by Andrew Pomeranz
North Carolina’s involuntary mental health commitment system is under significant strain, increasingly overwhelming jails, hospital emergency rooms,
and law enforcement, according to multiple lawmakers and experts
involved in committee hearings. Lawmakers are now revisiting state laws
as concerns intensify over gaps in the mental health system that affect
public safety.
The House Select Committee
on Involuntary Commitment and Public Safety has focused its recent
meetings on evaluating both mental health system capacity and the legal
processes for committing, treating, or releasing individuals.
After the killing of Charlotte resident Iryna Zarutska, lawmakers passed Iryna’s Law
last year. The law imposed stricter pretrial release limits and
expanded the role of mental health assessments in certain cases, further
constraining the system.
Since Iryna’s Law passed, the legislature has escalated its focus on
whether current policies adequately address the needs of individuals
with severe mental illness and public safety concerns.
Continuing this examination, faculty from the UNC School of Government presented a case study at a March 18 committee meeting, illustrating how current laws operate in practice.
The example centered on a 36-year-old woman, Paula, experiencing
homelessness who has been diagnosed with schizophrenia and a substance
use disorder.
In the case study, a court determined three years ago that Paula was
incompetent. As a result, she lost the authority to make decisions about
her property, health care, and finances. With no assets, Paula is
currently under the guardianship of the county Department of Social
Services. In the past six months, she has undergone two involuntary
commitments, but there has been no sustained improvement, highlighting
gaps in outcomes for individuals like Paula.
“What happens when that court adjudicated Paula as incompetent is
they took away her authority to make decisions for herself that can be
related to her property or her person, her health care, her finances,”
associate professor Meredith Smith said. “They removed her authority to
make decisions from her, and they gave it to someone else.”
Paula’s family — or another connected individual — can then file a
motion seeking guardianship due to concerns about Paula’s living
conditions. If approved, responsibility for Paula would shift from the
county to her family member.
Associate Professor Mark Botts noted that while family guardianship
can sometimes be a better outcome for the individual, that is not always
the case.
“Maybe the guardian is doing all they can do, maybe they’re not. But
even when they’re doing all they can do, there are limits, because you
need Paula’s cooperation,” Botts said.
The discussion underscores a recurring problem: Individuals often
cycle through involuntary commitment without lasting improvement. This
has prompted lawmakers to question how to strengthen the system’s
ability to intervene when someone with a mental illness poses a risk.
Botts said the issue is more complicated than that.
Under Iryna’s Law, magistrates must consider whether there is
reasonable cause to believe someone is dangerous, mentally ill, or poses
a risk to others when deciding on pretrial release. If these conditions
are met, the magistrate can issue an order to begin involuntary
commitment.
However, as Botts noted, this does not guarantee the patient will complete the process or receive treatment.
“That doesn’t mean that they necessarily get to an inpatient
facility. That doesn’t mean they will necessarily get treatment,” Botts
said. “Even if they do get to the facility and get inpatient treatment,
at some point, they’re going to be discharged.”
As the committee continues its work, lawmakers are expected to
consider whether adjustments to commitment standards, guardianship
authority, or system capacity are necessary to support the goals of
Iryna’s Law.
Full Article & Source:
NC House committee hears testimony on guardianship difficulties