Advocates for the homeless say that President Donald Trump's executive order making it easier for governments to remove homeless individuals from the streets and force them into hospitals could lead to mistreatment and mass institutionalization. (Photo by Clayton Henkel/NC Newsline)
President Donald Trump’s executive order making it easier for states and cities to remove homeless individuals from the streets and force them into mental health care or drug addiction treatment could wreak havoc on North Carolina’s already chaotic system of involuntary commitment, according to mental health experts and those who advocate for unhoused individuals.
The executive order could push thousands of unhoused individuals into a process that they contend is already “overused, misused, and harmful” and results in “tens of thousands of children and adults languishing in overwhelmed emergency departments for days or weeks on end, without court-appointed lawyers or adequate mental health treatment,” according to Disability Rights NC, a legal advocacy agency.
Corye Dunn (Photo: Disability Rights NC)“It (involuntary commitment) is one lever that we have in our system, but it’s one that should be used incredibly judiciously, it should be rare, it should be closely monitored and it’s not any of those things right now,” said Corye Dunn, director of public policy at Disability Rights NC.
In North Carolina, involuntary commitment is a legal process used when someone is believed to be a danger to themselves or others due to a mental illness or substance use disorder. The process can be initiated by anyone with firsthand knowledge of the individual’s condition by filing a petition with a magistrate. If the magistrate finds probable cause, a custody order is issued, and the individual is taken to a facility for examination by a commitment examiner.
Mark Botts (Photo: UNC School of Government)Mark Botts, an associate professor of law and government in the UNC School of Government and an expert in involuntary commitment law and procedure, worked with Disability Rights NC on a recent report documenting the misuse of involuntary commitments in North Carolina. Botts said Trump’s executive order seeks to broaden the legal criteria for involuntary commitment to include those who, due to a mental illness, are unable to provide a home for themselves.
“Currently in North Carolina, one’s lack of self-care ability due to mental illness meets the standard for commitment only if it creates a probability of serious physical harm in the near future,” Botts said in an email. “While this current standard may capture a subset of those who are mentally ill and homeless, the EO [executive order] seems to seek commitment for most or all homeless people who have a mental illness.”
Broadening the definition of “danger to oneself” would require legislative action, Botts said. It would also increase the number of people subject to commitment, he said, which the state is not prepared to handle.
“North Carolina already has insufficient psychiatric hospital capacity to handle the number of citizens who meet the existing commitment standard,” Botts said. “And, unless we institutionalize people for the rest of their lives, at some point they would need to be released back to the same conditions that led to their commitment unless additional public resources are targeted to housing and community mental health services.”
North Carolina operates three physciatric hospitals and relies on a network of private hospitals to provide mental health services. The N.C. Department of Health and Human Services oversees the state-operated facilities in Morganton, Butner and Goldsboro.
While hospitals have available beds, Dunn said, they do not have the staffing to expand bed availability.
The state Department of Health and Human Services responded to the executive order with a pledge to continue to help people who are unhoused and have mental health and substance abuse issues while it awaits more guidance from the Substance Abuse and Mental Health Services Administration and the U.S. Department of Housing and Urban Development.
“The Executive Order suggests people who are unhoused and have mental health or substance use needs should be committed and in custody,” the state Department of Health and Human Services said in a statement. “This does not honor personal choice or recovery, could make things worse, and ultimately pushes people away from seeking care or support.”
Trump’s executive order, “Ending Crime and Disorder on America’s Streets,” shocked organizations and communities that advocate for people experiencing homelessness. They fear it could lead to mistreatment and mass institutionalization of people with mental illness and drug addictions and criminalize people experiencing homelessness. Advocates also worry that local governments and states that do not abide by the order, which was handed down with funding, could lose federal dollars.
Trump executive order raises fear among advocates for people experiencing homlessness
Jesse Rabinowitz, campaign and communications director for the National Homelessness Law Center, said Trump’s order, like his budget cuts and policy reversals, will make homelessness worse and keep people homeless longer.”
