Mental Health Advocates Criticize North Carolina’s Plan to Shift Care from Hospitals to Community-Based Setting

Mental health advocates are concerned that North Carolina's plan to consolidate two psychiatric hospitals will prevent low-income patients from accessing services, the Fayetteville Observer reports. The state plans to close Dorothea Dix Hospital, in Raleigh, and John Umstead Hospital, in Butner, and open a new consolidated psychiatric hospital in an undetermined location (Locklear, Fayetteville Observer, 11/25). In addition, the plan calls for public mental health centers over the next five years to shift their responsibilities from providing care to contract with private providers for services. Patients also would be moved out of state-run mental health institutions and into community-based care centers (Kaiser Daily Health Policy Report, 5/16). While state officials say the change is needed to "revitalize a flawed system," mental health officials say that patients who are unable to pay for treatment will be "left out." Local centers also are likely to experience an increase in demand for services because of the loss of hospital beds. Claretta Johnson, area director of the Lee-Harnett Area Mental Health Center in Sanford, N.C., said that consolidating the hospitals will "burden" patients, who will need to travel farther for treatments. Don Dalton, a spokesperson for the North Carolina Hospital Association, added that hospitals would have to "absorb" any financial losses from treating uninsured mentally ill patients. "With lesser access to state hospitals, mental health patients will turn to whatever resources are available in the community, primarily the emergency rooms," he said.

State Response
The Observer reports that funds that have been used to provide services at the two facilities will be redistributed to the counties to build new facilities. State Rep. Verla Insko (D), who sponsored the legislation outlining the reforms, said the "first goal" is to construct new facilities and update other centers. She added that funds saved through consolidation will be used to build new group homes. "We won't cut funding, but we will improve services. We will move some out who will be better served in other locations. We will still house the seriously mentally ill patients who are a danger to themselves and others," she said. She added that referring some cases to private providers will allow patients to access needed services because local programs will be responsible for identifying those who need care (Fayetteville Observer, 11/25).