By Taylor Knopf
Since November, North Carolina lawmakers have been grappling with the problems plaguing the state’s intertwined mental health and criminal justice systems during hours-long monthly meetings packed with presentations from experts and state officials.
Their goal? To address the revolving door of people with mental illness who cycle in and out of emergency departments, jail cells and psychiatric hospitals. It’s not an easy fix.
During these monthly meetings, the House Select Committee on Involuntary Commitment and Public Safety has heard from jail and prison officials who say their facilities are overburdened and over budget housing incarcerated people with intense health needs, including mental illness. Health officials said state-run psychiatric hospitals are filled with an increasing number of patients who have been arrested for crimes and aren’t mentally well enough to participate in their own legal cases.
With few vacancies at the state psychiatric facilities, mental health patients going to emergency departments in crisis can wait for days or even weeks for an appropriate inpatient bed. Many more are being treated at private psychiatric facilities, some of which arguably provide a lower quality of care than the state hospitals.
As lawmakers prepare to release a report with their findings and recommendations, they are also asking the public for their input. The committee opened a public comment portal on the General Assembly’s website that will close April 1.
There won’t be a quick fix
There’s been a widespread recognition of the state’s mental health care gaps lately.
Gov. Josh Stein praised the committee’s attention to these issues when he signed an executive order on Feb. 5 directing state agencies to tackle issues with North Carolina’s behavioral health and criminal justice crisis on several fronts. The order acknowledged many of the stark realities that have emerged within the House committee hearings. Stein’s order largely convenes working groups and orders analysis rather than mandating policy changes — most of which would require action from the General Assembly.
“This executive order is not intended to remedy all of our challenges, but we have real problems staring us in the face, and the people of North Carolina deserve us to make progress,” Stein said during a news conference. “Everyone wants to live in a safe place. Families are looking for answers when their loved ones are in crisis.”
In addition to mental health treatment, Stein argued that the state must do more to support people with their housing and food needs, as well as their access to health care by protecting Medicaid.
The House Committee on Involuntary Commitment and Public Safety will meet one more time on March 18 and release a report with its findings and recommendations in April. Committee co-chair Rep. Tim Reeder (R-Ayden), who is an emergency physician at ECU Health when he’s not in Raleigh, said he expects there will be some kind of legislation during the upcoming session to tweak Iryna’s Law. That’s a bill the General Assembly hastily passed last year that will likely funnel more criminally charged defendants into the mental health system.
Reeder said he hopes other proposals that come from this committee will be worked on during the regularly scheduled committees on health and public safety. While the committee only consists of House lawmakers, Reeder said his colleagues in the Senate are aware of its work, and he’s hopeful they will come together to get some of the House committee’s recommendations passed.
“It is a huge, complicated system that has taken 20 years to evolve into what it is, and we’re not going to fix it in six months of meeting five times,” Reeder told NC Health News. “I think what we’re trying to do is create some actionable recommendations so that we can get some forward progress on fixing some things.”
Changes to Iryna’s law
The impetus for these committee discussions was a tragedy that took place in August in Charlotte where a young woman was stabbed to death on a commuter train. The surveillance video of the attack was shared widely — sparking confusion and outrage. The man charged in the crime has a criminal history and mental health issues, and he had cycled in and out of hospitals and the criminal justice system.
Local and federal politicians demanded that something be done to prevent this from happening again.
A month later, North Carolina lawmakers passed Iryna’s Law, named after the victim, Iryna Zarutska, which tightened pretrial release conditions. The law also changed the involuntary commitment process, including mandating that people arrested for crimes who also meet a set of mental health criteria undergo psychiatric evaluations at an emergency room.
The law was passed so quickly, and with little input, that House lawmakers said they will need to amend it. One sticking point has been where the mental health evaluations of people arrested on suspicion of a crime will take place. In November, hospital officials told the House committee that bringing criminally charged patients to emergency departments would put too much strain on hospital staff and pose a safety risk to other patients. Hospital officials want the evaluations to take place virtually while the individual is in jail.
In December, a representative for the North Carolina Sheriffs’ Association told lawmakers that jails aren’t the appropriate place for health evaluations. There are times when symptoms of physical health conditions appear as psychiatric symptoms, and jails don’t have the medical resources to handle that, the sheriffs argued. Lawmakers will need to address this conundrum.
The committee was also also asked to examine the circumstances around another killing that happened just months after the fatal stabbing in Charlotte. In January, a Raleigh teacher was attacked in her home by an intruder and later died in the hospital from her injuries. The man arrested also has a criminal background and history of mental illness.
Outside of recommendations to tweak Iryna’s Law, House lawmakers acknowledge that more needs to be done.
“One of the things that we as a committee are struggling with is the scope […] there’s some tension there, because we’re looking at the implications of Iryna’s Law, but there’s also a real desire to think about how we might use this to improve the system overall,” Reeder said.
