State Politics

Researchers measure NC psychiatric bed shortage

The state would need another psychiatric hospital nearly the size of Central Regional in Butner to reduce average wait times for beds to about one day for patients in the middle of the state, according to a study released this month.

Researchers at the University of North Carolina at Chapel Hill and Duke University used a computer model and information about hospital admissions to determine how many state hospital beds would be needed to cut wait times for entry.

The research, published online by the Psychiatric Services journal, does not name the hospital, but it is 398-bed Central Regional, one of the state’s three large psychiatric facilities.

People often wait for days in local hospital emergency rooms for admission to state hospitals, which are almost always at or near capacity. The university researchers found the state would need 356 more state psychiatric beds to reduce average wait times in emergency rooms from about three days to less than a day.

In addition to Central Regional, the state operates Cherry Hospital in Goldsboro and Broughton Hospital in Morganton. The research results apply only to Central Regional and its 25-county region.

With interest in hospital wait time growing, researchers wanted to develop a computer model to evaluate “supply-side” solutions, said lead author Elizabeth La, now at RTI Health Solutions.

Researchers used information from 2011 and 2012 in the study.

Data from the state Department of Health and Human Services covering July 2014 to March 2015 indicate that average wait times for Central Regional were longer than three days.

“It’s clear there is a shortage of psychiatric hospital beds in North Carolina,” said Joseph Morrissey of UNC-Chapel Hill, one of the authors. But adequate community support is necessary for people discharged from hospitals, he said.

“Hospital beds alone are not the answer,” he said.

Short-term care

The state has reduced space in state hospitals significantly since 2000. A legislative report from 2013 marked the decline in state hospital beds: The state had 1,755 in 2001 and 850 in 2012. Though there was talk among legislators in 2013 about building a fourth hospital in the southwest region of the state, nothing came of that idea.

The state has been trying to address the need for short-term in-patient mental health care by paying for space at local hospitals.

But local hospitals are not a substitute for state hospitals, and most do not have the staff to treat severely ill patients who may become violent, the study says.

“To make those functionally equivalent to state psychiatric beds, training would have to be bolstered somehow,” La said.

Approaches to public mental health have vexed policy-makers for years. Sheriffs complain about mentally ill people filling jails, while hospitals struggle to move patients from emergency rooms.

Rep. Gary Pendleton, a Raleigh Republican, hopes money from the sale of the Dorothea Dix hospital property in Raleigh will be used to convert spaces in rural hospitals, to make them suitable for mentally ill patients. Moving patients there would ease the pressure on bigger hospitals’ emergency rooms, he said.

Legislators want to use about half the money from the sale of Dorothea Dix property, $25 million, to develop beds for mentally ill patients in hospitals around the state.

Pendleton said hospitals that have high vacancy rates or those that have closed, such as hospitals in Louisburg or Belhaven, could reopen beds to accept mentally ill patients who are waiting for admission to state hospitals. The state would lease space and pay the smaller hospitals to operate the special wards, Pendleton said.

“It would be helping the little hospitals survive and the bigger ones unclutter their emergency departments,” he said.

Rep. Verla Insko, a Chapel Hill Democrat, said the state has never spent enough on community mental health services that would keep people from crises that send them to emergency rooms.

“We’ve never fulfilled the goal to provide enough community-based services to keep people stable,” she said.

As the state closed state hospital beds, the plan was to shift money to community services, said Insko. But that didn’t happen.

Insko said she’d like to see the legislature’s program evaluation office compare the cost of opening more hospital beds with providing adequate community mental health services.

Dr. Marvin Swartz, a Duke researcher and one of the study co-authors, agreed that the state has not compensated for the shrinking state hospital space with enough community services and support.

“The bottom line is we haven’t created enough alternatives to the beds that we closed,” he said.

Lynn Bonner: 919-829-4821, @Lynn_Bonner