Happy Election Day Intrepid Voters. I'm really really hopeful that this year we will have more votes cast than American Idol, and not in a fraudulent, I'm-going-to-send-in-50-text messages kind of way.

Today I went to clinical at Dorothea Dix Hospital as I have been every Tuesday and Wednesday for the past three weeks. You can see the building where I work in the picture on the left. Dorothea Dix is the state's oldest mental hospital, and there is a creepy graveyard on the campus that has graves dating back to 1859 when the hospital was first opened. The campus is huge and ancient with wooded hills and open grassy fields. Check out the picture below- its the view of downtown Raleigh from the Dix campus.

My group works on the men's short term unit. Diagnoses of schizophrenia with psychosis, bipolar disorder, and borderline personality disorder are most common. Most of our patients experience severely disorganized thinking, auditory and visual hallucinations, and some experience homicidal or suicidal ideations. Most of the guys are very nice. Today for example, I was serenaded by a very psychotic and hyperreligious but very sweet patient in the hallway. One of the scariest parts of working at Dix is the high number of well-educated previously high-functioning patients we see. There are patients my age or younger who are college educated and just completely lost it one day.

This was a special day however, and my cute little clinical group got to go on a field trip across the parking lot to the Forensic Unit. Dix is the only hospital in the state of NC that does pre-trial assessments to determine competency for trial, and its also the only hospital in the state that can treat and house patients who are not guilty by reason of insanity (NGRI). It is basically a prison for the mentally ill, and yes they do have big metal bars everywhere and huge old school keys to open the gates.

Okay, now for the climax of my tale: a man was brought in to the short term unit 25 years ago with paranoid schizophrenia, and on the night of his admission, he murdered his roommate. He was found NGRI and sent to the forensic unit. Years later (in fact less than 10 years ago), after assaulting several staff members, it was decided that he was unmanageable and that he needed to be isolated. So they built him a cage. Yes a cage- in the middle of what used to be a rec room, Hannibal Lector style, except he got his own sink, toilet, shower and tv. Not a bad deal I guess if you have to live in an actual cage. Two years ago, they hired a new nurse manager for the unit, who apparently thought that keeping the man in a cage was actually WRONG and thus let him out to live in a normal cell, and play scrabble and put together jigsaw puzzles with all the other patients. Sadly, I never got to talk to him about the years he spent there.

These are the days that really make me love being a nursing student.

As some of you may know, the original plan was to close Dorothea Dix Hospital this fall, and move all the patients to the new Central Regional Hospital in Butner (about 1 1/2 hours away in the middle of nowhere near the Virginia line). They are definitely going to move the 80 patients on the forensic unit to Butner, if they can ever attain security regulation compliance, and leave only 60 patient beds at the Dix campus. The floors not used by the mentally ill are apparently going to house state offices.
Both patients and mental health workers have protested the move, saying the unaddressed safety concerns, design flaws, and serious staffing shortages are going to make the move a catastrophe. Health care technicians who provide the most direct patient care are crucial to patient and staff safety. They get paid $11/hour starting. These guys basically get to choose between finding another job and spending half their paycheck on a 1 1/2 hour commute to and from work everyday.

In North Carolina, mental health is plummeting as quickly as the stock market.