“We’re looking for different tools to help people post incarceration and/or to prevent this sort of cycle,” he said. “Because we have these people who sort of cycle in and out very quickly with low level or nonviolent crimes, and I think that there is a recognition that they need some help. They would benefit from somebody watching over them.”
During these committee discussions, themes have emerged and lawmakers seem to have taken an interest in certain mental health interventions — particularly forced outpatient treatment. More on that in our story for Monday.
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Dear NC Health News,
As soon as I finished reading your article on broken mental health system in NC, a quick google search for the best mental health systems in the world pointed to the Netherlands, Norway, Sweden and in the US -Ohio’s “correctional system has dedicated mental health units that separate mentally ill inmates from the general population, treating them with tailored care” .
I hope the link below works. It is something to begin looking into, but the bottom line is- that a dedicated financial investment from federal, state, and public taxation needs to be in place to provide a robust medical and public safety workforce as well as carefully designed facilities.
Hello D Lewis,
We don’t allow links in our comments (for a bunch of reasons), but your comment is of interest to us. We’ve practiced something called “Solutions Journalism” which focuses on the solutions to problems rather than just the problems themselves. We’ve been looking for an opportunity to visit a place where they’re doing these mental health services better (and we have several ideas, Finland jumps to mind). Thanks for the suggestion. Ohio might be an easier place for us to look at!!
We need to open more mental hospitals and train staff to work with patients and monitor progress and outcomes!
A couple of decades ago, NC privatized the mental health system doing away with government-supported mental health centers. The government-supported system allowed for RNs to provide mental health care including supportive counseling. Nurses also provided teaching about prescribed medication, performed AIMS (abnormal involuntary movement scale) testing for potential side-effects from neuroleptic medications, blood draws, and more. When the system was privatized, nurses were left out of the plan and relegated to positions in inpatient facilities only. Now, supportive counseling is done by social workers who have little to no knowledge about medications, their side-effects, and other potential physical issues which may be the root of psychiatric symptoms or exacerbation of symptoms. The absence of nurses for outpatient care only adds expense and lessens the skilled and compassionate care for the mentally ill that nurses provide. Nurses need to be reintegrated into the current system; there is no doubt that this will be a step forward in improving the ineffective care the mentally ill are now receiving.
What we saw with the two horrific murders were the worst consequences of untreated psychosis. Through privatization of county-run mental health centers, shrinking of state hospitals, cuts in state funding and shift to managed care, it’s been almost impossible for persons with the most serious mental health needs to access community-based care. We’ve also seen a shredding of the social safety net — housing assistance is essentially gone. For the years before the Medicaid expansion in 2023, the route to Medicaid was through SSI. But with the mandated changes in the mental health system, there were no case managers to help people go through the disability application process. What we are seeing are the consequences of the dismantling of a community mental health system. Maybe some day we will return to a compassionate system focused on prevention and using public health strategies. It’s hard to fathom that we had that and took it apart.
I have a 20 year old son who has a severe mental illness and has struggled with it since he was 16 years old. At no fault of his own, he currently resides in solitary confinement at the local jail while waiting on a bed in a psychiatric hospital. He has already been locked away for almost 1.5 years, so it was devastating when we were told in January that the wait for a bed could take 8-12 months longer. It took almost a year for a 15-minute virtual evaluation, which is not sufficient to monitor and interview those with a severe mental illness. It took 2 separate private evaluations to finally have him deemed incapable of proceeding. Without the private evaluations, he could have slipped through the cracks, much like Decarlos Brown Jr. My son would have slipped through the cracks if he didn’t have many individuals advocating and fighting for him. The fact that it has taken all of this to even get on the list for a bed in a state psychiatric hospital is unfathomable. We need programs and facilities in place so that those with severe mental illness can get the help they deserve before it escalates to criminal charges and/or dangerous behavior. Psychiatric hospitals weren’t meant for criminals, but for those who are sick and in need of treatment so why does it take drastic criminal offenses to get into one? My son had been involuntarily committed 3 times, and we were on our 3rd mental health provider at the time of his arrest. We looked into many other resources to find help for him but lost hope as most facilities won’t take individuals who are experiencing psychosis and the other options aren’t affordable. Where’s the help for these individuals and their families? Can you imagine being taken from your home and placed in a tiny cell by yourself and only allowed to come out for 1 hour, 3 days a week for months or years with little to no treatment? Solitary confinement exacerbates existing mental illness. It causes rapid deterioration, severe cognitive decline, irreversible trauma, and an increased risk of self-harm/suicide. Not to mention the permanent brain damage being caused by lack of treatment. These individuals did not ask for their illness. They deserve to be treated and not locked away like “deranged animals” because they are not. I can assure you that many of these individuals had fairly normal, happy, and healthy lives prior to becoming ill, my son included. It is imperative that we all value the lives of those with mental illness and seek to serve in their best interest. As I send many prayers and wish you luck in fixing the broken system, may I remind you to see the person first and the mental illness last.