The state’s newest psychiatric facility was plagued by delays. Now that it’s open, will there be fewer people in the state’s emergency departments?
By Rose Hoban
Three years after it was originally slated to open, Goldsboro’s new Cherry Hospital was officially dedicated Tuesday by Gov. Pat McCrory
At an outdoor ceremony attended by hundreds of present and former staff, state and local officials, and legislators, McCrory glossed over the delays that kept the $138 million facility from opening in 2013. Instead, he focused on how mental health care has changed since the old Cherry Hospital was opened in the late 19th century, when it was a segregated facility for black North Carolinians.
“That changed in 1965, but that wasn’t too long ago,” McCrory said. “The second major thing that changed was that the original hospital [name] had the word ‘insane’ in it.
“Now that we’ve become more educated on mental illness and mental health, we realize that these are people dealing with issues that all of us are having to deal with.”
The new, single 410,000 square-foot facility moves away from older models of psychiatric facilities that put different patient populations into different buildings scattered across a large campus.
The new building instead puts everyone under one roof and features large windows, interior courtyards with plantings, muted colors on the walls and large photographs of nature scenes taken around Eastern North Carolina by hospital staff.
“The thought and intentionality behind every component, and the materials used and incorporating the patient’s perspective is a great step forward,” said Julia Wacker, a social worker who directs behavioral health policy for the North Carolina Hospital Association. “Seeing a facility like this, we know we’re making progress.”
In the past, Cherry Hospital had persistent issues with allegations of patient abuse and in 2008, patient Steven Sabock died while strapped to a chair, ignored by staff for close to 24 hours as he slowly died.
That incident, and others, temporarily cost the hospital it’s federal certification and sparked reform efforts at the facility.
Hospital director Luckey Welsh also said his staff learned from the logistical and construction issues faced during the building and opening of Central Regional Hospital in Butner in 2008. Issues with railings that would allow for patients to hang themselves, faulty security systems, breakable glass and other safety risks delayed Central Regional’s opening. Welsh said the staff from Central Regional gave people at Cherry “a lot of good ideas.”
He said, for example, the bathroom doors in patient rooms are cut at an angle to prevent a patient from attempting to hang himself off the top of the door. He also said nursing stations at Cherry will be placed behind glass partitions, instead of open, as at Central Regional.
“At Central Regional they learned very quickly the patients did not respect that space, and staff would retreat back into an area that’s not as functional as ours will be,” Welsh said.
“It’s like building a house, you build a house the second time, you build it a little bit better.”
He also said he’s made changes in the employee culture that allowed for Sabock to die slowly, even as staff played cards and ate meals within feet of where he sat.
“We changed the culture around trust of our employees, and they respect that,” he said. He also implemented an employee program known as “just culture” for dealing with problem staff.
“People make human errors and if they make a human error, we’ll help them learn how to do better. If they break a policy, we will coach them and take them for education. If they’re reckless, or if they hurt somebody, then we will deal with them and discipline them, even suspension or termination.”
Welsh said the treatment culture has also changed at the hospital, which now emphasizes recovery from mental illness, rather than merely getting patients to be “compliant” with their medications and treatment.
“These patients, we’re trying to get them ready to go back to their communities and recover from their illness to the extent possible,” he said. “Our job is teaching people independent skills for living, teaching them whatever they’re interested in, to learn how to function in society.”
The biggest problem, officials said, was the lack of staff for the facility.
“Staffing is a challenge,” said Dale Armstrong, the Director of State Operated Healthcare Facilities at DHHS and a deputy secretary for behavioral health. “Because recruitment is such a challenging issue, not just with the state, but in the field of mental health, for psychiatrists, for social workers, for health techs, there’s a lot of options. So competing for a small pool, that’s a highly competitive pool, that’s a challenge.”
About 196 patients at the old facility are slated to move into the new building at the end of September. After that, as officials hire new staff, the capacity will slowly increase up to 313 beds.
When asked if those additional beds will relieve the pressure on the state’s mental health system, McCrory said the need was “unlimited.”
“We’re not even close to what we need,” he added.
“It will continue to be endless if we don’t provide community-based services,” said Corye Dunn, who directs policy at Disability Rights North Carolina, in response. The organization has been critical of the state’s choice to put money into building psychiatric hospitals while short-changing community-based treatment.
“While we recognize that at the moment there are people seeking care who need hospital levels of care and have difficulty accessing it, the most important part of the solution is to make lower-levels of care accessible and more widely available, so that fewer people end up in crisis,” she said.
Dunn said that unless the state invests in community-based care and follow-up services, as other states have done, psychiatric hospital beds will quickly fill up and stay full, because there’s no place for discharged patients to go, and few supports for them.
“Those supports include clinical services, but also affordable, accessible housing,” she said. “We could continue to build hospital beds for a very long time and still not solve our mental health problems.”
Health and Human Services Secretary Rick Brajer agreed there’s need for more capacity in the community.
“We need more capacity both at the safety net level, as well as in the community as well as resources in between,” he said. “We’ve developed recommendations about increased community resources in case management, in emergency housing, in additional capacity for medication-assisted treatment, in planning services as well.”
Brajer stressed there’s a need for increased funding from the General Assembly. But many of the legislators invited to Tuesday’s ceremony failed to show up.