Two high-profile murders in the last six months prompted lawmakers in North Carolina to consider overhauling the way the state treats mentally ill people, including those not accused of crimes.
Iryna Zarutska, a Ukrainian refugee, was killed on a light rail train in Charlotte last year; and Zoe Welsh, a Raleigh school teacher, was killed in a home invasion in January.
According to multiple reports, the men charged with murder in each case had histories of mental illness.
The House Select Committee on Involuntary Commitment and Public Safety started meeting in November, following Zarutska’s death.
So far, the committee has focused on two questions: when should the state force someone into treatment, and how should their criminal record inform that decision?
What is involuntary commitment?
In North Carolina, a judge can require someone with a serious mental illness to receive treatment under certain conditions, even if they don’t want it. The involuntary commitment process differs, depending on whether the case starts in civil or criminal court and whether the person meets the legal standard for being a danger to themselves or others.
Involuntary commitment in North Carolina does not require a criminal charge or conviction. The process can be initiated by anyone who believes an individual is a danger to themselves or others, though the state Department of Health and Human Services warns it should be used as a last resort.
The concerned person completes an affidavit and brings it before a judge to make a determination.
Outpatient vs. Inpatient Commitment
If a judge determines an individual poses a threat, the judge can order that person to follow an outpatient treatment plan while living at home or in supportive housing instead of a psychiatric hospital.
The judge can require the patient to attend appointments, take prescribed medication and work with case managers. If the patient refuses, law enforcement officers can take them into custody and have psychiatrists reevaluate their treatment plan.
That process plays out in civil court. A patient who gets an involuntary outpatient commitment order may not meet the standard for inpatient hospitalization, but needs treatment to prevent a deterioration in their condition that “would predictably result in dangerousness,” according to state law.
If a person is an immediate danger to themselves or others, a judge can order them to be admitted to an inpatient psychiatric hospital. This also does not require a criminal charge under North Carolina law.
Criminal competency
When facing a criminal charge, a defendant or their attorney can ask for a judicial review of their competency - or their mental capacity - to understand the court proceedings and assist in their own defense. Prosecutors and judges also can move for a hearing specifically to gauge if a defendant holds the mental capacity to proceed in court.
After that hearing, a judge can pause the case and send defendants to a state psychiatric hospital if they pose a threat to themselves or others.
Does involuntary commitment work?
In this year’s committee meetings, lawmakers have focused on outpatient commitment and whether it could be an early intervention for people who would otherwise become dangerous to themselves or others.
In the weeks following Zoe Welsh’s death, Duke Health psychiatrist Dr. Marvin Swartz told state lawmakers that people who remained under outpatient commitment for at least 180 days were less likely to be committed to a psychiatric hospital and less likely to engage in minor violent behavior.
But he cautioned against assuming it can prevent extreme acts of violence.
“It really should be considered on the merits of improving treatment compliance and reducing relapse, but not as a violence prevention technique per se,” Swartz told lawmakers in January.
Meanwhile, defendants who are subject to involuntary commitment orders in criminal court are often hospitalized briefly, then released only to return to court days later, according to Lisa Coltrain, a prosecutor with the NC Conference of District Attorneys.
Coltrain described the system as a “very quick revolving jailhouse door” during a February committee meeting.
Over 10 years, involuntary commitment orders in North Carolina doubled from more than 53,000 in 2011 to more than 106,000 in 2021, according to an analysis from NC Health News.
Some advocacy groups, including Disability Rights NC, have said those numbers suggest judges issue too many involuntary commitment orders.
The House Select Committee on Involuntary Commitment and Public Safety meets again on March 18. Legislative committee meetings are always open to the public.
State lawmakers have not proposed any legislation yet but say they want to determine whether Iryna Zarutska and Zoe Welsh’s deaths exposed a gap in state law or a failure to use existing laws effectively.
Consider the questions lawmakers face:
-Should North Carolina judges use involuntary commitment more often?
-Should the state raise or lower its threshold for confinement under involuntary commitment?
-Does North Carolina have the capacity to treat more patients if the policy expands?
-Can involuntary commitment strengthen public safety without encroaching on civil liberties?
Have thoughts about what should be done?
This article first appeared on NCLocal and is republished here under a Creative Commons Attribution-NonCommercial 4.0 International License.