“You got this love… Okay. Love you, sweetheart. Bye, honey,” Debra Marlowe said.
She was on the phone with her son, who is in his early 30s and suffers from schizophrenia. He was diagnosed in 2009 at the age of 19. He lives on his own in a townhouse his mother helps him keep up, but visits her frequently.
WHQR found Marlowe through a Google review she’d left about New Hanover Regional Medical Regional Center’s behavioral health hospital.
Back in 2017, Marlowe had her son taken to NHRMC when he was experiencing a psychotic episode. It was an involuntary commitment, which in this case meant a deputy from the New Hanover County Sheriff's Office took him to the hospital.
Because there was a wait to get a bed at the behavioral health hospital, which is built for handling people in crisis, Marlowe's son was taken to a room in the Emergency Department and held there. This waiting area is essentially a series of rooms located around a central desk. According to Novant, there is a behavioral health provider on call, but the facility doesn't have the same level of dedicated resources that a psychiatric facility would have to treat someone, like Marlowe's son, dealing with a psychotic episode.
Afraid, her son tried to run to the door and escape the hospital, thinking people were going to attack him. That’s when four guards tackled him to the floor, dragged him to a bed, and four-point restrained him to it, according to Marlowe.
“He's 6’2, weighs ... Well, he weighed like, 375 [pounds]. I mean, he's about as big as that refrigerator," Marlowe told WHQR, gesturing to the family fridge.
Marlowe's son alleges that for two days, he was tied down, unable to use the bathroom, and screaming for his mother. When she was allowed to visit him after those first 48 hours, she was horrified. During his time there, he was never seen by a psychiatric doctor, Marlowe said.
While the hospital can't comment on specific cases because of HIPPA, a Novant spokesperson said the hospital tries to avoid using this type of restraint — but they are sometimes necessary to protect patients or staff.
A last resort
While what happened to Marlowe’s son at the hospital may have been unavoidable, it’s left her with questions about whether or not emergency department visits for mental crisis are always beneficial to patients.
Ryan Estes, Chief Operating Officer of Coastal Horizons says it becomes a catch-22 in many cases.
“Does trauma potentially happen at that point? Absolutely. I've seen individuals who are in an under-resourced system, meaning that there may not be a psychiatrist that can check in on them," Estes said. "Did they have an opportunity to get someone to take care of their pets or to pack a bag, all of these different things that go into, does in this very instant, this person need to be in a hospital setting?”
In the case of Marlowe's son, the situation may have been severe enough that an involuntary commitment was necessary. But the experience — including being transported by law enforcement and waiting for a bed in the hospital (even without being restrained) — was traumatic. Enough so that Marlowe, and many people in her situation, have understandably sought alternatives.
Alternatives for crises
Marlowe sent her son to NHRMC as a last resort, because he was ‘in crisis’ — but what does that mean?
Kelly Crosbie is in charge of the mental health division for the state health department. She says it’s more than literally talking someone down from a ledge.
"In the most extreme sense that someone is thinking of hurting themselves or hurting others, because that is the purest, highest level of mental health crisis. But sometimes it's just a person who's feeling incredibly overwhelmed and…they need just a quiet place to sit, and really need professionals to talk to you right away," Crosbie said.
The hospital serves the most severe cases — but there are few options in New Hanover County for more moderate crises. But that’s not the case everywhere.
Behavior Health Urgent Cares are peppered around the triangle (Raleigh, Durham, and Chapel Hill) for this exact reason. They’re staffed with licensed medical professionals: therapists, clinicians, and psychiatrists, and have many services they're required to provide in order to earn their urgent care title. One of their functions is being able to determine whether or not someone needs to be involuntarily committed.
But, Crosbie says these facilities provide people with a quiet place to soothe themselves and receive medication if necessary in the moment. The longest time an adult or child will typically spend at an urgent care is 23 hours and 59 minutes, she said. Many times that’s all they need.
“Sometimes, when we use traditional methods of crisis response, like 911, like law enforcement, like ambulances, like taking someone to the emergency department, that can have the effect of potentially escalating the situation," Crosbie said.
A lesser-known and underutilized alternative to ED visits is a mobile crisis team, Crosbie said. Mobile crisis teams can be sent to a person’s location to assist with stabilization, being able to stay with patients for hours.
When people dial 988, the national mental health hotline number, their call is routed based on their area code (if you’ve moved out of the area code’s state, the call can be redirected to the state you currently live in).
Unfortunately, the state only has 30 teams for 100 counties. Not enough, but a start, Crosbie said.
New Hanover Regional Medical Center is the main medical facility in the region, serving nine adjacent counties in Southeastern North Carolina. However, it remains a short-term crisis stabilization facility. The Behavioral Health Hospital facility is a short-stay psychiatric crisis stabilization hospital with 62 licensed beds — and there’s a wait time of 35-37 hours to get one of those beds. A Novant spokesperson says patients who are admitted generally spend three to seven nights to provide stabilization.
NHRMC serves a large area, with just shy of a million people. And, while estimates of the need for psychiatric beds vary, even on the low-end several studies call for 30 beds per 100,000 people — meaning NHRMC would need close to 300 beds for its entire region, and around 130 beds just for Brunswick, New Hanover, and Pender counties. There are other facilities in the region, including private facilities, but the wait time at NHRMC indicates more beds would help people get seen more quickly — even if it isn't the ideal treatment for everyone.
If a better option had existed at the time of her son’s crisis, Marlowe would have taken it in a heartbeat, she said. Both she and her son have been traumatized and she’d rather risk being harmed herself than to have him experience something like that again.
“It's better than them hurting him," she said.
Editor's note: This article has been updated to clarify that the account of Marlowe's son's experience is an allegation as well as the level of resources available for psychiatric treatment in the Emergency Department.
