The crisis in mental health began here in Forsyth County five years ago just as the state was beginning its reform program, officials said.
In 2000, CenterPoint Human Services, the local public mental-health agency, closed its 12-bed psychiatric ward on Highland Avenue, in what was then the Reynolds Health Center, for lack of money.
Advocates warned at the time that without local beds for psychiatric care, admissions to the John Umstead Hospital in Butner, the state psychiatric hospital for this region, would rise.
That's exactly what happened.
According to figures provided by the state, admissions from this region have nearly doubled since 2001, from 578 to 1,056 last year.
"I miss the old Reynolds Health Center. They cut that out because of budget cuts and now we're finding, by golly it's necessary," said Ken Farrington, a board member with the local branch of the National Alliance on Mental Illness. "The hospitals have not taken up the slack."
In fact, three months after CenterPoint shut its psychiatric ward, Charter Behavioral Health System of Winston-Salem, a private psychiatric hospital with 111 beds for adults and children, closed because its parent company was bankrupt.
"Our plan was to contract as much as possible with local hospitals to pick up the slack and literally within weeks of our announcement Charter closed and the community lost all the services Charter provided, including a large number of adult beds," said Ron Morton, the former director of CenterPoint.
The state plan for reform of its $2.3 billion mental-health system did not provide for 24-hour crisis care here or elsewhere to replace local hospital beds.
"It was either a gross oversight on the part of the state or the state assumed communities would pick up the slack, which has not been the case," said Farrington, whose adult son was admitted to Umstead after the local public psychiatric unit closed.
With reform under attack, state and local mental-health officials now say that the most important thing they can do to keep people out of the state psychiatric hospitals is provide 24-hour crisis care in communities across the state. The details have not been worked out, but round-the-clock care could include a crisis center, similar to the one CenterPoint ran, or outreach workers and specially trained police squads.
State officials say they will work on improving payment for such services. Carmen Hooker Odom, the secretary of the N.C. Department of Health and Human Services, said she also hopes to help local hospitals keep their psychiatric wards open by negotiating with federal-health officials for an increase in the payments from Medicaid for psychiatric care. A request is pending with federal-health officials, she said.
In the meantime, emergency rooms at local hospitals are struggling to keep up with patients who need crisis care.
Forsyth Medical Center, with 43 psychiatric beds, is negotiating a new contract with CenterPoint to admit some of CenterPoint's uninsured clients, said Kevin Beauchamp, CenterPoint's chief financial officer.
Despite this region's extensive medical community, hospital officials said they should not bear the financial burden of creating a 24-hour crisis center locally.
"Our responsibility is adult, acute-care management" and not mental-health services, said Jo Haubenreiser, the executive director of post-acute services for Forsyth Medical Center. "I truly believe the community isn't looking for hospitals to do it."
Officials at Wake Forest University Baptist Medical Center agreed.
Vaughn McCall, the chairman of the medical center's department of Psychiatric and Behavioral Medicine, said that both hospitals have some role in creating round-the-clock care, but psychiatric care is not the hospital's top priority. Baptist has 44 psychiatric beds.
"I think hospitals may have responsibility in being part of a communitywide program," McCall said. But "it would simply be impossible for Wake Forest University to single-handedly rescue what is a bad situation."
So what is the solution? Some mental-health advocates said that the federal government needs to increase reimbursement for mental-health care, which could encourage hospitals to add more beds for those patients.
Mental illness is "just another disorder, like diabetes or heart disease," said Benjamin Staples, the executive director of the state branch of the National Alliance on Mental Illness in Raleigh. "How you can have a hospital and not have a psychiatric unit is disturbing."
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