Second of two parts; read the first part
For much of his adult life he'd been a slave to cocaine, marijuana, prescription pills and alcohol. Twice he had gone through weeks of intensive psychiatric and drug treatment at Baltimore Behavioral Health Inc., only to go back to using drugs on the streets.
By summer 2008, Stephen Brown was three months into his third stint at BBH. That's when the private treatment center in Southwest Baltimore deemed him ready for a new challenge: to manage a rented rowhouse where he would live with seven other patients. His duties included enforcing curfew, hunting for hidden drugs and unlocking a cabinet so residents could take their psychiatric medicine.
But he says the assignment, which paid him $120 every two weeks, caused serious stress. Not only did he receive no training, he says, but he was still in mental health treatment, still on antidepressants.
"I didn't really want to be house manager," said Brown, 53, a native of Trinidad. "I didn't want that kind of responsibility. It was too much for me, being a patient and just coming off 90 days clean from being on drugs. I accepted it because that's what they gave me. I said, 'Let me just try it and see.'"
The two-story brick house on South Fulton Avenue that he managed is part of a network of rowhouses that BBH rents in Southwest Baltimore. As of July, 150 of its roughly 800 outpatients were living in the houses, which are clustered in a battered working-class area where prostitutes ply corners before noon and city Health Department data show that more people die of overdoses than in almost any other part of Baltimore.
For BBH patients, many poor or homeless, the housing has meant not having to worry about finding a place to sleep. For BBH, it has attracted indigent patients whose outpatient care is usually paid for by taxpayers, according to interviews with former patients and staff at the West Pratt Street clinic. To help ensure that they attend treatment, BBH has vans that pick up patients in the morning for daily therapy.
But some former patients and staff as well as outside doctors say that BBH, which last year grossed $17 million, finds mental illness in patients whose main affliction is substance abuse. And state records show that drug users are three times more likely to be deemed mentally ill there than at treatment providers across Maryland.
The housing has become an integral part of BBH's model as a treatment center geared to helping people who struggle with both mental illness and drug addiction. Executives at the family-run nonprofit say their goal is to make treatment more successful by making it easier for patients to focus on getting well.
But a Baltimore Sun investigation has found that the arrangements raise concerns, including doubts about the wisdom of giving newly sober patients like Brown the key to the medicine cabinet. Among the findings:
•No aspect of the housing network falls under state regulation. Maryland's public mental health system has paid the tax-exempt provider more than $70 million over the past five years to treat thousands of patients, yet state health officials concede that they have no authority to regulate how the houses are run. Baltimore housing officials say that most houses leased to BBH were not properly registered.
•No houses rented by BBH have on-site professional staff. Instead patient-managers with as little as 60 days of sobriety are given the responsibility to enforce house rules and mediate disputes.
•The head of the state Mental Hygiene Administration, which oversees Maryland's public mental health system, says he worries that the housing may have been an "inducement" for some patients to enroll in state-funded outpatient treatment that they didn't need.
•BBH rents 10 houses from an investor group made up of three corporate drug salesmen, one of whom marketed prescription drugs to BBH. Separately, BBH has paid more than $2 million in house-finding fees since 2004 to a man who once ran several homes in Washington from which mental health officials ordered patients removed over issues of safety, disrepair and other "deficiencies."
•Though some former patients described houses in good condition, others complained that one had a rodent problem and no kitchen stove. Two residents of another house complained about living in a basement with no exit. And former patients and staff say illicit drug use is an enduring problem.
William "Kris" Hathaway, chief executive of BBH, declined requests for interviews and did not reply to eight written questions about the housing. In an e-mail in May, he told The Sun that BBH spent $3.4 million last year on "charitable services" such as patient housing. The services were "uncompensated," he said, meaning that they were not reimbursed and affected the nonprofit's bottom line.
Hathaway said giving patients a bed makes practical sense. "It is hard to focus on one's mental health or addiction issues when there is not a conducive living situation.
"It is otherwise ludicrous," he said, "to expect positive outcomes when the authorized level of care is outpatient-based for this segment of our population."
While Hathaway described the housing costs as uncompensated, there is an evident financial upside for BBH: For a given patient, the nonprofit has long been able to recoup several times the monthly rent it pays the landlords — $200 per patient, according to its housing director — by billing the public mental health system for treatment yielding payments of several thousand dollars a month.
Addicts put in charge, drug use common in BBH housing
Sun investigation found arrangements raise concerns, including doubts about giving newly sober patients the key to the medicine cabinet
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