RALEIGH — Salima Mabry watched over her son Tuesday as he slept awkwardly in the chair where he had spent eight days waiting for a bed in a state mental hospital.
Joshua Stewart, 13, is severely autistic and has an IQ of 36. He can only speak in short, single words, such as "Ma" or "hurt."
He first arrived at Wake County's Crisis and Assessment unit for people with mental illness in the back of a squad car on Jan.18 after he attacked his mother and little brother.
The mother and son began a second week in a small interview room with no bed, no television and a single window. There was also no shower. Mabry had been sponging Joshua off over the sink in a public restroom down the hall. In a corner of the room are several plastic shopping bags stuffed with clothes.
"I'm exhausted," she said. "Most people flip out if they have to wait an hour to see the doctor. We've been here eight days. They say we've broken the record for waiting."
Joshua is among thousands of patients within the last year who have languished in emergency rooms or mental health clinics waiting for an open bed in a psychiatric hospital.
Years of budget cuts and failed reforms have left North Carolina's mental health system without sufficient resources to care for all those who need help.
The budget Gov. Bev Perdue signed in August cut $155million from an already struggling system, resulting in the loss of 354 jobs at state hospitals.
"Sadly, this young man is just one of many who will be stuck as the cuts to state services really hit home," said Vicki Smith, director of the advocacy group Disability Rights North Carolina. "People aren't getting the help they need; they go into crisis and then require crisis care and hospitalization."
Children's ward empty
On their first night at the Wake facility, Joshua was approved for admission to the children's unit at Central Regional Hospital, a 378-bed facility n Butner that opened in 2008. Though a whole children's ward at the $138million hospital sits empty because there are too few staff members to open it, Wake officials were told for the past week that the hospital could not take Joshua until another child checked out.
Though Central Regional theoretically has the capacity for 72 children, only 13 were there Tuesday because the hospital didn't have the workers to accommodate more.
At the county crisis unit, which is designed only for short stays, staff members made 67 calls over the past week to the state's four mental hospitals and 11 private facilities in search of an available bed. Each time, they were told there was either no space or the facility was not equipped to serve Joshua.
No end of troubles
"Joshua has complex needs," said Crystal Farrow, Wake County's director of mental health services. "We have given Joshua the best care we can under the circumstances in an outpatient crisis center, but we don't have a bed for him."
On the second day, police officers had to subdue and handcuff Joshua three times when he tried to leave.
Mabry, a single mother, has cared for her troubled son largely on her own. Joshua is enrolled in a special sixth-grade class for children with developmental disabilities at East Millbrook Middle School, but his mother is limited to working part time in a low-paying data entry job so she can be home when school lets out.
The family has no health insurance, though Joshua is covered under Medicaid because of his disabilities.
Joshua has always been energetic. But recently he has become more aggressive both at home and school, Mabry said. Though he has roughly the intellect of a toddler, Joshua's body is quickly growing into that of a man.
He is now stronger than his mother, and she has slowly come to realize she can no longer physically restrain him. He sometimes runs out the door only to become confused and burst into the homes of unsuspecting neighbors. Other times, he takes off running toward four lanes of traffic on nearby Capital Boulevard.
Mabry tried her best to stop him Jan. 18. But her son grabbed her hair and pushed her to the floor, punching her in the back of the head. Mabry's 9-year-old son then jumped on his big brother's back. Joshua flung the child across the kitchen and into the refrigerator, Mabry said.
"When he hits me, I can't hit him back, because he doesn't know any better," she said.
Reluctantly, she called 911. The Wake Forest police took Joshua to the crisis center in an aging building behind WakeMed's Raleigh campus. A few hundred yards away, the county is building a $23million center that will have a limited number of overnight beds, but it won't be ready until the end of the year.
Mabry said staff members at the Wake facility suggested she might have to take Joshua to another state to find a hospital that would take him. Many private facilities won't accept patients with a recent history of violence and aggression.
"They want to pick them like cherries from a tree," Mabry said of the admissions process. "They don't want anyone who might make a problem for them."
A bed in Morganton
The News & Observer asked a spokeswoman at the state Department of Health and Human Services on Thursday afternoon to comment about Joshua's plight. An administrator called back in less than an hour to say a bed was available for the teen at Broughton Hospital, a state mental facility in Morganton, about 200 miles west of Raleigh.
Dr. Michael Lancaster, the state's chief of clinical policy, said the issue wasn't necessarily a lack of beds, as the staff at Wake's crisis center had been repeatedly told. He said there was a concern that a state mental hospital wasn't the best place for Joshua.
"The initial hope was that we could stabilize him in the crisis center where he was," Lancaster said. "The second hope was that we could get him into a respite care situation, more appropriate for his [developmental disability] symptoms and autism issues that he struggles with."
Respite care facilities are private homes caring for a single patient or a group of residents. Group homes have been among the programs hit hard by the state's most recent budget cuts.
Tuesday night, Mabry wept as she prepared to load Joshua in the back of a Wake deputy's car for the three-hour drive to Broughton.
"We've never been apart for more than two days," she said between sobs. "I know I have to send him away so he can get help, but it is so hard to know he won't be coming home with me."
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