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The pressure to release patients is occurring despite the fact that a growing percentage of MPC's patients have criminal, and sometimes violent, backgrounds. In 1993, of the 740 patients admitted to the hospital, only 7 percent came from correctional facilities like Rikers, Sing Sing, and Attica; in 1997, these patients accounted for 70 percent of the hospital's 134 new admissions. Today, virtually all of the new patients entering MPC have criminal backgrounds.
Up until a few years ago, all but a handful of MPC's admissions were referrals from Bellevue, Metropolitan, Harlem Hospital Center, and other acute hospitals in Manhattan. But in 1996, staff say, these "receiving hospitals" were directed by the state to divert any patient who required extended care to Rockland Psychiatric Center in Rockland County. (Critics of this move believe the governor has steered patients away from the city as a way of preserving jobs for his upstate supporters.) The following year, under a separate state policy, MPC began receiving more and more patients from correctional facilities.
Some of these patients can pose a threat to the community if they are discharged prematurely, particularly if they stop taking their medication or if they revert to using drugs and alcohol. Such relapses aren't uncommon, according to doctors and advocates, because community treatment programs are often understaffed and cannot legally force patients to take their medication or even return to the facility each night.
"As we get to the more severe patients, with drug addictions and criminal histories, we can expect a larger percentage of trouble after discharge," a former MPC physician told the Voice.
But not every physician at MPC is as worried that the pressure to release patients will result in dangerous people walking the streets. "You get brownie points if you get patients out," says one physician still working at MPC. "But only a physician can sign an order to discharge patients. Many of the patients can respond just as well in a supervised community setting."
The key, experts say, is to gradually move patients to independence and release and to make sure that patients continue to receive adequate care and supervision outside of the hospital. Patients can be completely lost if they are placed in a community residence that doesn't suit their specific needs or if there is no one to help ease their transition to independent living. This may be even more important at MPC, where many of those being discharged have been living in the hospital for years.
The Manhattan State Citizens Group, among other patient advocate groups, believes that MPC is in such a hurry to place patients in community beds when they become available that hospital officials are making important placement decisions without proper input from patients' families.
A case in point: Dorothy Goode's son, Michael, was released from MPC in December after receiving treatment in the hospital for more than 13 years. Despite the fact that she supports Michael financially and keeps a close eye on his progress, the 80-year-old woman learned of her son's discharge not from the hospital, but from the supervised residence that was accepting her son.
Goode says that the hospital also neglected to arrange for her son to get his government entitlements ahead of time. She says that the officials at the supervised program actually told Michael that he needed to go to the Social Security Administration office himself to apply for SSI. While navigating the bureaucratic maze can be a dizzying task for any New Yorker, Goode felt that it would be nearly impossible for someone who hasn't lived an independent life for more than a decade. Ultimately, she went down to the government office on her son's behalf.
"They're in a hurry to get the patients out. Once they find somewhere that will take them, they just rush them out," Goode says. "If I wasn't alive, I don't know what would happen."
Even for patients who remain at the hospital, the atmosphere is increasingly grim. In recent years, MPC has begun to look more and more like a prison. Officials have built fences, tightened security, and greatly restricted the number of patients allowed to walk around the grounds.
On a recent afternoon, the MPC's recreation and rehabilitation facilities looked like a ghost town. Staff say this is because the rehab center which includes a library, a bowling alley, a theater, a cafeteria, and pool tables is located in a separate building from the patient wards, and only a small number of patients have access to these facilities.
Shortly after Peter Fazio committed suicide, a patient at MPC composed an emotional letter to MPC administrators that eventually circulated throughout the hospital. She wrote: "All you have been concerned with is downsizing the hospital as quickly as possible and you forget that you are dealing with human lives and feelings. You can not all of a sudden force patients you have kept here for so many years to leave. Forget your stupid deadlines and let time be spent on these patients to prepare them so they don't all of a sudden feel abandoned. Because the hospital is locked down now 95 percent of us never go further then Casa Verde [a fenced-in recreation area], and yet you are discharging people left and right who haven't spent a day on their own in years.