Thankfully, it is uncommon, but two weeks ago WakeMed had to close its emergency department to all but those with heart attacks, stroke or severe trauma because dozens of mentally ill patients had caused the department to reach capacity.
The crisis underscored what state officials have been trying to address: too little capacity for the mentally ill to receive care.
The shortage dates to a failed effort at mental health care reform starting in 2001 when state officials, well-meaning but as it turned out ill-prepared, wanted to curb the use of mental hospitals. The resulting plan to treat patients through networks of care in their own communities failed because of inefficiency and a lack of oversight, among other problems.
Now, the state has three psychiatric hospitals instead of four, and a larger replacement hospital for Cherry Hospital in Goldsboro is two years behind a planned opening. Too many mentally ill people are winding up in jail when they should be in hospitals, and too many with no alternatives, as evidenced by the problem at WakeMed, are seeking care in emergency rooms.
Verla Insko, a state representative from Chapel Hill with an expertise in mental health, says the state's expenditures for mental health facilities and care simply haven't kept up with population growth. "We're just reacting to emergencies instead of building a sustainable system," she said.
Patients who might benefit from longer-term care in hospitals designed specifically to help them are simply going from crisis to crisis. That gives them little hope for managing their illnesses.
The crisis at WakeMed apparently has at least gotten the attention of lawmakers and state officials. The Department of Health and Human Services has a lot on its plate, but it is involved in seeking a plan to increase care for the mentally ill.
With the failure of community care, it's clear that the number of psychiatric beds must be increased, and that means the state's investment must be boosted. The truth is, this may be a case when Gov. Pat McCrory and lawmakers need to organize an effort involving caregivers, policymakers and legislators to answer the long-term needs of the mentally ill.
Such an effort could be a defining accomplishment for McCrory's administration.
North Carolina's track record on mental heath care isn't good. The state ranks 44th in the number of state psychiatric beds per 100,000 people. That's unacceptable, and it's a good point for McCrory to make to the leaders of the General Assembly in terms of the need to address this crisis now, not later.