Behind the Children’s Psychiatric Institute in Butner

Thank you for your article that detailed some of the physical plant problems at the Children’s Psychiatric Institute in Butner. I worked at CPI from 1990 until 2001 and was CPI’s acting clinical director for nearly two years. Most of the problems that your article mentioned are not new. However, there are much more significant problems that also need attention.

A bit of background: Over the past two decades health insurance companies have pulled the plug on almost every private inpatient psychiatric facility in North Carolina. This has led to a tremendous increase in admissions to state psychiatric facilities. With demand for state-funded beds on the rise and the number of such beds decreasing (due to recent misguided efforts at mental health reform), the state psychiatric hospitals now can do little more than offer a revolving door — patients are admitted, “stabilized” and discharged without any changes in the environments that played a part in the problems for which they were admitted.

In the not-so-distant past CPI was able to work with children and their families long enough to facilitate changes that increased the likelihood of a successful return to the community.

This kind of work was professionally and personally rewarding to CPI’s employees, many of whom spent decades helping troubled children and teens. Dr. Marc Amaya and his staff recruited people who were willing to work with very difficult people over the long haul.

Now most patients stay at CPI only as long as they are judged to be “acute.” As soon as they settle down a bit — in other words, as soon asthey are able to participate in meaningful psychosocial treatment — they are discharged. This is a problem at two levels.

First, patients cannot get any continuity in their treatment. They are shuffled from one program to another like so many widgets on an assembly line. This is the underlying fault in our recent reorganization of community mental health programs and it is a problem for patients in our state hospitals as well. In order to work with difficult and troubled people, you must take the time to form relationships with them. You can’t be shifting them from person A to person B every few days.

Second, the personal and professional rewards that staff once could expect when they spent many days and weeks working with difficult kids are no longer available. As soon as children show a bit of improvement, they are discharged to their home community — usually a community whose own local mental health program has been subcontracted to a collection of providers who change from day to day.

While your article pointed out some of the unpleasant aspects of CPI’s 65-year-old physical plant, it did not address the psychological and social issues that make life there — whether as a patient or as a staff member — increasingly difficult. If North Carolinians want to be able to take pride in our state psychiatric facilities (as we could in the 1980s and 1990s), we must attend to the psychological needs of the people who work there and who are served there. More new buildings are not the answer, however much they might be needed.

Paul Brinich
Chapel Hill

The writer is a clinical professor in the Departments of Psychology and Psychiatry at  the University of North Carolina at Chapel Hill Psychoanalytic Education Center of the Carolinas.