Monday, August 6, 2007

Frightening article on hospital admissions

The article below is quite long but is a good read. NASW-NC is consistently involved with our coalition partners on issues of access. This is a prime example of what is NOT right with the transformation of our mental health/developmental disability/substance abuse services system.

Subject: lead article from the 6 August News & Observer
Published: Aug 06, 2007 12:30 AM Modified: Aug 06, 2007 04:43 AM

Mental patients suffer delays
The waiting list for Dorothea Dix is lengthening, straining other facilities and families

Michael Biesecker, Staff Writer

RALEIGH - Local doctors and social workers say they are increasingly being told there is no room for new patients at Dorothea Dix Hospital, the state psychiatric facility in Raleigh.
Those referred to Dix for treatment are often forced to wait days for a spot to open or are diverted to other, out-of-town hospitals.

In May, June and July, patients seeking admission to Dix were placed on waiting lists about two-thirds of the time -- 60 out of 92 days, according to state records.
"We've seen a trend over the last four or five years where it has always been difficult to place patients at Dorothea Dix, but even more so over the last three months," said Melody Hunter-Pillion, communications coordinator for Rex Healthcare. "We are pretty consistently, more often than not, getting word from them that they just don't have the space."

The situation leaves staff at the county's major medical centers -- WakeMed, Duke Health Raleigh Hospital and Rex -- scrambling to find spots for their patients in psychiatric facilities as far as three hours away. Many private mental hospitals won't take patients without health insurance or who exhibit violent or threatening behavior.

"It's becoming increasingly difficult to find a good inpatient setting for some of these patients," said Carla Parker Hollis, a spokeswoman for Duke Health Raleigh. "The dilemma is that these patients often end up in our emergency rooms when they need inpatient psychiatric care.
That's just not a service we're equipped to provide."

At WakeMed Raleigh Campus, which has the busiest emergency room in the county, about a quarter of patients in need of placement in a psychiatric facility now spend at least one night waiting.

"We end up holding them as inpatients so they're not sitting indefinitely in an emergency room bed," said Dr. James Hartye, WakeMed's medical director for clinical services. "That's not optimum. That's not fair to the patient."

The limit on admissions at Dix is funding, not square footage. The 156- year-old hospital west of downtown Raleigh has space to accommodate hundreds more patients than are currently admitted. Since North Carolina began reforming its state mental health system in 2001, total capacity at Dix has been downsized by about a quarter, to 307 patients.

Monthly admissions of adult patients at the hospital, by contrast, have increased by more than a third in the past four years. And the numbers often spike in the hot summer months.
Having more patients than available beds has inevitably led to increasing periods of "admissions delay," when the hospital freezes new admissions as it works through a backlog of patients needing to get in.

"We do have a maximum capacity, and when we exceed that by roughly 110 percent, then we go a on a delay status until we have an opening through a discharge," said Dr. Jim Osberg, who was director at Dix until Tuesday, when he was promoted to a new job as chief of operative services for the state Division of Mental Health. "Going on delay is becoming more frequent because admissions are increasing."

A mother's fright

In June, when Eileen Marks' teenage son was hearing voices in his head and saying he would kill himself to silence them, Wake County's mental health crisis center sought to refer him to Dix.
But after the county called the state psychiatric hospital, the Cary mother says she was given an answer she found both frightening and infuriating.

"Dix said there weren't any beds," Marks remembers. "My son was threatening suicide, and they wouldn't take him. I was terrified."

After a delay of several hours, Marks' son was admitted.

But advocates for the mentally ill say treatment delayed is too often treatment denied, and that the difficulty getting in to Dix is only half of the equation.

"They're turning away consumers who need to be there," said Frank Edwards, president of the Wake County chapter of the National Alliance for the Mentally Ill. "The other thing we're hearing is that they are letting the consumers go too quickly, where the family members can tell they are not even close to being ready to come out, and the Dix people are saying, 'No, no, they're ready,' and releasing them. Many times, they end up back on the street or in jail."

