By Megan V. Williams
http://stream.publicbroadcasting.net/production/mp3/whqr/local-whqr-685160.mp3
Wilmington, NC – Thousands of people a year suffering from mental illness spend time in one of North Carolina's psychiatric hospitals, getting treatment for their most extreme episodes. All this month, we're following the labyrinth of mental health care in North Carolina. In the second part of our series, WHQR examines how the system handles people in crisis.
Crisis. That's what it's called when your brain betrays you. The moment when your mental illness, whether undiagnosed or previously held in check with medication, rises out of control.
Sitting in the Wilmington offices of Peer Bridgers, a psychological counseling service both of them use, Grace S. and Julie L. describe the worst days of their illnesses
For Grace, who has struggled with bipolar disorder for more than thirty years, the final break came after winning a particularly high-stress job in Washington, DC. The pressure launched her on an escalating cycle, jerking through fits of mania and depression. "I thought people were out to get me," she recalls, "I wouldn't answer my phone, I wouldn't answer my door. Personal hygiene, didn't care about that. Eating was out the door."
Julie is blonde and in her early thirties, although she looks younger. Twisting nervously at her key ring, she tells the story of the crisis that finally launched her into treatment. "Basically, my paranoia took over. I thought people were trying to poison me or people were trying to kill me, even my own parents," she says.
Crisis starts in the mind the individual, but from there, it's often not long before the first official contact, often with EMTs or the police.
The Wilmington Police Department and the New Hanover County Sheriff's office have both started training their officers to better recognize and deal with mental illness. Patrolman Jeff Martens says often the most effective strategy is also the simplest -- talking to people like they're people, and taking his time.
In general, crisis calls take a different mindset, and a different approach.
"Most of the time when we deal with people in crisis and they are combative, you could easily take them to jail," Martens says. "It wouldn't take but a second to find a charge, slap the cuffs on em, and take them to jail and be done with it. But what have you done? You've put somebody in jail that, honestly, does he really belong there? Honestly, probably not. He or she needs to get help."
Often, the next step toward that help is a psychiatric evaluation at the local Emergency Room or the crisis station of regional mental health service provider.
Many of the people who reach the ER calm down enough to be released simply with medication and a follow-up appointment. But others require days, or even weeks of hospitalization to stabilize. Julie knows the local system firsthand.
"I had an episode and I ended up in Oaks hospital and I got released from there but then a year later, I had another episode and I went back to Oaks..."
The Oaks is New Hanover Medical Center's 63-bed psychiatric facility, a quiet place to the side of the main hospital. If you aren't too violent and if you have some way of paying the cost, this may be your home until you stabilize. And simple stability is the top priority, according to psychologist Patrick Martin, the Oaks' medical director.
"Here in the hospital, we are interested in getting people better really fast, because they are very uncomfortable, they are suffering, and our time is not unlimited," he says.
As part of the mental health care reform that started in 2001, North Carolina has increasingly emphasized getting people in crisis into places like the Oaks instead of the four state-run psychiatric hospitals.
"When you go to a state hospital, you leave your home, your community, and all of that, and you have kind of this hiatus in your life when you're in the hospital," Leza Wainwright, one of the state's co-directors of Mental Health says. "If you could receive those services closer to home and be more integrated, we clearly believe that would be in folks' best interest."
But Martin says the state isn't backing up that belief with funding. For most community hospitals, he says, having psychiatric beds is just a bad business decision, so bad, in fact, that more and more of them getting out of the business entirely.
"Used to be every month, but now we're down to so few hospitals it's not happening every month. But certainly every quarter we hear of another hospital that's decided not to have inpatient psychiatric services because they lose so much money," he says.
So if there aren't enough beds at the Oaks, or if you don't meet their criteria, it's time for a two hour drive, up to state-run Cherry Hospital in Goldsboro. It's a trip Julie made last summer, after she and her parents decided the group home she was staying in wasn't helping.
"I wasn't stable when I first got there," she says of her arrival, "I just thought I was going to be put in prison. That's what I thought it was, I thought it was a type of prison or something."
She could be excused for thinking that; to a newcomer's eyes, Cherry Hospital is hardly welcoming. It's designed to control the movement and ensure the safety of its involuntarily committed patients -- the doors are solid, and every one of them locks. Nurses and attendents travel with heavy, jingling rings of keys.
Our tour guide is the hospital's director, Dr. Jack St. Clair, a soft-spoken man with an Old West mustache and a Food Lion discount fob on his keychain. As he walks through the intake ward, St. Clair jokes with tired-looking attendents who report on the day's tally of fights and new patients.
St. Clair says the hospital is frequently over-capacity, often with exactly the kind of patients the state says it's trying to create other services for -- people in short term crisis who can stabilize within a week or two. That he's seeing so many of them here is, in St. Clair's view, evidence that the system isn't working somewhere else.
"The key to it is there is a full array of services available. And without that, you'll continue to see systems being overloaded, other systems being under loaded."
The dangers of crowding are made worse by Cherry's obsolete design. In layout, the facility is more of a campus than a hospital. Its dozen brick buildings are scattered across former farmland, and the newest dates to the 1960s. Every meal patients eat has to be delivered by truck from a detached commissary. Every day requires the slow shuffling of patients and medical records from building to building.
Outdated facilities, according to St. Clair, are a constant problem.
"It's almost impossible to have enough staff to observe all activities of all patients at all times," he says, "and remember, of course, people come here because they're in imminent danger of harming self or others, so close supervision is paramount to our ability to maintain safety."
The state is currently building a replacement just down the road, a modern facility with everything under one roof, designed to help staff keep a better eye on patients.
Julie doesn't remember feeling particularly safe when she first arrived at Cherry last summer: "Cherry is rough. I mean, there's people there that are like trying to start fights and all that kind of stuff. And as long as you just try to stay to yourself and say, 'I'm going to get out of here.'"
Julie did get out, after a three week stay that stretched on only because it took that long for case workers to find a supported living situation with space for her in Wilmington. After half a year there, she's finally ready to move again; tomorrow Julie begins settling in to her own apartment.
Hard work has kept Julie stable, but she was lucky too, to land in a supportive environment. Many of Cherry's patients walk out with two weeks-worth of medication and a few scheduled appointments with psychiatrists and case workers. The goal is to keep them stable, out of crisis, and out of the hospital.
Within a month, one in ten will return to Cherry.
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Listen to a longer interview with Dr. Jack St. Clair here
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