By Taylor Knopf
A bill to expand the use of involuntary psychiatric treatment in North Carolina, and further study the intersection of the state’s mental health and the justice systems, is well on its way to becoming law. While many praised the legislature’s attention to these issues, some lawmakers and experts question whether the bill does enough to address systemic problems that have accumulated and festered for decades.
House Bill 1104 adjusts some aspects of Iryna’s Law, legislation passed quickly in late 2025 in response to the fatal stabbing of Iryna Zarutska on a Charlotte light rail train last summer. The man charged with her killing has a history of mental illness and incarceration, and he has been found to be incompetent to stand trial.
All this prompted lawmakers to take a deeper look at what could be done to prevent such tragedies and get people with severe mental health issues the help they need.
The bill is a culmination of several recommendations by a special House committee, which met for six months to examine the state’s involuntary commitment process in response to multiple concerns after Iryna’s Law passed.
One of the biggest sticking points was a provision that required law enforcement officers to take someone for a psychiatric evaluation at a hospital emergency room if they believe the person is mentally ill and dangerous to themselves, or if they were arrested for a violent offense and had been involuntarily committed in the past three years. Hospital leaders said bringing these patients to the hospital would be unsafe for their staff and other patients.
Lawmakers agreed. The new bill directs the mental health evaluations of these arrested individuals to be done in jails instead, using telehealth.
Beyond adjustments to Iryna’s Law, the bill aims to tackle some of the other issues that arose during the committee meetings, such as staffing shortages and lack of available beds at the state’s psychiatric facilities and the rising number of people arrested who are mentally unfit to proceed with their trial.
“Most people with mental illness do not commit crimes and do not commit violent crimes. Many people who commit violent crimes don’t have mental illness, but we know that there’s some overlap,” bill sponsor Rep. Tim Reeder (R-Ayden) told the Senate Judiciary committee last week. “What we’re trying to do in Iryna’s Law, and then subsequent to that, is to look at the intersection of those populations.”
Reeder, an emergency room physician and co-chair of the special committee on involuntary commitment and public safety, helped shepherd the bill through the chambers of the General Assembly. It’s currently at its last stop — the Senate floor — before heading to the governor’s desk to become law.
“There was tension of how much of the mental health system are we trying to fix, and we’ve taken 20 years to get to the broken system that we have,” he said. “So our committee was really focused on this subset of the population.”
While there are a few concrete statutory changes, the bill largely consists of studies, plans and pilot proposals — and no additional funding. Reeder said there could be some money in the overall state budget for a few provisions, which legislative leaders say will be released this week.
People who have worked in the mental health system for decades say it will take more than studies to bring about real improvements.
Seeking more information
During the Senate Judiciary committee on June 23, Sen. Mujtaba Mohammed, (D-Charlotte) thanked House lawmakers who worked on these issues but said he’d like to see more concrete action right now, such as intensive case management for people chronically moving in and out of jails and hospitals.
“My concern always with studies is that sometimes we study, and we’re not gonna actually fix it,” Mohammed said.
Reeder told NC Health News that while lawmakers gained a better understanding of some of the issues during the months of committee meetings, there are still many unknowns and more information is needed.
“So we were criticized for having a lot of studies in the bill,” Reeder said. “We want to understand how and what we’re funding and how and what is needed before we just start putting money toward something that we’re not exactly sure what’s needed.”
The bill directs the NC Collaboratory, a multi-disciplinary research group funded by the General Assembly and based at UNC Chapel Hill, to conduct several studies on involuntary inpatient and outpatient commitments and make recommendations for improvements. The group will be tasked with examining the delivery of behavioral health care in county jails. The bill directs the group to look into the feasibility of transferring operation of the state’s three psychiatric hospitals — Broughton, Central Regional and Cherry — to another entity.
The bill also directs the North Carolina Sheriffs’ Association to create a pilot program to conduct the first examination in the involuntary commitment process under Iryna’s Law in jails by telehealth rather than taking people to hospital emergency departments. It directs the N.C. Department of Health and Human Services and the state’s three mental health management organizations to develop a plan to use mobile crisis units for those first examinations for involuntary commitment.
The bill creates a new inpatient capacity restoration program for criminal defendants found mentally incapable of participating in their own trial. Currently, there are a few options for this type of restoration treatment in county jails, but to be admitted to an inpatient facility, someone must meet criteria for involuntary commitment — that they are a danger to self or others. This bill would widen that to allow someone incapable of proceeding to trial — who doesn’t meet those commitment criteria but could still benefit from inpatient care — to be admitted to a facility.
Under the bill, DHHS and the Administrative Office of the Courts will create a work group to study the factors contributing to the “revolving door” pattern, where people cycle through jail cells and psychiatric facilities only to be released back into the community without support. It also directs DHHS to develop a plan to address the staffing and bed shortages at the state-operated hospitals, which are the only inpatient settings equipped to treat people with criminal charges.
Earlier this month, Carrie Brown, DHHS’ chief psychiatrist and medical director for the state-operated health care facilities, gave the Senate Health committee a glimpse of the work that the department has already started. The department has begun recruiting people to these positions to open more beds in the state psychiatric hospitals for justice-involved patients.
