Modernizing Mental Health Dr. Steven Sharfstein reflects on his legacy at Sheppard Pratt

After a 30-year term at Sheppard Pratt, including 25 years as CEO, Dr. Steven Sharfstein retired on June 30, leaving behind a legacy of innovation and growth.

Under Sharfstein's watch, the Sheppard Pratt Health System maintained quality patient care as the organization underwent exponential growth, expanding its geographic footprint and treatment offerings and shifting to an outpatient-focused model.

His term has seen Sheppard Pratt grow from two sites to 38, expand into outpatient care from inpatient and provide exceptional care to Maryland's residents. Under his supervision, Sharfstein boasts that the organization excelled in "providing care and treatment near to where people live and work."

"We had to reinvent ourselves, transform ourselves," Sharfstein said. "What we decided to do after a lot of internal conversation and external review was to expand. Even though we were contracting as a hospital, we wanted to expand as a health system."

The 73-year-old grew up in a Jewish household in the community of Great Neck in Long Island, N.Y. An active member of the Reform movement, Sharfstein found one of his first leadership roles in the North American Federation of Temple Youth (NFTY) before becoming engaged in the civil rights movement.

He attended Dartmouth College for his undergraduate career and earned his medical degree from the Albert Einstein College of Medicine. Following his education, Sharfstein had a 14-year career as a psychiatrist in multiple capacities, including both inpatient and outpatient care in which he performed research at the National Institutes of Health, wrote some of the first papers on the AIDS epidemic and worked with the administration of President Jimmy Carter on the Mental Health Systems Act.

"Steve Sharfstein is a visionary in the mental health field, and I am honored to follow in his footsteps." - Dr. Harsh K. Trivedi

Rather than seek out a job at Sheppard Pratt, Sharfstein was recruited by Robert Gibson, his predecessor as president. In 1986, Sharfstein came on board as medical director and vice president of the hospital. He became president in 1992.

Sheppard Pratt was founded by Moses Sheppard, a local Quaker. The sect of Christianity is known for being pioneers in the quality and humane care for the mentally ill through the 18th and 19th centuries. Sheppard devoted his entire fortune to what was then known as the Sheppard Asylum, which later became the Sheppard Pratt Hospital with the arrival of philanthropist Enoch Pratt.

However, Sheppard Pratt has changed more since Sharfstein arrived than it had since its founding in 1891, growing into the largest mental health nonprofit in Maryland.

The differences bet-ween then-Sheppard Pratt Hospital and the Sheppard Pratt Health System of today are both numerous and vast. The shift from inpatient to outpatient care over the course of the past few decades is one of the most notable changes. When Sharfstein first arrived at the hospital, it provided almost exclusively inpatient care - the average stay of a patient was 80 days. Today, the average patient will stay for nine-and-a-half days.

This shift resulted from the first crisis that Sharfstein faced as CEO. The issue was money. Insurance for inpatient care had changed with the start of managed care, which cut both patient tenure and profits at the hospital.

"Understand that Sheppard Pratt is not for profit, and we still have a Quaker heritage," he said. "You know, a lot of people think that Sheppard Pratt is for the wealthy, that it's for profit, it's not true. We take care of everyone. Most of the payment comes from public funds."

Sheppard Pratt established itself as a service system by expanding both its inpatient and outpatient programs. This was achieved by developing a number of subspecialty areas that had programs for children and adolescents, geriatrics, eating disorders, brain injury and autism among others.

The growth of Sheppard Pratt as a health care system is obvious. It has expanded from being almost entirely inpatient to having inpatient, outpatient, residential and rehabilitation programs. Sheppard Pratt had two locations when Sharfstein started in 1986. It now has 38 locations across the state of Maryland, including the original Sheppard and Enoch Pratt Hospital, a Sheppard Pratt Hospital in Ellicott City and a number of outpatient sites through affiliates such as Mosaic Community Services in Timonium, Way Station, Inc. in Frederick and Family Services, Inc. in Montgomery County.

Over time, Sheppard Pratt has absorbed about a dozen nonprofits from across the state into its health care service system, which strives to uphold its Quaker heritage by providing health care to anyone in need. Of the health system's almost $400 million budget, 80 percent of its money comes from government funding via Medicare, Medicaid, grants and contracts and funding for schools in which Sheppard Pratt provides special education.

