Top of Mind: Updates to North Carolina’s involuntary commitment policies slow to trickle down

WILMINGTON, N.C. (WECT) - Each year, hundreds of people are taken to New Hanover Regional Medical Center to be treated for their mental health issues by way of involuntary commitment.

Involuntary commitment is a legal intervention used to get people care when they are deemed to be a danger to themselves or others. Once the papers are filed in North Carolina, law enforcement typically finds the person then transports the patient to the hospital to be evaluated and placed in a psych bed at the proper facility.

National studies show the rate of involuntary commitment petitions have risen faster than the population has over the past decade. More people than ever before are struggling with mental health issues and the system of getting care to the community’s most vulnerable is stretched to the max with the increased demand and a lack of resources on each level.

Reports submitted to NC DHHS show from July to December of 2019, 552 individuals received inpatient treatment at NHRMC under involuntary commitment (IVC) petitions. Between January to June of 2020, 486 people were receiving inpatient treatment under IVC petitions.

Some of those patients have stories just like Laura Bobotas’ son.

“He’s in his late 20s now, and he’s been diagnosed with everything from a mood disorder all the way to schizophrenia,” said Wilmington NAMI volunteer Laura Bobotas.

She’s had to go through the involuntary commitment process several times to get her adult son inpatient care, and knows firsthand how painful it is to call the police on your own child.

“Especially when your son is violent — I know when I call the police, my son’s not gonna say ‘Hi, let’s go!’ He’s gonna fight and kick and scream if it’s escalated to the point that I need to call the police,” said Bobotas. “It’s incredibly painful. I haven’t done it in three years and I don’t think I’ll ever have to do it again because he’s well medicated. It’s just the emotional toll it takes on you, it doesn’t go away.”

Prior to 2019, state law mandated everyone involuntarily committed and transported to the hospital by law enforcement had to be handcuffed, whether the patient was a combative adult or a 10-year-old with suicidal thoughts.

However, NC Senate law 630 provided counties more flexibility in their crisis plans, including a provision allowing the transporting agency to decide whether or not they need to use restraints.

As a NAMI family support coordinator and a volunteer who trains law enforcement, Bobotas says she’s seen little change in how things are done.

”Seems like it’s just so ingrained in how we’ve done things, and you could say COVID slowed it down; but [in] my experience — I’ve been dealing with mental health issues for more than 20 years in our family — things change at a snails pace, even when the actual laws get on the books,” said Bobotas.

It’s not just state statutes. The sheriff says New Hanover County’s transport agreement no longer requires all patients be handcuffed.

”It’s my opinion there’s not an excuse for any of the deputies or officers that work for us to not know the law changed and not realize, you know, we need to do better,” said Sheriff Ed McMahon.

The handcuffing rule was made long ago to ensure officer safety. The sheriff says they’re trying to step away from the old way of doing things, and the way they’re doing that is a renewed emphasis on Crisis Intervention Training, known as CIT.

“They’re not a criminal. They’re a person that’s in mental health crisis and if we can help it, we don’t want to handcuff them; we don’t want to make it worse than it already is. This training allows them to understand it a little bit better.” said McMahon.

After a two year pandemic hiatus, Trillium began offering the CIT class again on Monday, and this week’s class included officers from five regional law enforcement agencies. The goal is to give officers a higher level of awareness to various mental health disorders and other avenues to provide help to someone in the middle of a crisis.

”Maybe we can stop it before commitment papers have even been taken out. When we arrive and make sure the scene is safe, we have other partners we can call. We have a mental health crisis team that can come, made up of professionals. But at that point, we can leave the individual with their family members and it doesn’t have to be an arrest or a commitment,” said McMahon.

Half of the New Hanover County Sheriff’s Office deputies and detention officers have already undergone CIT training, but the sheriff’s goal is to put each officer in his agency through it now that the courses have started up again.

Bobotas knows the kind of changes advocates want to see won’t happen overnight though.

“Police are using the tools that [they] have, the hospitals are doing the best they can, so it’s no one doing the wrong thing,” said Bobotas. “It would take deep cultural shifts and belief you can safely transport somebody to the hospital without handcuffs. If people transporting them believe they’re not safe, they’re going to want to use them.”

This three-part series continues Wednesday and Thursday looking into the next step in the IVC process and unpacking what happens once those patients arrive in the ED.

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