Changes Coming to Mental Health Patient Transport in North Carolina
When individuals face a mental health crisis—such as thoughts of suicide, unpredictable behavior, or hallucinations—they often find themselves in hospital emergency rooms. Unfortunately, due to a lack of specialized facilities, this is one of the few places they can go for immediate help.
If a medical provider assesses that a patient poses a risk to themselves or others, it is common practice to seek a judge’s approval for an involuntary commitment. This process typically involves law enforcement, which can add to the distress of those in crisis.
Involuntary commitments are meant as a last resort to ensure that individuals receive psychiatric care at an inpatient facility for a specific duration. However, the experience can be traumatic for patients and their families. For instance, one mother described her heartbreak as she watched her 25-year-old daughter leave the hospital in handcuffs and ankle shackles, escorted by officers to a transport van. Others have believed they were being arrested, rather than being taken for necessary medical care. Parents have even pleaded for permission to drive their children, some as young as 11, between facilities, but these requests have been denied.
Despite rising concerns, law enforcement officers in North Carolina have expressed their reluctance to take on the role of transporting mental health patients, arguing that this responsibility should belong to mental health professionals. They also highlight that transporting patients across the state can take deputies away from their essential duties, straining their resources and response times to other emergencies.
For years, families and patients have reported their trauma related to the involvement of law enforcement during mental health crises. State officials have heard these concerns and acknowledged the need to address the stigma surrounding mental health treatment. Recent legislative efforts aim to improve the situation, with a significant focus on finding better transportation options for patients who are involuntarily committed.
In the 2023 budget, North Carolina lawmakers allocated $835 million for mental health needs, which includes a pilot program for non-law enforcement transportation of involuntarily committed patients. The state Department of Health and Human Services has invited proposals from transportation providers to help implement this program in two regions.
Former Health and Human Services Secretary Kody Kinsley emphasized the importance of creating a compassionate and supportive transportation system, stating that current practices often hinder recovery and do not reflect the care that patients deserve.
Increasing Reliance on Law Enforcement
Data shows a steep rise in involuntary commitment petitions in North Carolina, with requests increasing by almost 100 percent between 2011 and 2021. As community mental health resources have diminished, more residents are turning to emergency rooms in crisis.
Under state law, counties are responsible for transporting individuals committed involuntarily. Historically, this has fallen to law enforcement, which often leads to a default practice of using police during these situations. Even if a patient voluntarily visits a hospital, they can still be subject to involuntary commitment.
Though North Carolina law was updated in 2018 to allow for alternative transportation methods, many counties have opted to continue using law enforcement for these tasks. A recent report indicated that while 43 states allow for non-law enforcement transportation of involuntarily committed patients, the majority still rely heavily on police involvement.
A Call for Better Solutions
Law enforcement officials have expressed the need for a more suitable system for transporting mental health patients. They are often pulled away from primary duties for hours, creating strain on their already limited resources.
A national survey revealed that a significant portion of agency budgets is spent on transporting these patients, equating to nearly $1 billion annually across the country. Additionally, officers may lack the proper training to handle mental health situations, which can sometimes escalate conflicts.
Research indicates that many individuals who have been transported by police report negative experiences. Those encounters can exacerbate existing mental health challenges and discourage individuals from seeking help in the future.
To address these challenges, North Carolina is currently reviewing proposals for innovative transportation services. Health officials are seeking providers who can create a model that emphasizes care and support rather than enforcement.
Examples from other states include mental health crisis response teams, such as Oregon’s CAHOOTs program and Durham’s HEART program, which often operate without needing police backup. These programs illustrate the potential for community-based alternatives to transport those in crisis safely.
Critically, North Carolina law does permit a healthcare provider or a family member to request transport for a patient under involuntary commitment instead of using law enforcement. However, hospital staff often do not communicate this option effectively to families.
As North Carolina moves forward with reforms, officials hope to establish a transportation system that prioritizes compassion, care, and the well-being of individuals facing mental health challenges.
