NAMI North Carolina NC Psychiatric Hospital Study Report Documents Severe Problems

News Release

NC Psychiatric Hospital Study Report Documents Severe Problems

Advocacy Group Focuses on Human Consequences

Released April 22, 1998

Last August, North Carolina legislators agreed to commission an efficiency study of the state’s four psychiatric hospitals. Next week, as copies of the resulting 655-page final report plunk down on their desks, they will encounter findings of severe, system-wide Inefficiency, all documented in mind-numbing detail, along with recommendations for radical change.

Those with the fortitude to read beyond the nine-page Executive Summary of the three-month, $500,000 study by MGT of America, Inc., will find, within the details, the consequences of those problems on patients and their families.

“I’m sure most North Carolinians will be shocked at what this report says about our psychiatric hospitals,” said Beth Melcher, Ph.D., executive director of the North Carolina affiliate of the National Alliance for the Mentally Ill. “Anyone who’s visited any of the four hospitals can see the buildings are crumbling, too.

“But this report is about more than accounting systems and broken elevators. This is about people with mental illness who are suffering the terrible consequences of all these problems.”

The picture that emerges from a close reading of the report is one of nurses who are too busy mopping floors and adding columns of numbers on timesheets to interact with patients—of health care technicians whose only way to get help if a violent patient attacks is to yell and hope someone hears—of patients crowded into cigarette smoke-filled, brick-latticed porches because there’s no outdoor space for them to use—of wards filled with geriatric and wheelchair-bound patients who could not be evacuated if there were a fire—of administrators unable to account for major expenditures or make informed decisions because the hospital’s internal accounting controls are so weak.

According to Melcher, the problems result from decades of neglect. “The state hospitals have been on nobody’s radar screen,” said Melcher. “Mental health care has been a low priority in administration after administration. All these years, we’ve given the hospitals little more than Band-Aids and duct tape to work with and told them, ‘Good luck.’ This report shows the shameful results.”

Report Highlights

At the heart of the efficiency study report are 20 findings paired with 20 recommendations which, if fully implemented, will result in radical change at all four of the facilities—Dorothea Dix Hospital in Raleigh, Broughton Hospital in Morganton, John Umstead Hospital in Butner and Cherry Hospital in Goldsboro. Several key recommendations go beyond the hospitals to require substantial improvements in community-based programs throughout the state.

Findings and Recommendations for Patient Care

Patients in many units receive little or no intensive therapy.

Instead of caring for patients, direct care staff at the four hospitals spend an estimated 97,461 hours each year on housekeeping, timekeeping and medical record keeping at a total cost of $1,377,574.

Legal-status patients now mainstreamed into patient populations at all four hospitals should be transferred to the Forensic Treatment Unit.

Some psychiatric hospitals have more than their share of beds for adults, based on the populations of the regions they serve.

Patients Who Don’t Belong

The study identified several categories of patients the authors believe would be better served by community programs.

The study’s authors recommend a 42 percent decrease in the total number of beds in North Carolina’s state psychiatric hospitals.

All Four Hospital Facilities Should Be Replaced

Facilities at all four hospitals are poorly configured for treating patients and inefficient to operate.

The study’s authors recommend replacing all buildings at all four hospitals, except for one built in 1996 at Umstead.

Total construction costs are estimated at $154 million.

The total reduction in 10-year operating costs, assuming the recommended 42 percent decrease in total beds, is estimated at $1,346,907,073.

The daily per-bed rate decreases, assuming new construction and recommended number of beds, from $293 to $222.

The authors recommend using federal Disproportionate Share Hospital (DSH) funds to finance construction.

The authors emphasized a need for the General Assembly to act now, while funds are available.

Administration & Staffing Problems Must Be Solved

The hospitals lack effective internal accounting controls. Meaningful management information is not being collected.

Each hospital uses its own accounting methods and terminology, making it difficult or impossible to compare data among the four.

More patients are admitted to state psychiatric hospitals during the second and third shifts, yet hospital admission units have more staff assigned to the day shift.

The hospitals do not measure patients’ psychiatric acuity—only their medical acuity. Since the patients’ psychiatric acuity determines the care they need, an effective measurement system is essential for making informed staffing decisions.

Only one hospital (Umstead) uses unit-centered nurse staffing, resulting in greater efficiency and better patient care. At the other three hospitals, nursing supervisors spend about two hours a day allocating staff. Staff members assigned to unfamiliar units require additional training.

Housekeeping staff members work only on weekdays, leaving their duties for nurses and health care technicians to perform evenings and weekends when there are the most patients on most wards. By rescheduling shifts, the hospitals could have housekeeping services available seven days a week for at least two shifts.

High staff vacancy rates suggest market competition for qualified nurses and health care technicians is impairing the hospitals’ employee recruiting and retention efforts.

The study’s authors believe some major hospital functions—particularly the services of Medical/Surgical Units at Dix and Broughton hospitals—should be outsourced, but staff members tended to consider only relatively minor functions suitable for possible outsourcing.

During one year, the four hospitals provided housekeeping, security and maintenance services to other public agencies worth $1,527,263 for which the agencies either underpaid or did not pay at all.

Technology Needed to Improve Efficiency & Safety

Current manual time-keeping systems at all four hospitals are time-consuming and inefficient.

The hospitals need to upgrade computer systems, the maintenance work order system, personal protection system and paging system.

Funding Should Be Consolidated

The authors believe North Carolina’s practice of funding its psychiatric hospitals separately from its area mental health care authorities is at least partly to blame for many problems identified in the study.

The authors maintain, “Single-stream funding, combined with the construction of four new smaller hospitals, would provide North Carolina one of the nation’s premier public mental health systems.”