Agenda - 12-15-2009 - 3b - Laserfiche WebLink

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25 MENTAL HEALTH TASK FORCE REPORT The quick release from hospitals and the lack of community treatment forces those with mental illnesses to seek help elsewhere. It is becoming more common for the Healing Place of Wake County, an addiction recovery program, to have residents who have been in and out of mental hospitals, said executive director Dennis Parnell. He said he is worried that when Dorothea Dix closes next year, the Healing Place shelter and detox program will be overwhelmed by people whose main problem is mental illness. "It could really endanger our whole mission," he said. The U.S. Justice Department wants the state to have a better grasp of what happens to patients once they leave the hospitals. It has asked Geller for more information about how the hospitals plan for treatment once patients leave. In 2002, a team ofinental-health experts working for the Justice Department found that hospitals were discharging patients to unhealthy or dangerous living arrangements. For example, a consultant working for the Justice Department found a 28-year-old man at Broughton who had a sexual relationship with his mother. The hospital's plan was to send him to Florida under his mother's supervision. The consultant described the arrangement as "clinically inappropriate to say the least." Patients from Cherry left the hospital to live with other former patients. In some cases, those living arrangements offered easy access to illegal drugs. Michael Moseley, director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, said post-release problems aze not the hospitals' fault. Such problems occur, he said, because the state does not have enough housing for patients or emergency mental-health treatment at the county level. Once hospitals stabilize patients, they often have little choice but to send the patients back to the same circumstances that brought them to the hospital. That fosters a cycle of admission, release and readmission. "If they're returning to what they came out of, the writing's on the wall," Moseley said. Geller acknowledged the hospitals' dilemma. Hospital staff members cannot force patients to get follow-up caze, he said, and they cannot fill gaps in local mental-health services. Still, he recommended Cherry Hospital set up a committee to figure out why it was repeatedly admitting patients for short stays. All four hospitals are trying to find out why some patients keep coming back, said Laura White, a state administrator. The rate of mental hospital use in North Cazolina is more than twice the national rate. "One of the things the hospitals are really working on is how to work better with the communities azound those people who have high numbers of admissions because that's just terrible," said White, who oversees the four hospitals. "We really want to reduce that." In the past five years, connections have weakened between hospitals and community counselors who help make doctor appointments and living arrangements. Fewer community mental-health workers are available for meetings with hospital staff and patients to prepaze patients for life outside. Some patients say the hospitals are too quick to discharge them. Durham resident Hazel Gulley needed new medications in late 2005 for an illness that combines symptoms of schizophrenia and a mood disorder. She said she spent about a week in John Umstead Hospital to have her medication adjusted, then returned home. A case manager who works with Gulley, 49, noticed she was having delusions, and she was back at Umstead a few days later. "My mind wasn't cleaz enough to come home," Gulley said. "The medications were all messed up." Erin Delaney, 30, said she spent a little more than a day at Dorothea Dix in January at the end of a trek through hospitals and clinics in Raleigh. Delaney, who has bipolar disorder and had substance abuse problems, said she was discharged from a private hospital after three days when her insurance coverage ran out. She tried to make an appointment to see a psychiatrist with Wake County but was told the wait would be up to three weeks. She ended up in a WakeMed emergency department bed in Raleigh and was sent to Dix from there. At Dix, Delaney said, a doctor told her during a brief interview that she was not bipolar, though she had been repeatedly diagnosed with the disorder. "I talked to him for 15 minutes, and he undiagnosed me," she said. Delaney said the doctor took her off one of her two medications and prescribed another. She had a place to sleep for a few hours, then left Dix. She is now in TROSA, a two-year residential program in Durham for substance abusers. 23