Built on a grassy hill overlooking downtown Raleigh in 1856, the Dorothea Dix state hospital was one of the first major psychiatric institutions in the country.

It won't be first to close.

Around the United States, dozens of hospitals like Dix have shut down in recent years. Lawmakers and city leaders have struggled with what to do with the properties afterward.

Some have been successes.

In Athens, Ohio; Traverse City, Mich.; and Fergus Falls, Minn.; hospital campuses were given new life with museums, restaurants and offices. Historic buildings were saved, and vacant land kept open for parks.

Others have been struggles.

In Northampton and Danvers, Mass., and Pittsburgh, Pa., hospitals sat empty while communities argued over their fates. Historic buildings were demolished and controversial new construction planned.

Those who have studied other former hospitals say decisions made by the legislature and the city of Raleigh over the next few months about money, maintenance and management will determine what happens years from now.

If funding isn't found, the land will probably be sold to the highest bidder. If historic buildings aren't maintained properly, they will eventually be torn down. And if the public doesn't have a say in the site's future, whatever happens will prove contentious.

"You've got to have a plan immediately," said Kate Allen, a New York construction manager who has studied former hospitals.

So far, the debate in Raleigh hasn't gone well. Eight different proposals have been put forward for the 300-acre property, and all have been criticized for different reasons. Advocates for a major park have clashed with city leaders and state lawmakers.

And no one has answered three questions that will determine the future of Dix Hill.