RALEIGH - Despite long-standing plans to shut down Dorothea Dix Hospital in February, Wake County appears close to a deal to keep a small part of the aging state psychiatric facility open until 2011.
In an agreement expected to win approval from Wake commissioners Monday, the county will pay the state up to $5.3 million a year to retain up to 32 psychiatric beds in a building on the Dix campus.
The temporary unit would stay open until a planned Wake County crisis facility and an addition to Holly Hill, a private mental hospital in Raleigh, are complete.
The state Department of Health and Human Services would operate the 32-bed unit and kick in an additional $1.9 million a year to help cover expenses, according to a draft report included in the county commissioners' agenda materials.
Most of the state and county money will go to cover the cost of 75 full-time workers needed to staff the facility 24 hours a day.
"We're essentially contracting with the state to provide a needed service," County Manager David Cooke said of the proposal Friday. "If we didn't do this, some patients would not have a place to go."
Laura White, team leader for the state hospital system, confirmed Friday that DHHS is in "close negotiation" with Wake County about the continued use of Dix, but she said she couldn't yet discuss the details.
"We want to see something work," White said. "It's just that we're not in a position to say anything is final and go on record in the newspaper yet."
The agreement, if approved, would be an attempt to provide a local solution to an ongoing capacity crunch with mental health beds.
The state is moving forward with plans to simultaneously close Dix and John Umstead Hospital in Butner in favor of a new facility under construction. When it opens next year, Central Regional Hospital in Butner will offer 432 patient beds -- 171 fewer than are now at Dix and Umstead.
The state is cutting its patient capacity in the midst of a bungled reform effort that was intended to ease demand for psychiatric hospital beds in favor of outpatient, community-based care provided by private companies.
Instead, admissions at North Carolina's four mental hospitals have soared since the reform effort was begun in 2001.
At Dix, the 156-year-old mental hospital west of downtown, patients are routinely placed on waiting lists for admission because there are not enough beds.
In the past six months, patients seeking admission to Dix were placed on waiting lists nearly two-thirds of the time -- 108 out of 184 days, according to state records.
The situation leaves staff at the county's major medical centers -- WakeMed, Duke Health Raleigh Hospital and Rex Hospital -- scrambling to find spots for their patients in psychiatric facilities as much as three hours away. Many private mental hospitals won't take patients who don't have health insurance or who exhibit violent or threatening behavior.
At WakeMed Raleigh Campus, which has the busiest emergency room in the county, a recent study found that about a quarter of patients needing placement in a psychiatric facility spent at least one night waiting.
The county government is planning to build a $21 million mental health crisis center and substance abuse detox unit, which is planned to open in 2010.
Wake has also contracted with Holly Hill to admit the indigent patients the private facility would have previously turned away. In cooperation with the county, the hospital also has plans to add 44 beds to make up for some of the capacity lost when Dix closes.
The 32 beds at Dix retained through the agreement under consideration Monday are intended to help cover the gap until at least 2009, when the construction of a new wing at Holly Hill is expected to be complete.
State officials say they may also keep 115 beds at the old Umstead Hospital open as "overflow capacity" -- meaning that at least some beds at the two aging facilities set to close in February will have to stay open to handle the increasing demand for treatment.
"Clearly, we've added a 115-bed unit because we realized a 432-bed hospital was not adequate for the patients we're currently serving," White said Friday. "We do have some [admissions] delays. If we are successful in getting a unit with Wake, I do believe that would relieve some of those delays."
It was not immediately clear Friday what effect the new plan might have on Raleigh's bid to buy Dix's 306-acre campus from the state to establish a new city park.
A $10.5 million offer for the land made by Mayor Charles Meeker in June received little enthusiasm from legislators, and the state still has not finalized plans for what to do with the hundreds of non-hospital DHHS workers now housed in buildings on the sprawling Dix campus.
Meeker said he first learned Friday of the proposed deal to keep part of the old hospital open.
"I think any use of the Dix property for mental health treatment takes priority over other potential uses for the property," Meeker said.
-Information from News and Observer, The Carolina Journal, Coalition Partners, and Medical personnel.