As CEO of the Sheppard Pratt Health System, Sharfstein was kept plenty busy with his daily duties, let alone by his involvement with various organizations. However, adding more to his plate does not give him the slightest hesitation if it is a worthwhile cause.

When Annette March-Grier was preparing to open Roberta's House, a haven in Baltimore for people dealing with the loss of a loved one, she was advised by Sen. Barbara Mikulski to seek out Sharfstein. He not only agreed to talk with March-Grier, but he became a coach, adviser and mentor to her and the nonprofit that is located on St. Paul Street.

"He has really been an anchor to getting Roberta's House grounded and the support it needs from the greater community," said March-Grier, Roberta's House founder and president. "He has been with me since the inception" and continues "to remain loyal" and available.

"He is very meek and humble but powerful and very influential," she continued. "He has a lot of respect in the Baltimore, Maryland region and probably nationally as well."

Sharfstein served on the board for five years and now, three years later, he is just as involved, she said. "We definitely love him. He's gone above and beyond, helping guide and direct" Roberta's House.

"As busy as he is - and we are a small local nonprofit - he is present," attending meetings and leading capital campaigns, March-Grier said. And most important, she said, Sharfstein helped her make the connections needed to start Roberta's House and keep it vibrant. He plans to remain involved with the organization.

As he prepares to become president emeritus of Sheppard Pratt, Sharfstein is increasing his leadership role at his synagogue, Baltimore Hebrew Congregation, where he became president of the board in the first week of May. He will serve a two-year term.

During his roughly 25 years of membership at Baltimore Hebrew, Sharfstein has been "a very strong member" of the synagogue's executive committee and has "been very available to us" whenever a congregant was experiencing a mental issue, said Rabbi Andrew Busch. "He is a familiar face around the synagogue" who values both the heritages of Reform Judaism and Baltimore Hebrew Congregation, Busch said. "He is very smart. He has a very flexible mind, open to hearing new information."

The stereotype of psychiatrists being great listeners is true of Sharfstein, the rabbi said, adding that when involved in synagogue business, he listens to all parties.

This awareness of those around him has been a pervasive force in Sharfstein's life, which was apparent to those who attended his final lecture, "Reflections on 30 years at Sheppard Pratt and the Future of Behavioral Health Care," on June 22.

The lecture hall was filled with Sharfstein's friends, family and co-workers. When the time came for the audience to ask questions, many simply expressed their thanks to him or shared stories about how remarkable he is in his capacity as both CEO and a personal confidant.

One such attendee was Dave Buller, a recently retired mental health worker who worked at Sheppard Pratt for 43 years. He had the opportunity to witness the entirety of Sharfstein's leadership firsthand. He stood up and shared how Sharfstein helped him when he was having a difficult time - he would always tell people that a real person ran Sheppard Pratt, not just a managerial figure.

In fact, Sharfstein has always been "open to people coming to him," Buller said. "He introduced a hotline to go straight to the top." Buller recounted telling Sharfstein that he was going to call the hotline later as they passed in a hallway, which Sharfstein countered by inviting Buller to just come to his office to talk. "If something wasn't going well and he knew about it, he would fix it." This is the ideal that Sheppard Pratt's incipient CEO, Dr. Harsh K. Trivedi, will be following.

"Steve Sharfstein is a visionary in the mental health field, and I am honored to follow in his footsteps," Trivedi said. "For 30 years, he has been at the forefront of innovations in psychiatric care, always emphasizing the importance of providing compassionate, patient-centered care and evidence-based treatment to those in need. I look forward to continuing this work and ensuring that every patient, student and family member receives the very best care and is treated with the dignity and respect they deserve."

Sharfstein will remain active in both the community and the hospital - his office is merely moving across the street to another building on campus. He plans to teach and write. In fact, he is currently writing two books - one on involuntary treatment and the other on the changing mental health system in America focusing on hospitals. He also intends to see clients in an outpatient setting at the newly named Steven S. Sharfstein, M.D. Integrated Health Care Center in Baltimore City.

As he transitions roles, Sharfstein does not have any immediate plans. He explained: "Whenever I start something new, [my mindset] comes from Hippocrates, 'Do No Harm.'"

He hopes that in the future Sheppard Pratt will expand its services beyond Maryland to other locations in the country and maintain its reputation for providing quality care. Steven Sharfstein becomes president emeritus at Sheppard Pratt on July 1.

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