NC Reps. Hugh Blackwell and Timothy Reeder are chairing a House committee seeking to improve the process that forces people into mental health treatment. (Photo: screenshot)
A criminal justice law the state legislature passed this year is likely to funnel more people into forced mental health treatment using a system that hospitals and former law enforcement officers say doesn’t work.
That was the takeaway from the first meeting of the new state House Select Committee on Involuntary Commitment and Public Safety. Its task is to recommend changes to strengthen the state’s mental health system and involuntary commitment processes.
The committee was formed after the legislature passed Iryna’s Law in September in response to the fatal stabbing of Iryna Zarutska, a Ukrainian refugee, in Charlotte. A man with a history of severe mental illness is charged with her death.
Iryna’s Law includes new procedures for magistrates that will likely result in more people suspected of having a mental illness being ordered by the court to be evaluated for mental health treatment.
At its meeting Thursday, the panel heard from experts who explained that the mental health system is already overwhelmed, leaving some people stuck for weeks in hospital emergency departments with no mental health treatment and no access to a lawyer.
Judicial officers, usually magistrates, order defendants to receive examinations for involuntary commitment, Mark Botts of the UNC School of Government explained. A law enforcement officer then transports the defendant to a hospital emergency department or crisis facility with commitment examiners.
If the examiner determines involuntary commitment is appropriate, the search is on for an empty bed in a psychiatric hospital. The defendant is evaluated for a second time at the psychiatric hospital, and a Superior Court hearing is scheduled.
“It can take time to locate an inpatient psychiatric facility with the specialized treatment needed for that person’s condition,” said Johana Troccolli, system vice president for behavioral health at Duke University Health System.
“The shortage of psychiatric beds, especially in specialty units, create bottlenecks that leave patients boarding in the EDs for days, weeks, and sometimes months,” she said.
The involuntary commitment petition expires in seven days if no hospital bed is found or if commitment is no longer appropriate. But magistrates can renew petitions repeatedly, leaving defendants stranded in general hospitals’ emergency departments without second evaluations or lawyers.
There’s no good data on involuntary commitment, Botts told the committee, so it’s unclear how many people are ordered into treatment and how many must wait in emergency departments for psychiatric hospital beds.
Emergency departments are not equipped to hold people who are violent or may have committed crimes, Troccoli said. Keeping people with mental illnesses in emergency departments is not safe for providers or patients, she said.
House members who are former law enforcement officers also said transporting people from hospital to hospital takes considerable time away from other duties.
Rep. Reese Pyrtle (R-Rockingham), a former Eden police chief, said he had his department track the increased time officers spent in emergency departments over a dozen years or more. The department saw some of the same people repeatedly committed to treatment, he said.
When people were released from the hospital, there was no way to make sure they were connected to a mental health mobile crisis unit, Pyrtle said.
“Law enforcement and hospitals can’t say ‘no,’” Pyrtle said. “It’s disheartening because it means the consumer who needs the services is not getting them.”
Rep. Timothy Reeder (R-Pitt), a committee co-chairman and a medical doctor, said he wants a better system for evaluating patients and getting them treatment if they need it.
“I hope we’re going to come up with a way to improve the system and not just put Band-Aids on the existing system, because what I think you’ve heard today is that the system is not functioning in a way that is efficient and effective,” Reeder said.
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