Across the country states have been closing psychiatric hospital beds in favor of less restrictive community-based mental health care. Theoretically this sounds ideal, yet it presupposes that there really is a community-based mental health care system that can provide the individual care needed. As we are all aware, none of the major, public hospitals in Wake County have any psychiatric beds. The impact of closing the hospital beds has focused on an attempt to keep our mentally ill from needing hospital services by building a generally non-existent community-based mental health system and finding funds to support this system of care. In Wake County there has been a major focus on the issue that without Dorthea Dix, where will our mentally ill receive their short-term psychiatric hospital care? Sometime within the next 2-5 years, Wake County hopes to be able to provide a short-term hospital with some 60 beds, with all but 16 beds allocated to substance abuse needs. Whereas it is important to think about the substance abuse needs, does anyone really think 16 beds will be sufficient to accommodate the needs for our mentally ill? What type of mental illness can the county hope to offer treatment for that wouldn't require more than 16 beds (translated into 480 bed days/month)? It is my understanding that our Dix utilization rate (WC Crisis and Assessment Services plus Wake Med) is historically double that rate, if not more. Are we gearing up for a Wake County Psychiatric Hospital that can only provide a day or two treatment and then kick out the patient so a bed can be available for the person waiting in the admissions room? Are we being short-sighted in proceeding without first doing a needs assessment for what is the "best practice" for hospital psychiatric treatment? Consider that recent data related to psychiatric hospital length of stay for patients in Virginia show that the average length of stay for patients in the state hospital system was 55,3 days, but only 6.1 days for the community beds. (Catalyst, Fall 2007)
Many of us have heard presentations from the Division of Mental Health (DHHS) which included references to a criticism that North Carolina had a higher rate of state hospital bed utilization than (many) other states. This has been interpreted by the Division (and others) as a rationale for closing of hospital beds. With evidence showing that public psychiatric hospital capacity is inversely related to crime and arrest rates, it is even more compelling to ask our state officials to rethink this policy. If the community-based alternative to state psychiatric hospitals results in committing our mentally ill to a life of jails and prisons, our well-intentioned public policy has failed miserably!
