Within Carolinas HealthCare System’s hospital network alone, 10 to 25 patients wait in emergency rooms every day because there are no available beds for psychiatric care.
That shortage will be eased somewhat this week when the system opens a 66-bed, $32 million adult psychiatric hospital in Davidson. The first patients are scheduled to be admitted Monday.
“There’s so much pent-up need that we could, if it was practically possible, be full on the first day,” said Dr. Tom Gettelman, vice president and facility executive for Carolinas HealthCare System Behavioral Health-Davidson.
With more staff still to be hired, Gettelman said the hospital will initially accept only 26 patients on two of its three inpatient units. Full staffing and occupancy is expected in a couple of months.
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Carolinas HealthCare first proposed the hospital three years ago to ease overcrowding at Carolinas Medical Center-Randolph, the county’s longstanding psychiatric hospital on Billingsley Road. That 66-bed hospital, with the state’s only psychiatric emergency room, will continue operation.
CMC-Randolph was owned by Mecklenburg County until 2012, when Carolinas HealthCare took ownership. Its beds are typically filled, meaning that many patients wait for days in emergency rooms or acute-care hospital rooms where they don’t receive appropriate treatment. Many families must drive hundreds of miles, and even leave the state, to find care for loved ones.
And the Davidson hospital opens at a time when “the state is running away from” the responsibility of caring for the mentally ill, said Carolinas HealthCare CEO Michael Tarwater.
About half of state-operated psychiatric beds have closed in recent years. Broughton Hospital, the state’s psychiatric hospital in Morganton, once received several hundred patients from Charlotte a year but takes fewer transfers now. In fact, Davidson’s 66 beds were transferred from Broughton, part of the down-sizing of state-owned psychiatric hospitals.
Novant Health Presbyterian Medical Center also operates 75 psychiatric beds, and an average of five to seven patients a day are waiting in Novant’s Charlotte-area emergency departments for placement in psychiatric beds. Mecklenburg lost about 200 beds in the 1990s with the closing of two private, for-profit psychiatric hospitals – Charter Pines and Cedar Spring.
Because reimbursement for mental health care doesn’t cover the cost, Tarwater has repeatedly said the Davidson hospital will lose money, about $30 million over the first five years of operation. But he said it’s the public hospital system’s mission to take care of all patients, regardless of ability to pay. “We are a safety net provider,” he has said. “These patients don’t have anywhere to go.”
Initially, the new hospital was proposed for Huntersville, but some residents complained and town officials rejected the rezoning in March 2012. Officials from the Davidson area then stepped forward, inviting Carolinas HealthCare to locate there.
Saddled with stigma
Julie Roddey Paul of Cornelius, who was treated for anxiety and depression at CMC-Randolph in 2008, said community support for the new hospital, including from Davidson Mayor John Woods, will break down barriers to mental health care.
“I know that I dealt with stigma for a long time and it kept me from getting treatment,” said Paul, 51, a member of the new hospital’s Patient and Family Advisory Board.
“Having the community behind the hospital means ... a person in crisis will feel more connected, and this community support, with time, will help to remove the fear and shame for a person needing to seek treatment.”
Initially, the Davidson hospital was envisioned as a treatment center for people with mood disorders, such as clinical depression and bipolar disorder, instead of more serious psychotic disorders, such as schizophrenia.
Gettelman, who spent 22 years as a psychologist and administrator at CMC-Randolph, said the Billingsley Road hospital is the most appropriate setting for patients who are “very chronically mentally ill” because it has psychiatrists on duty around-the-clock in the emergency room and a staff experienced in treating that population.
Still, he said Davidson will accept patients with psychotic illnesses when necessary. And, like CMC-Randolph, it will take patients with or without insurance.
“If somebody’s in an emergency department needing an inpatient bed, and if there’s any way this is an appropriate setting, we’re taking them,” Gettelman said.
Patients coming to the Davidson hospital, which doesn’t have an emergency room, will be transferred from other hospitals or doctors’ offices. Staffers will be waiting to escort patients to one of the three units, named Fraser Fir, River Birch and Mountain Laurel.
“It’s all designed to maintain privacy and security,” Gettelman said.
Outside, the 67,280-square-foot hospital resembles a mountain lodge, with wood and stone construction, and is surrounded by woods on a rural 22-acre lot off N.C. 73 east of Ramah Church Road and across from Bradford Park. In addition to the inpatient hospital, the building includes a 10,000-square-foot outpatient behavioral health practice that will offer treatment for adults as well as children.
Lots of windows allow plenty of natural light into rooms that are painted in calming hues of blue and green. Each patient will have a private room with a private bath. There’s a gym for exercise and movies, a private dining room, a day room with a television and game tables, and an enclosed outdoor courtyard.
“If you’re in a (regular) hospital, you’re usually in your room,” Gettelman said. “But in this type of environment, the goal is social interaction and being out.”
For other times, there’s also a “comfort room” with a rocking chair where patients can go “if they’re feeling particularly agitated, to remove themselves from being around a lot of people,” Gettelman said.
Support for families
The Davidson hospital will employ about 160 people, including six psychiatrists and 18 psychotherapists, along with nurses, psychiatric technicians and “peer support specialists” who have received past treatment for mental illness or substance abuse.
All of the psychiatrists are hospitalists who will work only at the Davidson hospital, seven days in a row, with seven days off. They will work closely with therapists, who will also work seven days on and seven off. Nurses and techs will work 12-hour shifts. That staffing model is designed to create teams that foster “clinical consistency, efficiency, communication and collaboration,” Gettelman said.
In response to feedback from patients and families, Gettelman said the Davidson hospital will also assign a therapist to be available for about 20 minutes before every visitation period to speak to families and friends about what to expect.
“What we’ve heard is how disorienting it is for families if they’ve never experienced it,” he said. “If you want to, joining others and sharing your experience and supporting one another is really helpful.”