RALEIGH — More than 156 years after the state opened its first hospital for the mentally ill, the last patients will leave its campus this week.
The hospital, which opened in 1856 during a wave of innovation spurred by the national crusader Dorothea Dix, is saying goodbye just as another wave of controversial mental health reforms struggles to take hold.
Those reforms aim to de-emphasize institutional care in favor of community treatment for the mentally ill. Though the end has been coming for years – a consultant’s report back in 2000 recommended closing the hospital named for Dix – some of its supporters say its shuttering is a symbol of the state’s failure to properly treat mentally ill people.
The remaining Dix patients are being transferred to Central Regional Hospital in Butner, a new facility that critics say doesn’t have nearly enough beds to treat those with the most severe mental illnesses.
“Dix has been just a critical part of keeping people with mental illness safe and out of jails,” said Ann Akland, former president of the National Alliance on Mental Illness in Wake County. “While we have a great new hospital in Butner, there are not enough beds for people who are mentally ill enough to need them. People are backing up in emergency departments and crisis centers because there are not enough of those kinds of beds left.”
Dix always served as an “intensive care unit” for psychiatric patients, and its facilities lessened the burden on community hospitals that did not have enough beds for mentally ill patients, said Dr. Brian Sheitman, medical director of a UNC community mental health center and a former clinical director at Dix.
“The state hospital was sort of a safety net for everything,” he said. Patients with the most severe mental illnesses often end up waiting in general hospital emergency departments, he said.
When the state started considering closing Dix, it held about 430 patients on an average day. Central Regional Hospital has 384 beds.
On Friday, the only beds available for adults in state psychiatric hospitals were on a special unit for deaf people at Broughton Hospital in Morganton. An average of 622 people a month were on waiting lists for state hospital beds over a 12-month period that ended in June, according to the state Department of Health and Human Services.
The average wait was nearly three days. Some wait much longer. A patient who checked in to Durham’s short-term care center on July 20 didn’t get a hospital bed until Aug. 3, according to Alliance Behavioral Healthcare, the local mental health office covering Durham and Wake counties.
Wake County hospitals in particular have become concerned about mentally ill patients crowding emergency rooms. The deal struck in May between WakeMed and UNC Health Care requires that UNC spend $30 million to develop and operate a 28-bed, inpatient psychiatric facility in the county and commit $10 million over five years to support other mental health services.
Challenge of change
The last years at Dix have been tumultuous. As the hospital prepares to close, the state is trying to reinvent mental health treatment to make it more community-based. But the required network of community mental health services has not grown, and Dix and the other three state hospitals ended up admitting more patients for repeat, short-term stays.
Amid the upheaval, Dix and the other hospitals had been under pressure from the federal government to improve patient treatment.
The continuing surge of short-stay patients was one of the biggest challenges, said former Dix director Jim Osberg, who served two stints as the hospital’s leader.
“Anyone who showed up on the doorstep had to be hospitalized,” Osberg said. “That was really a major challenge to this ever-expanding capacity, making sure you have sufficient staff and space.”
The hospitals today don’t admit every patient who needs care, putting some on waiting lists. All the beds for adults at Central Regional are taken; one person from Durham and six people from Wake were on the waiting list Friday.
Last patients at Dix
The last patients at Dix live on one floor of the nearly vacant hospital. The light green walls have white patches that used to be covered by signs and art. Staff messages saying good-bye to the hospital are scrawled on the few remaining decorations.
Those who remain are minimum-security forensic patients – people charged with crimes but found not guilty by reason of insanity. They will move into a renovated unit that was part of the old John Umstead Hospital in Butner.
These forensic patients have more freedom than the average patients because proving they can live outside the hospital is part of their treatment. They learn to take buses to shops and take trips together to local restaurants. Some work at jobs outside the hospital, and one attends barber school in Raleigh.
Mike Hennike, CEO at Central Regional, said six or seven of the 28 patients moving to Butner this week work outside the hospital. A few will have jobs in Durham or Chapel Hill, he said, and the staff is working to get a few patients jobs close to Central Regional.
Still, employees who work closely with these patients say they will not have the same opportunities to demonstrate their adjustment to community living when they move to rural Butner and away from the Triangle, with its jobs, public buses and diversions.
“It’s going to be a great setback for them,” said Eugene Aldridge, who has worked at Dix for 16 years.
Hennike said he’s confident the hospital will be able to provide comparable employment for every one of the patients. Two people will continue to commute to Wake County, he said, including one patient attending barber school.
Hennike said the housing in Butner is nicer than the old Dix unit. Patients will also have the advantage of expanded clinical services that aren’t available at the stripped-down Dix, he said.
Pieces of the past
As the last patients leave, so will dozens of hospital employees, some of whom have built their lives and careers around Dix.
Dix Hill, as it was known, once covered more than 1,000 acres. That was before the push to move patients out of institutions shrank its patient population and chunks of land were picked off for roads, N.C. State University and the State Farmers Market. A few thousand patients at a time were treated at the hospital. Some lived in houses scattered across the grounds, which included a working farm and cottages for employees.
Weddings, funerals and memorial services were conducted at the hospital’s chapel. The hospital was a training ground for doctors specializing in psychiatry, psychologists, social workers and other professionals.
For longtime employees such as Eddie Cox, working at Dix was a family tradition.
Cox started working at the hospital in 1985 at age 20 and was one of the last to live in a house on the campus, a place he shared with two other men. Cox took dates to the Dix cafeteria and met his current wife on the job. One sister, three of his brothers, and about a half-dozen cousins also had jobs at Dix.
Cox, who has a twin brother with Down syndrome, said he took the job to learn more about people with disabilities.
“I wanted to work one year then go to college,” Cox said during a walk across the hospital grounds last week. “I’m still trying to finish that year.”
He started commuting from his home in Smithfield to a new job at Central Regional in 2010.
Today, some of the artifacts from Dix’s history are locked up in a house on the property. A portrait of Dorothea Dix hangs in a front room. Old photographs of the farm hang on the walls. There’s an old book full of faded prescriptions for morphine. And in an empty office, there’s an electroshock machine.