“This order does not fund any housing,” Rabinowitz said during a recent press conference. “It does not address the leading cause of homelessness, rents that are too high, and it does not fund any new supports or services.”
Rabinowitz said the order also violates due process and civil liberties.
“It expands the use of police and institutionalization to respond to homelessness and prioritizes funding for states that treat homelessness as a crime,” Rabinowitz said.
And Mary Frances Kenion, chief equity officer for the National Alliance to End Homelessness, pointed out that the impact of Trump’s order will not be felt equally. People who have traditionally had less economic, social or political power will suffer the most, Kenion said.
Overuse, misuse and harm in NC
In a report released in May, Disability Rights NC found an “overwhelmed mental health system where people of all ages, with serious behavioral health needs, languish in EDs [emergency departments] without court-appointed legal counsel or adequate mental health treatment.” The organization said involuntary commitments have become an “easy button” for crisis responses for unhoused people and those struggling with drug addictions.
Here are the key findings in the Disability Rights NC report, which found that North Carolina’s involuntary commitment process is marked by systemic overuse, misuse, and harm:
Lack of due process: People are detained in emergency departments under civil custody orders without appointed legal representation or timely judicial oversight. They remain in legal limbo, often for days, weeks, or months, awaiting psychiatric placement. Traumatic detention: Individuals — including some young children — are strip searched, physically restrained, forced to take medication, handcuffed and shackled in transport, and spend long periods in emergency departments, some noisy, harshly lit, and chaotic, with little to no treatment. Harm to families and communities: The involuntary commitment process often excludes parents and guardians from decisions, disrupts lives, causes job loss and financial hardship, and uses law enforcement and hospital resources unnecessarily. The experience make some people reluctant to seek out psychiatric care when needed. Systemic failures: The process lacks adequate data tracking and evaluation. From the data that does exist, it’s known that at least 63% of involuntary commitment petitions over the last six years have not resulted in actual commitments, highlighting widespread inappropriate use. This affects tens of thousands of people in North Carolina each year. Misuse: Involuntary commitment is sometimes used by nursing homes and assisted living facilities to expel residents, by family and friends as a form of control, and by providers as a means of shifting care responsibilities — rather than addressing mental health needs compassionately and effectively.Ensuring legal representation at the time of a custody order is among Disability Rights NC’s recommendations for improving the system. After an involuntary commitment petition has been filed, a person can be detained for 10 days before going before a judge. Health care providers can also reissue petitions every 10 days.
“We’ve had clients in an emergency department for weeks and weeks, but they aren’t eligible for representation by an attorney, and a hearing before a judge until 10 days after the last petition,” Dunn said. “So, you could spend literally weeks in an emergency department, get transferred to a 24 hour facility, which is the receiving facility for IVCs.
“The way to get people the help they need and want without those collateral consequences, is to intervene upstream and create robust community based prevention and treatment services and involve people with lived experience in designing the solution,” Dunn said.
Dunn said peer support and peer services work to reduce unnecessary involuntary commitments. She noted that programs such as Durham’s Holistic Empathetic Assistance Response Team, a public safety unit that’s staffed with mental health clinicians, peer support specialists and EMTs, also work.
“It works by engaging people where they are without handcuffing them, shackling them, putting them in the back of a police car, and having them sit in an emergency department for hours or days, or weeks,” Dunn said, referring to the Durham initiative.
Another mark against wholesale involuntary commitments, Dunn said, is that rounding up people experiencing homelessness and forcing them into treatment for mental illness or substance abuse often does more harm than good.
“It’s not just that it doesn’t help, it hurts,” Dunn said. “There has to be a real risk to the life health safety of a person before before this would ever make sense as a systemic intervention.”
Improving the system, Dunn said, would require creating additional community-based services. Otherwise, she said, people never get to leave treatment facilities or they are set up to fail when they do.
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