On any given day WakeMed hospital in Raleigh is caring for mentally ill residents who may be suicidal, psychotic and dangerous. These patients spend anywhere from several days to several weeks down the hall from people recovering from physical illnesses, car wrecks and other accidents because theres nowhere else for them to go.
Relief may be on the way. UNC Health Cares proposal, announced last week, to build a 28-bed psychiatric hospital in Wake County is designed to address the problem of mentally ill patients who are crowding emergency rooms and hospital wards throughout Wake County and the region.
They will stay in the emergency department for hours and days, said Jack Naftel, vice-chair of clinical affairs in the psychiatry department at UNC-Chapel Hill. Just imagine someone with a heart attack waiting days to get upstairs for a bed.
But despite the pressing need, the $30 million hospital could take at least several years to become reality.
Indeed, theres no guarantee it will win all necessary approvals, although rival WakeMed, which often challenges other hospitals for available beds, has already signed off on the project. Thats because the hospital is part of the deal UNC and WakeMed hammered out to get WakeMed to drop its hostile takeover bid for UNC-owned Rex Hospital. WakeMed officials have long argued that their facilities treat a disproportionate share of the regions poor, uninsured and mentally ill.
Still, the public handshakes and photo ops belie the hurdles ahead. Simply preparing all the necessary paperwork to submit applications to build a hospital is expected to take a year. It may also require fending off opposition from such health care providers as Holly Hill Hospital, a cross-town competitor and the only private hospital in the county that specializes in psychiatric services.
But first UNC must persuade state officials to increase their need projections for psychiatric beds in Wake County, a number that sets a limit on hospital construction.
In this case, however, much of the groundwork for UNCs proposal has already been done. UNC and Wake County spent nine months researching need and concluded that 28 more beds are needed in the county, the same amount proposed for the new UNC hospital, said Wake County Manager David Cooke.
That study shows that the psychiatric beds will generate revenue from a newly created financial source: the Affordable Care Act, dubbed by some as Obamacare. The controversial law, which is being reviewed by the U.S. Supreme Court and could be overturned this summer, would reduce the number of uninsured individuals and expand Medicaid coverage, providing a much increased revenue stream to support Medicaid substance abuse services that are in high demand by the mentally ill.
The state is currently estimating a need for just 12 psychiatric beds in its draft 2013 medical facility projection. UNC will request a revision of the final projection to at least 28 new psychiatric beds. Revising the annual limit by petition happens almost every year, usually in the area for hospice beds, and is often granted, said Julie Henry, a spokeswoman for the N.C. Department of Health and Human Services.
The states 2012 projection set the limit at 37 beds, and Holly Hill Hospital requested approval to add the full allotment to its facility. A hearing on that request will be held in Raleigh in June. Neither WakeMed nor Rex is objecting to Holly Hills application.
If the state does change its 2013 need estimate, UNC which has not determined where it will build the facility would have to win approval for the beds through the states certificate of need process. Its not clear whether Holly Hill will view a new mental health hospital in the same county as a competitive threat. Holly Hill officials did not return calls. But a fight would not be surprising in the contentious world of hospitals.
I would assume Holly Hill would do everything to position itself for a competitive advantage, said mental health activist Ann Akland, a board member of the Wake County chapter of the National Alliance for Mental Illness. I doubt they would be overjoyed with UNC entering Wake County.
Wait times for psychiatric beds have been growing statewide since North Carolina halved the number of beds in its mental hospitals as part of a reform launched in 2001. Dorothea Dix Hospital, which once housed 300 psychiatric beds in Raleigh, is slated to close and now has just 30 patients left. Most of the patients have been moved to Central Regional Hospital, the facility built in Butner to replace Dix, about 40 miles north of Raleigh.
It was almost like re-institutionalizing all of those people out on a reservation, Akland said.
The state currently has 2,594 licensed psychiatric beds at county, state and private institutions. But not all are staffed, and some are designated for youth or have other restrictions.
If we had 28 beds
Putting the 28 needed beds in the Dorothea Dix building is not an option because the aging facility would not meet modern building standards and would have to be renovated, officials said.
The problem of mentally ill patients overflowing to hospitals has become more acute especially in the last several years, said Jim Hartye, manager of behavior health services in the WakeMed system. He said WakeMed treats between five and 18 mentally ill patients a day, with an average stay of 2.5 to 3 days, with some staying multiple weeks.
Hartye said that at WakeMed the patients are assigned to rooms and are visited by a staff psychiatrist, but the hospital is not a psychiatric unit that provides comprehensive treatment to the mentally ill. He said its especially difficult to transfer patients who are disruptive or violent, or those who are older and ill.
I dont think theres ever such a thing as solve in the mental health profession, Hartye said. If we had 28 beds that can take patients who are highly complex, then that would be a huge help.