After more than 30 years with Sheppard Pratt Health System, Steven S. Sharfstein, MD, retired this month. His tenure included the roles of vice president and medical director, as well as his most recent role as president and CEO of the Baltimore-based mental health and psychiatric not-for-profit organization.
A direct-care clinician and a political advocate, Sharfstein tells Behavioral Healthcare that his work in treatment has informed his advocacy and vice versa.
“Before Sheppard Pratt, I was involved in a number of activities, including working with the White House and Rosalynn Carter on their mental health initiative, which was responsible for the Mental Health Systems Act of 1980,” he says. The legislation provided grants to community mental health centers.
He also worked for the National Institutes of Health for four years and helped to develop the consultation-liaison psychiatry service. In more recent years, he’s addressed big-picture policy issues, such as state provisions for involuntary treatment to help families secure care as well as gun control laws in the context of suicide rates.
It’s difficult to take an honest look at the mass shooting incidents in this country and not talk about gun policy, Sharfstein says.
“The fact that we don’t have common sense gun control creates risk factors for those few who may have mental illness to hurt lots of people,” he says. “Of course, most mass shooters are not people with mental illness. They are obviously troubled people but are not in the same category as someone with schizophrenia or bipolar disorder or dementia.”
Sharfstein says debating the horror of mass shootings often distorts the conversation about what is needed to improve mental healthcare and leads to the erroneous assumption that people with mental disorders are dangerous. While he sees the need for legislation, he believes gun policies and mental health policies should be wholly separate. The focus of any regulation should be centered on the need to increase the percentage of people with diagnosable disorders who actually receive treatment.
Sheppard Pratt Health System, a private not-for-profit organization in Maryland, offers mental health, substance use and special education services. It grew from a single psychiatric hospital more than 100 years ago to its 38 locations today that serve 60,000 people each year.
In 1986, Sharfstein joined Sheppard Pratt as medical director. At the time, length of stay for inpatient services was 80 days across all age groups. Today, the average time has decreased to 11 days as the system has transformed to emphasize a continuum care. The number of admissions has also increased tenfold under his leadership.
“For folks who came here, treatment was focused on their disorder, but there was poor outpatient coverage, so the concept was that they would be here until they got better or until their insurance ran out—whichever came first,” he says.
The model shifted as managed care payers changed reimbursement over the years, and now outpatient services are in demand. Sharfstein says he was proud of the way the organization as a whole made the transition across the various specialties, especially for clinicians who had been accustomed to the previous model. It was a new way of doing business and delivering services. Additional services and levels of care were added to expand Sheppard Pratt’s capabilities.
Demand for care
As the industry looks to place more patients in community-based care today, the demand continues to exceed the supply of accessible providers. Of the 10,000 discharges completed by Sheppard Pratt per year, about half continue to lower levels of care within the health system’s network, while some go to other community providers. However, there is still a large gap of patients who aren’t able to access continuing care in their own communities, Sharfstein says.
“Funding is problematic,” he says. “There’s still a lot of work to be done. There are gaps in funding and that is reflected in the gaps for people who need care.”
Those who are homeless and those engaged in the criminal justice system are especially vulnerable, he says.
For the future, Sharfstein recommends that providers take advantage of the current trend toward integration. Coordinating behavioral and medical care will offer synergies and improved outcomes.
“Putting that together is a task for the future,” he says. “Many organizations are looking creatively within the context of that opportunity, and there will be reimbursement for that as well.”