She said the DHHS is using reappropriated American Rescue Plan Act funds to recruit people at all three hospitals with aggressive sign-on bonuses — $35,000 for nurses who commit to 18 months and $15,000 for technicians. She said the goal is to hire roughly 17 nurses and 43 technicians per hospital to open at least one new justice-focused unit at each facility by Dec. 1, with contract staff as a backup if the full-time hiring falls short.
Reviving outpatient commitment
One area the bill does take action on is outpatient commitment — a legal tool in which a judge orders someone with mental illness to comply with treatment in the community rather than being hospitalized.
Lawmakers showed great interest in outpatient commitments earlier this year, and the bill makes several changes aimed at making that process more functional. Under this bill, the commitment orders would be extended from 90 to 180 days, which researchers say is long enough to lead to sustained behavior change. The state-funded mental health management organizations would be required to keep a list of everyone under an outpatient commitment order and report any noncompliance to the court. Providers would be required to develop specific treatment plans that would be incorporated into patients’ court orders. Noncompliance with an outpatient commitment order would trigger an evaluation for involuntary commitment and possible admission to a psychiatric facility.
Though North Carolina has had outpatient commitment laws on the books for decades, there is no current data on how often it’s used. Psychiatrist and Duke University researcher Marvin Swartz said the use of outpatient commitments has declined through the years as the mental health infrastructure that supported them deteriorated when the state shifted to a privatized mental health system in the early 2000s.
In 2001, Swartz published one of the most cited studies on outpatient commitments and found that these patients — when paired with intensive mental health services — were about a third less likely to be rehospitalized, had shorter hospital stays and showed less aggressive behaviors. To revive outpatient commitments in this state will take a lot more than the legislative changes in this bill, Swartz told NC Health News.
“DHHS does not have the firepower to operate the kind of outpatient commitment system that the legislature would envision,” he said. “They just don’t have enough people.”
New York has one of the most effective involuntary outpatient commitment systems in the country, Swartz explained. That state allocates millions of dollars annually to oversee the program and the individual orders and to track patient progress.
“It’s a very robust data system and oversight system in New York, and I think it would take something like that to get North Carolina to use it again,” Swartz said.
Swartz, who presented to the legislative work committee on outpatient commitment, said what he’s noticed through the discussions on Iryna’s Law is that multiple state departments are being asked to do more without additional funding. Questions regarding funding also came up on the House floor as the bill passed through the chamber.
“I think one of the more general problems is that for the last good period of time we’ve starved all these agencies that we need to have an adequately operational public safety and mental health system,” Swartz said.
Reeder pointed out that the legislature allocated more than $800 million in the mental health system last budget cycle and that money continues to be invested and evaluated.
“I’m very much interested in ensuring that the money that the General Assembly allocates for programs is achieving the outcomes that we expect,” he said. “We want to make sure that what we’re doing is meaningful and that the measures we have aren’t just ‘How much money did we spend?’”
One metric Reeder suggested was seeing whether people received treatment that they otherwise would not have received.
“Do we have a decrease in our recidivism rate?” he posited as another measure. “Do we have people who are healthier and have their disease treated when they are out of the criminal justice system?”
Controversy over court-ordered treatment
Not everyone believes that expanding forced, court-ordered treatment is the right or ethical approach — even with sufficient funding and infrastructure behind it.
Mental health researcher Nev Jones recently analyzed three randomized controlled trials of outpatient commitment — including Swartz’s 2001 North Carolina study — and found no evidence that a court order, separate from the intensive services that accompany it, produces better results than voluntary treatment. Jones argued that intensive outpatient services such as Assertive Community Treatment and supportive housing work just as effectively without legal coercion.
The RAND Institute, analyzing the Duke study’s commitment data for the California legislature near the time of publication, also concluded that there is not enough evidence that court-ordered treatment leads to better outcomes than voluntary treatment.
Laurie Coker, founder of GreenTree Peer Center in Winston-Salem and longtime mental health advocate, said the state has never invested in the kinds of recovery-oriented services that actually help people, and that coercion pushes people away from care rather than toward it.
“If the system were more approachable and engageable and respectful, we would have far fewer people choosing not to get help,” she said.
“If someone is committed and mandated to get a rich array of services, that’s no different than if they had been able to get those same services in a well-staffed and well-funded system — so why add that negative piece to it all?”
Swartz said the critique about coerced treatment is fair, but pushed back. He argued that the court order itself does something beyond the intensive services alone and requires adherence to treatment.
“The court order sends a message that the judge is paying attention to this,” he said. “The courts are sending a message not only to the individual but also to the providers that this is a priority patient.”
For Coker, the bill’s reliance on studies and court orders reflects a system focused on expenditures not outcomes for patients.
“They’re not really thinking in terms of results in people’s lives,” she said. “They’re thinking in terms of numbers and what can be paid for.”
What North Carolina has is not really a mental health system at all, Coker said.
“We have a very holey safety net.”
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