RALEIGH More than 156 years after the state opened its first hospital for the mentally ill, the last patients will leave its campus this week.

The hospital, which opened in 1856 during a wave of innovation spurred by the national crusader Dorothea Dix, is saying goodbye just as another wave of controversial mental health reforms struggles to take hold.

Those reforms aim to de-emphasize institutional care in favor of community treatment for the mentally ill. Though the end has been coming for years – a consultant’s report back in 2000 recommended closing the hospital named for Dix – some of its supporters say its shuttering is a symbol of the state’s failure to properly treat mentally ill people.

The remaining Dix patients are being transferred to Central Regional Hospital in Butner, a new facility that critics say doesn’t have nearly enough beds to treat those with the most severe mental illnesses.

“Dix has been just a critical part of keeping people with mental illness safe and out of jails,” said Ann Akland, former president of the National Alliance on Mental Illness in Wake County. “While we have a great new hospital in Butner, there are not enough beds for people who are mentally ill enough to need them. People are backing up in emergency departments and crisis centers because there are not enough of those kinds of beds left.”

Dix always served as an “intensive care unit” for psychiatric patients, and its facilities lessened the burden on community hospitals that did not have enough beds for mentally ill patients, said Dr. Brian Sheitman, medical director of a UNC community mental health center and a former clinical director at Dix.

“The state hospital was sort of a safety net for everything,” he said.

Patients with the most severe mental illnesses often end up waiting in general hospital emergency departments, he said.

When the state started considering closing Dix, it held about 430 patients on an average day. Central Regional Hospital has 384 beds.

On Friday, the only beds available for adults in state psychiatric hospitals were on a special unit for deaf people at Broughton Hospital in Morganton. An average of 622 people a month were on waiting lists for state hospital beds over a 12-month period that ended in June, according to the state Department of Health and Human Services.

The average wait was nearly three days. Some wait much longer.

Carolyn Robinson, secretary of the National Alliance on Mental Illness Charlotte, wasn’t aware of many patients from the local area going to Dorothea Dix, but still had concerns about the hospital’s closure.

“Where are these people going to go?” she said. “Are there other places for them?”

The last years at Dix have been tumultuous. As the hospital prepares to close, the state is trying to reinvent mental health treatment to make it more community-based. But the required network of community mental health services has not grown, and Dix and the other three state hospitals ended up admitting more patients for repeat, short-term stays.

Amid the upheaval, Dix and the other hospitals had been under pressure from the federal government to improve patient treatment.

The continuing surge of short-stay patients was one of the biggest challenges, said former Dix director Jim Osberg, who served two stints as the hospital’s leader.

The hospitals today don’t admit every patient who needs care, putting some on waiting lists. All the beds for adults at Central Regional are taken; one person from Durham and six people from Wake were on the waiting list Friday.