psychiatric symptoms” -  and that for some individuals, “no placement outside the institution may ever be appropriate.”   

3. There should be adequate funding for State hospitals as well as for other State facilities for persons with mental disabilities.

4. There should be an adequate number of inpatient beds (public and private) within the State of Maryland. Patients needing crisis care should not have to wait for a bed to become available. Certainly, the number of beds available in the State system for persons with psychiatric disabilities should not in any circumstances be reduced and ought to be increased. to meet the needs of the patient population.

5. Psychiatric hospital services should be available across the State. Patients should not have to be placed in hospitals at discouraging distances from their communities, families, and social supports.  

6(a). NAMI of Maryland generally opposes closure of State mental health hospitals. We recognize that, at the present time, Maryland is encountering severe budget problems and difficulties in funding State programs; and we anticipate that mental health programs must also expect cuts and compromises. Nevertheless, closing of a State mental health hospital can be accepted by NAMI of Maryland only with serious reservations and caveats. It must be recognized that the closing of such a hospital: (1) reduces potential bed capacity in a system operating at theoretical capacity even if the number of existing beds is supposedly maintained; and (2) unless appropriate steps are taken, will impair care for many patients as a result of increasing distances for family and community support systems.

(b). In effecting any closing of a State mental health hospital, the State should attempt to have the resulting regional hospital system place all hospitalized  patients in proximity to, and in no event more than 100 miles from, their homes or families. NAMI of Maryland supports transportation assistance, including financial help, to enable families to visit a relative in a State hospital and participate in the relative’s treatment. 

7.We support the provision of grievance procedures for consumers and their families and support measures to remedy or repair negative experiences in psychiatric hospitals and other facilities.

8. We are concerned about safety and inappropriate treatment issues in hospitals and other psychiatric facilities. NAMI of Maryland will continue to monitor such hospitals and facilities for inappropriate restraints, seclusion, and generally inappropriate treatment. Unexpected deaths and injuries shall be reported to the Office of Health Care Quality (OHCQ) and the Director, Mental Hygiene Administration. OHCG should investigate and recommend corrective actions in such cases as it deems such actions to be appropriate. The Director should make such reports and related records of investigations and corrective actions available to the public in a timely manner, making such deletions in publicly disclosed records as may be necessary to protect the confidentiality interests of the patients involved.

9. Aftercare treatment plans shall be developed for each person being discharged from a hospital Arrangements ought to include interagency cooperation to ensure adequate housing, medication, and medical care in the community. No one should ever be discharged to a homeless shelter, a crisis center, or the street.

                       

Approved by the NAMI Maryland  Board of Directors  on April 17, 2004

 

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