Dix, over and out

August 15, 2012 

They say the road to hell is paved with good intentions. Not that we expect any of North Carolina’s mental health officials or complicit legislators to be drafted into Satan’s army, but the good intentions beneath the closure of Dorothea Dix Hospital have not exactly paid off, so far, in better overall care for the mentally ill.

Maybe the reforms that are supposed to minimize hospital stays and enable more patients to be treated in community settings eventually will work. But as the last patients leave Dix – the final page in a story that began in the decade before the Civil War – the bottom line is fewer hospital beds, unmet demand for those beds and a community care model whose effectiveness has yet to be shown.

Dix has drawn many patients from Raleigh and Wake County. Now the closest full-service mental health facility is in Butner, north of Durham. That’s less convenient for families and employees alike. What’s more, the new Central Regional Hospital has 384 beds. When the Dix phase-out started, it held an average of about 430 patients each day.

A 28-bed facility to be built and operated in Wake by UNC Health Care will ease the crunch – at some point. Meanwhile, a problem that has become sadly familiar will likely continue: Patients who need to be hospitalized for mental health treatment will wait, wait, wait – often in the limbo of a regular hospital’s emergency room.

The concept of community-based treatment sounds humane and perhaps cost-efficient, if done properly. In the state’s decade-long struggle with reform, however, costs exploded while the mentally ill too frequently found “treatment” on park benches or in prison cells. Nailing down real improvements in care must be a priority of the next governor.

Then there’s the little matter of what happens next with the Dix property, prime real estate adjacent to the Capital City’s downtown. Ideally, it will become recreational space of some kind, with sale proceeds helping to perpetuate Dorothea Dix’s legacy of care for the victims of mental illness. That might be the only way to make lemonade out of this particularly large and sour lemon.

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