Marvin Brown already had committed one sex crime by the time he moved into the 37-bed Maplewood Personal Care Home in Ambridge.
On May 23, 2012, police said, he committed another, raping a 71-year-old fellow resident in a second-floor bathroom as the woman's cries for help went unheard.
Brown, now 52, was one of 305 patients released from Mayview State Hospital during a three-year downsizing that preceded the hospital's closure in December 2008. While state and local officials say they're proud of efforts to move people with mental illness into the community, the process has been tragic in a handful of cases, bumpy for about 40 who have been arrested and ultimately short-lived for dozens who already have died, most from natural causes.
Bobbi Bishop, a former patient, now helps others
Bobbi Bishop was a patient at Mayview State Hospital. Now she lives on her own with the help of mental health outpatient treatment. (Video by Julia Rendleman; 9/23/2013)
These incidents have kept alive the controversy surrounding the hospital's closing and raised new questions about whether the outpatient treatment system is strong enough to serve people with severe mental illness, especially those who are violent.
How Brown ended up in a care home -- a setting that gives residents considerable freedom -- is an unanswered question. Carol McDowell, the care home administrator, declined to discuss the incident.
In all, 46 of the 305 have died since leaving Mayview, according to data provided by Allegheny HealthChoices Inc., the agency that helped plan the closure. The agency provided the following breakdown but declined to provide additional details:
• One was murdered.
• Seven died in accidents. That includes two who were struck by vehicles and at least one who choked to death on food.
• One committed suicide, and the death of another person, found unresponsive at home, remains undetermined pending toxicology tests.
• Thirty-six died of natural causes. They ranged in age from 40 to 87, and their average age was 62.
Mary Fleming, CEO of Allegheny HealthChoices, said people with severe mental illness tend to die earlier than the general population because they have difficulty managing physical health-care problems. She noted that the former Mayview patients were connected with primary-care physicians and other physical-health services as part of the discharge process.
"It's unknown whether or not transitioning from Mayview aggravated existing ailments that people may have had," Ms. Fleming said in an email. "Some of [the] individuals did have existing physical-health conditions upon discharge. These conditions were taken into consideration during discharge planning."
Proper outpatient care
Like proponents of deinstitutionalization around the country, the Pennsylvania Department of Public Welfare, which facilitated Mayview's closure, believes that people with mental illness can lead richer lives in the community with proper outpatient care.
However, the hospital's elimination provoked objections from those who believe that state hospitals still have a legitimate place in the system of care. They say state hospitals, or similar settings, are needed to provide long-term care to patients with severe and persistent mental illness and short-term care for those who temporarily lose control of their illnesses and need a place to get well.
At the time that the downsizing began, 44 percent of Mayview patients had been there three years or longer. Ten percent had been patients for 15 or more years, and 15 percent for less than one year.
"Some of the staff were nice, and some of them were really mean," said Bobbi Bishop, 33, who walked out of Mayview forever -- after a 3 1/2-year stay, the eighth of her life -- on June 21, 2007.
Today, Ms. Bishop goes to bed and gets up when she wants. She travels to and from her East McKeesport home as she sees fit. No longer does she live behind locked doors, with rules and staff who intruded on her freedom.
Topaz Calloway, 36, was hospitalized twice at Mayview, most recently for a nine-month period that ended in 2008. Today, she lives in her own apartment and works at Allegheny HealthChoices.
Of her days at Mayview, she said, "It's a closed chapter in my life."
Sharon Baker, 35, said she felt "like a prisoner" at Mayview. During 10 years there, she said, she left the grounds only two times -- for a family member's wedding and another relative's funeral.
Now, she lives in a Mount Washington apartment building, walks to Mass, attends therapy, exercises, shops with her aunt and studies to become a teacher's aide in a day care center. In March, she visited family in Texas.
When officials told her she was leaving Mayview, "that was the best day of my life," she said. Community living, she said, has given her incentive to work on staying well.
Indeed, many former patients have experienced a decrease in psychiatric symptoms and become more accepting of medication regimens in the 41/2 years since the hospital closed, according to an update this summer by a University of Pittsburgh team that has surveyed 92 of the 305 former patients.
But managing a mental illness is a daily effort. Since leaving Mayview, 212 of the 305 former patients have been treated at community hospitals at least once for mental health emergencies, according to Allegheny HealthChoices. Ms. Bishop sought treatment 13 times, most recently in 2009.
Mental health crises are only one challenge the 305 have faced. Allegheny HealthChoices said that since leaving Mayview:
• 39 former patients have been arrested.
