Closing of Dorothea Dix Hospital marks failure of state reforms | Wake County | Indy Week
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Closing of Dorothea Dix Hospital marks failure of state reforms 

North Carolina was once a leader in mental health. After a decade of "reforms," it no longer is.

On Dix Hill, the cold December stillness only serves to reinforce the feeling of abandonment.

These splendid, rolling grounds, overlooking the center of Raleigh from the south, were occupied not so long ago by a state psychiatric hospital established in 1848 that had grown to serve a patient population of 3,000. The staff, working around the clock seven days a week, numbered two or three times that many. A working farm comprised the back 1,300 acres. It's gone now, turned (most of it) into the new Centennial Campus for N.C. State University.

Historic Dorothea Dix Hospital, which in 1974 comprised 282 buildings on 2,354 acres of land, according to state records, has since been reduced to 306 acres of hospital property and 40 buildings, many of which are empty or half-empty. Its patient count is down to fewer than 160 and dropping fast. It would be a ghost town except for the 1,400 officials and staff of the Department of Health and Human Services spread thinly in 24 of the remaining buildings. If and when Dix closes, their presence may serve as a reminder that North Carolina was once a leader in mental health though, after a decade of "reforms," it no longer is.

Dorothea Dix isn't closed yet, but it stopped admitting patients last week and is in the process of transferring all but about 30 high-risk patients, people who committed crimes and are housed in a maximum-security unit, to other state hospitals in Butner and Goldsboro. DHHS Secretary Lanier Cansler has announced that these patients, too, will be relocated within a few months.

The only way Dix will remain open is if the Republicans, who will control the General Assembly starting in January, intervene with money that the Democrats, who've been in control, were unwilling to spend. But the state is facing a $3.5–$4 billion budget gap, and the Republicans have promised no tax hikes, only spending cuts.

The upshot, Cansler told the Indy in an interview Monday, is that social services, including mental health, will be pared severely. If any new money were to materialize, he said, he would recommend that it be used to contract for psychiatric beds in local hospitals, not to keep the Dix hospital running.

The local beds cost one-third less, on average, than a bed at Dix, he said.

Cansler said he's delayed the Dix closing until the new General Assembly is seated, and the final decision will be theirs. But outside of Wake County's legislative delegation, he's heard no groundswell of support for keeping it open.

Wake's legislators, Democrats and Republicans alike, have fought the closing of Dix for the last seven years, or ever since the Easley administration decided to replace the two old psychiatric hospitals in Raleigh and Butner with a single new facility—and chose Butner over Raleigh. They've dragged it out, but they never could forestall it.

To critics like Chris Fitzsimon, executive director of N.C. Policy Watch, the closing of Dix epitomizes the failure of Easley's 2001 reform package, which was supposed to replace outdated hospital sequestration methods with community-based programs using modern psychiatric and psychotropic (drug) therapies.

Instead, Fitzsimon argues, state backsliding has prompted an investigation by the U.S. Department of Justice into reports by a watchdog group, Disability Rights N.C., that more than 6,000 mentally ill people are living in often squalid rest homes and receiving little or no treatment. "The disastrous 2001 mental health reform scheme," he says, "called for fewer [state] hospital beds and greater investments in community services so patients could be treated closer to home. The services have never been adequately funded, and they are certain to be slashed next year."

What's unclear now is how long DHHS will remain on Dix Hill and whether it will seek to expand there or find another place for its employees that's less fraught with history.

The giant agency has staffers working in 39 other, rented buildings in Wake County, Cansler says, and they need to be consolidated in a single location. A study is under way to determine whether that should occur on Dix Hill or in a new building or buildings elsewhere. He said the results of the study may be known within 60 days.

Three years ago, Raleigh Mayor Charles Meeker joined forces with groups in the city that hope to make Dix Hill a park one day. Together, they offered to pay the state $10.5 million for the rights to the land should Dix Hospital be closed. Their goal for the future: "A world-class destination park."

Their offer has lain on the table ever since. Meeker said Tuesday that Gov. Bev Perdue's staff is in the process of analyzing what to do about Dix and DHHS, but he's heard no conclusion. The head of one of the groups, Bill Padgett of Dix306, says park advocates were clear that mental health was the priority, and they'd defer—or share—if the state decided to keep the hospital going. One idea was to renovate some of the old dormitory buildings for use as transitional housing for people in treatment for mental illness.

Meanwhile, advocates for the mentally ill haven't given up hope. Until the state's promises of good community-based programs are realized, says Ann Akland, a leader in Wake-NAMI—the local chapter of the National Alliance on Mental Illness—even a shrunken Dix fills a critical gap in the center of the state. "Keeping Dix open provides a safety net and a relief valve for the system," Akland says.

Wake-NAMI recently issued a report showing that in the first six months of 2010, seriously mentally ill patients who came seeking treatment to a community hospital emergency room in North Carolina were kept waiting an average of 2.6 days before being admitted to a state hospital or a local psychiatric facility. Many, according to Akland, waited weeks, not days, and were put in jail, tasered or put in restraints.

"Fighting for local beds is very important," Akland says. "If people can find help locally, that is always preferable. But then there is the obvious—with close to 1 million citizens in Wake County, there is a large patient pool here that would benefit from treatment closer to home."

Still, she adds, "We are not fighting for Dix because we live in Wake County. We are fighting for Dix because the beds are desperately needed. When reform began, state officials promised that the state hospitals would not be closed until community services were in place. That promise was forgotten."

Secretary Cansler had more to say about mental health reform and better days ahead; see our Citizen blog.

  • North Carolina was once a leader in mental health. After a decade of "reforms," it no longer is.

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