NC considers adding fourth psychiatric hospital near Charlotte

lbonner@newsobserver.com , mgordon@charlotteobserver.comApril 2, 2013 

A decade after deciding to close one of North Carolina’s psychiatric hospitals and eliminate hospital beds, some legislators and doctors are urging the state to reverse course and add a new hospital to serve Mecklenburg and nearby counties.

The state Department of Health and Human Services issued a report to legislators this week that put the cost to build and open a 200-bed hospital serving a dozen counties from Mecklenburg to Scotland and north to Davidson and Rowan at $137.2 million. A legislator from Stanly County, Rep. Justin Burr, wants lawmakers to now consider building what would be the state’s fourth psychiatric hospital.

In 2001, the state decided to rely less on expensive psychiatric hospitals in favor of more extensive care in communities. Since 2001, the state has cut space in state psychiatric hospitals by more than half. A national report using 2010 figures ranked North Carolina 44th in the number of state psychiatric beds per 100,000 people.

Burr said the state went too far in reducing hospital beds, creating a burden on local hospital emergency rooms and hardships for patients. Mentally ill patients wait for hours, sometimes days, in hospital emergency rooms for beds in state or community hospitals.

Burr said he’s visited his local hospitals and found them calling multiple private hospitals looking for places that would accept mentally ill patients.

“We have to have the capacity to handle these severe individuals,” the Albemarle Republican said.

Considering its size, Mecklenburg County doesn’t send many residents to state hospitals, according to the report issued this week. At 180, fewer Mecklenburg residents were admitted to state hospitals last year than came from less populated Durham, Wake, or Guilford counties.

But Charlotte-Mecklenburg, the state’s largest population center, has seen its number of psychiatric hospital beds shrink over the last decade because of the closing of two private hospitals.

Carolinas HealthCare System, the state’s largest hospital system, plans to open a new psychiatric hospital near Davidson next spring. But for now, patients must be sent to CMC-Randolph in Charlotte, home to the state’s only psychiatric emergency room, which operates at more than 100 percent of capacity. The state’s recommended occupancy rate is 75 percent.

“We just don’t have the beds,” said Ellis Fields, executive director of the Mental Health Association of Central Carolinas.

‘A tremendous demand’

Mecklenburg doctors say they would welcome a state hospital close by.

“There is such a tremendous demand for psychiatric services throughout the state,” said Dr. Greg Clary, medical director of Presbyterian Hospital’s psychiatric wing. “With resources being limited and hospitals unable to handle the patients we’re seeing now, we have very few options outside of a community effort like that.”

The problem is particularly severe for mentally ill children, Clary said, because there are fewer than 100 beds in private hospitals open to them.

Not everyone is convinced that building and opening another hospital is the right choice. Some legislators would rather pay community hospitals to treat more short-term psychiatric patients.

And finding a spot for a new hospital can be laden with drama. Some Wake residents remain bitter about the decision to close Dorothea Dix Hospital in Raleigh and move patients to the new Central Regional Hospital in Butner.

Vicki Smith, executive director of Disability Rights North Carolina, said the state should devote more money to community services that would keep people from needing hospitals.

“You could start fixing the lack of community services a lot quicker than you could build another building,” she said.

Even Fields wonders if the money needed to build and operate a hospital for the Charlotte region might be better spent elsewhere, before mental illness has reached a crisis.

“I’m still bothered and concerned that we’re not doing enough early on,” she said. “Early intervention and identification would be the least expensive form of treatment.”

Economical expansions

The state may need another hospital to keep pace with population growth, said Sen. Louis Pate, a Mount Olive Republican who helps lead the health and human services budget committee. But the idea needs more careful consideration, he said, and the Senate budget will not include money for a new hospital.

“We don’t want to be jumping at the first chance,” Pate said.

The state is in the middle of a psychiatric hospital building boom. A replacement for Cherry Hospital is set to open in Goldsboro later this year, and a replacement for Broughton Hospital is scheduled to open in Morganton next year. The new Cherry Hospital will have room for 314 patients, 124 more than are now available. The new Broughton Hospital could hold nearly 100 more patients and Central Regional could hold another 43 people in the old John Umstead Hospital site.

The state report says expanding the existing hospitals is the most immediate and cost effective way to create more space.

Dr. Brian Sheitman, medical director at WakeBrook, a mental health crisis facility in Raleigh, said the state needs more psychiatric hospital beds, but suggested coming up with new ways to make them available.

The state should consider moving patients from state hospitals to community hospitals after they no longer need intensive care, Sheitman said. That would free up space for new arrivals.

“It’s a more logical way for how the system could work,” he said.

Bonner: 919-829-4821

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