• 10 committed, or were victims of, physical or sexual abuse.
• 2 have been involved in outbreaks of contagious diseases.
• 8 attempted suicide.
• 82 were involved in what the agency called "other incidents -- serious nature."
The numbers likely overlap. For example, some of the people who were arrested also may have attempted suicide or been involved in abuse cases or been among the 46 who have died.
By other measures, too, the goal of integrating former patients into the community remains a challenge. In interviews and surveys conducted by the Pitt researchers, some complained about a lack of social opportunities and named social workers and caregivers as the people they see most often. While Ms. Bishop lives in her childhood home with her fiance, Raymond Kolb, and cat, Baby Boy, many of her peers still live in residential programs operated by social-service agencies.
A report that provided housing data for 210 former patients as of March 2012 said only 55 were living independently, defined as on their own or with family. Nineteen lived in apartments or other settings with supportive services, and 80 lived in supervised settings, such as group homes and personal-care homes.
Fifty-six lived in restrictive settings -- five in jails or prisons; 10 in nursing homes; eight in Torrance State Hospital in Westmoreland County; two in extended-acute-care facilities; 23 in long-term structured residences, some of which are locked; and eight in community hospitals, where five were being treated for physical-health problems and three for mental health crises.
By the time that report was written by Allegheny HealthChoices and the counties that Mayview served, about 40 former patients already had died, and another 55 or so weren't being tracked, either because they moved out of the area or refused to cooperate with the study, Allegheny HealthChoices said.
In some cases, according to a May 2009 white paper on the Mayview closure, a shortage of apartments forced former patients into housing that was more restrictive or institutional than they or their caseworkers would have liked, given that community integration was the goal of the hospital's elimination.
Christine Michaels, executive director of the southwestern Pennsylvania chapter of the National Alliance on Mental Illness, an advocacy group, said she isn't surprised that a large number of former patients still live in restrictive and supervised settings because of the severity of their illnesses and need for community supports.
But even in highly structured settings, former patients have a lifestyle markedly different from that in a state hospital, said Ms. Michaels and Lynne Loresch, executive director of Mental Health Association of Washington County. For example, they said residents of a long-term structured residence live as a family and have community outings.
Many former patients have moved into living arrangements less restrictive than those they first had upon leaving the hospital, according to this summer's status report by the Pitt researchers. Ms. Bishop and Ms. Baker illustrate this trend; both lived in group homes before moving to their present homes.
But some patients have moved into more restrictive settings. . Brown, for one, is headed to prison.
Violent patients difficult to place
The incidents involving Brown highlight the challenges of managing some people with mental illness in the community, especially as budget cuts eat into the outpatient treatment system.
It isn't clear when Brown was discharged from Mayview or where he first went after being released from the state hospital.
But Richard Kuppelweiser, former Mayview CEO, recalled that officials struggled to find appropriate services for him because of his history -- in May 2004, while a patient at Mayview, he was charged with raping a fellow patient in a doorway.
A special five-part series
Overview and portrait of former Mayview State Hospital patients.
Monday, Sept. 23:
Community hospitals struggle with mental-health caseloads.
Tuesday. Sept. 24:
Police, courts improvise to manage ill offenders
Wednesday. Sept. 25:
Housing a weak link in mental-health system
Sunday, Sept. 29:
The future of mental-health treatment
In August 2005, he pleaded no contest to a count of indecent assault and was placed on probation for two years, while continuing to live at Mayview, according to court records. The other charges were dismissed.
By 2010, court records showed, he was in Beaver County, and arrested on aggravated assault and related charges. Brown pleaded guilty to one count and was sentenced to up to 23 months in jail.
He entered Maplewood on April 27, 2012, following a year's incarceration and seven months in a long-term structured residence, according to a state Department of Public Welfare report that provided details on the rape, which occurred less than a month after he arrived at the home.
Brown pleaded no contest to rape. Last week, he was sentenced to five to 10 years imprisonment and to undergo mental health treatment.
Maplewood wasn't the only home to have trouble with former Mayview residents.
Gerald Sutyak and Garry McGrath, owners of Anna's Home, a former personal-care home in Monongahela, said budget cuts impeded their ability to care for disruptive residents who once lived in Mayview.
One, they said, crept up on a caregiver in the middle of the night and attacked her.
Mr. McGrath said a local hospital worker once told him, "We can't handle two of your people at the same time."region - mayviewstories
Joe Smydo: firstname.lastname@example.org or 412-263-1548. First Published September 22, 2013 4:00 AM