After working for nearly a decade to close Dorothea Dix Hospital, state mental health administrators now intend to keep a sizable number of staff and patients at the aging Raleigh facility for years.
Lanier Cansler, secretary for the state Department of Health and Human Services, said this week that he plans to move about half of Dix's more than 200 patients to Central Regional Hospital in Butner when it opens fully in October.
But he said Dix will remain open as a stand-alone psychiatric hospital, with its own director and administrative staff. It will no longer serve as a satellite campus for the new Butner facility.
State legislators affirmed that decision earlier this month when they approved a state budget that restored $6 million in funding for operations at Dix for the next year. That move came as legislators made $155 million in spending cuts for other mental health programs in the 2010 budget.
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"My expectation is, absent inability to get funding, we would continue at Dix for several years," said Cansler, who was appointed by Gov. Beverly Perdue.
The move to continue operating Dix as a state mental hospital will hamper efforts to turn the more than 300 acres between downtown Raleigh and N.C. State University into a major park operated by the City of Raleigh or a nonprofit foundation.
It also offers evidence that the sweeping 2001 mental health reform plan has failed. A centerpiece of that effort, which was passed by the legislature and carried out by the administration of former Gov. Mike Easley, was a plan to reduce the need for beds at mental hospitals. Instead, there would be more private, community-based treatment.
The state halved the number of state hospital beds but then diverted much of the money intended to increase outpatient care.
As a result, demand for the remaining beds at state facilities has grown so high that those in need of help are routinely turned away while the expected cost savings from reform never materialized. Closing Dix now would exacerbate the crisis.
"The implementation of reform was not successful," said Rep. Verla Insko, a Chapel Hill Democrat who co-chairs the legislative oversight committee for mental health. "I don't think you can call it a complete failure, but certainly it has not measured up to our expectations. Now is not the time to downsize, given the budget cuts to community services."
The $6 million budgeted for Dix operations is not a recurring appropriation, meaning that legislators will have to approve additional money to keep Dix open past 2010. But state officials say they no longer plan to close Dix, and key legislators say the facility is likely to be needed for the foreseeable future.
State officials will need judicial approval to move beds from Dix to Central Regional Hospital.
Wake County Superior Court Judge Allen Baddour issued a temporary restraining order last year that bars the state from closing Dix, which opened in 1856. The judge acted in response to a class-action lawsuit filed on behalf of Dix patients by the advocacy group Disability Rights North Carolina, which raised concerns about numerous problems that endangered patients at the new $138 million hospital in Butner.
From the day it opened in July 2008, operations at Central Regional were plagued by poor planning, design flaws, a faulty security system and insufficient staffing. For the last year, large sections of the massive new building have remained vacant.
Cansler said the department intends to return to court in September to ask that the restraining order be lifted.
Vicki Smith, the director of Disability Rights, said that during the last year the department has made headway in addressing most issues raised in the group's lawsuit, though staffing remains a big problem. The state is heavily reliant on temporary employees, especially nurses, at the Butner hospital.
"The temporary restraining order has served a purpose in that it has forced the state to address deficiencies at Central Regional," Smith said Thursday. "We think the state is moving in the right direction. They have addressed many of our concerns. There are still a few conditions we are negotiating."
What will remain at Dix
Under Cansler's plan, a 60-bed adult admissions unit would remain at Dix under a contract between the state and Wake County.
A unit for treating minimum-security forensic patients, who were involuntarily committed to the hospital after being accused of a crime, would also stay.
Dix will continue to operate a long-term unit for children, while minors expected to stay for shorter periods would be treated at Central Regional.
Cansler said the children's unit at the former John Umstead Hospital in Butner, criticized for poor conditions that include mold and roach infestation, will be closed.
Insko said that she supports keeping the additional capacity at Dix but that she is concerned that other cuts to mental health services enacted this month will ensure people in need of help continue to languish in emergency rooms waiting for a bed in a state hospital to open up.
"There will be some people who continue to drop through the cracks," Insko said.