The revolving door

Admissions of mental patients for stays of one to seven days increased more than 82 percent from 2001 to 2005. Often, it can take more than two weeks for anti-psychotic drugs to begin working.

Many of those released quickly return to be admitted again, according to state data. Critics say the surge in admissions shows that the strategy of downsizing state mental hospitals in favor of private outpatient care is not working.

The problems are growing so severe, Edwards said, that his group is preparing a special memo for the families of those admitted to Dix with tips on how to keep their loved ones from being pushed out the door.

Marks says that's what happened to her son, an 18-year-old who was diagnosed more than two years ago with bipolar disorder. After about a week in the state hospital, she was pressured to move him to a private facility.

"They wanted him outta there," she said. "They were very clear."

Marks' son now lives in a local group home for the mentally ill, where he is receiving the long-term care once provided by the state hospital system.

"I'm a lot more sane, now that I know he is monitored," the mother said. "I can go to work and not have to worry about coming home to a dead kid."

Many don't find such constructive accommodations. A recent study funded by the N.C. Governor's Advocacy Council for Persons with Disabilities found that people with mental illness are increasingly ending up in county jails.

It is estimated that more than 11,000 inmates in North Carolina jails have serious mental health problems.

Hospitals closing

Health care professionals and advocates for the mentally ill are concerned the issue will only get worse when the the state shuts down two of its four psychiatric hospitals in February 2008.
Dix and John Umstead Hospital in Butner will be replaced by a 432-bed facility under construction in Butner. That is 171 beds fewer than are now available at the two aging hospitals.
The scheduled cut is the latest in a series of downsizings to the state's mental health institutions.
In 1972, North Carolina's four state mental hospitals had room for nearly 7,000 patients. Though the state's population has nearly doubled over the past three decades, the capacity of its mental hospitals will shrink to 1,153 after Dix closes.

Osberg, the operative services chief for the state, said that changes made when the new Central Regional Hospital opens next year should help ease the capacity crunch.

Fifty beds in a forensic psychiatric unit now at Dix will be transferred to Broughton Hospital in Morganton. An additional 36 patients can be accommodated at the new hospital if some of the larger patient rooms are converted to double occupancy. Another 115 beds at the old Umstead hospital campus will be retained as overflow capacity.

State officials maintain that the number of beds for short-term adult psychiatric patients, those most often admitted, will decline by only 14 when the new hospital opens.

"The capacity will essentially remain unchanged," Osberg said. "I can't say there won't be any delays at the new hospital, but there should be additional crisis services available in the local communities, whether it's Wake County or any other area, to help decrease demand on the hospitals. Frankly, I don't think it will be any worse than it is today."

Plans in Wake

Wake County is planning to build a new mental health crisis center to open in 2010. The county is also contracting with Holly Hill Hospital, a private psychiatric facility in Raleigh, to admit the indigent patients it now turns away.

In cooperation with the county, Holly Hill wants to add 44 beds to its hospital to make up for some of the capacity lost when Dix closes.

Regulatory approval for the expansion at Holly Hill is pending, but interim chief executive officer Ron Howard said last week the new wing should open by early 2009.

That could still leave a gap of at least 10 months between the closure of Dix and the opening of additional beds at Holly Hill.

County officials and medical centers are working to prepare for the change, while Raleigh police officers and Wake sheriff's deputies have been receiving additional training on handling those with mental illnesses.

If there's a silver lining to Dix's impending closure, according to those involved, it is that the remaining local institutions are working more closely than ever to focus on helping the mentally ill.

"We have much better communication now," Dr. Hartye at WakeMed said.
"In the past, for whatever reason, folks were working in their own silos.
That time is gone. We're all in this together."

Staff writer Michael Biesecker can be reached at 829-4698 or michael.


Since February, the number of days Dorothea Dix Hospital has put those seeking admission on waiting lists has increased. Patients can spend days waiting for a spot to open. Over the past three months, new patients were deferred about two-thirds of the time.
February 4
March 12
April 4
May 16
June 23
July 21

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