Mental hospitals limit admissions

North Carolina mental-health officials are putting a lid on admissions to the state's psychiatric hospitals, a move that could lead to longer stays in hospital emergency rooms for mentally ill patients.

State psychiatric hospitals won't accept transfers from community hospitals when the short-term wards at the psychiatric hospitals are at more than 110 percent of capacity, said Mike Moseley, director of the state division that oversees mental-health services.

Hospital admissions have ballooned since 2003, but this is the first time the state has moved to cap the overflow. The state has four psychiatric hospitals, and all had bursting admissions units in the last six months, Moseley said.

Dorothea Dix Hospital in Raleigh at one point had as many as 112 people in wards with 78 beds. John Umstead Hospital in Butner had as many as 144 people in its 118-bed unit.

Hospitals can shift staff, but there are limits, Mosley said.

"We have to have some ceiling to work from so we're not creating unsafe environments for patients as well as for staff," he said.

Community hospitals will be asked to hang on to patients until the state hospitals have space.

Hospitals are concerned about the policy, said Mike Vicario, vice president of regulatory affairs for the N.C. Hospital Association. Hospital emergency departments have become the first stop for many mentally ill patients, he said, and some hospitals have seen close to a 10 percent increase in mentally ill patients in a year.

In many counties, there aren't special services for people with mental-health emergencies, so they go to a local hospital.

"The emergency department has become the place of last resort," he said.

Dorothea Dix had 82 patients in its admissions units Monday morning, and it's not unusual for the hospital to have more than 78, said James Osberg, the hospital's director.

The hospital can manage a few extra, but sometimes it's hard to find doctors, psychologists and social workers who can spend enough time treating patients on crowded admissions units when they have other duties.

Deby Dihoff, executive director of NAMI North Carolina, an advocacy group for the mentally ill, said she worries about hospitals delaying admissions.

"Crises are going to happen," she said. "There have to be beds to serve people with mental illness."

The state has good long-term plans for finding treatment for people who need immediate help, she said. Plans to beef up community treatment for drug and alcohol abusers are in the works, and the state is expanding community mental-health crisis services.

"I think the division is doing a good job planning for the future," she said. "It's the present we're all a little worried about."