North Carolina’s involuntary commitment system is facing scrutiny as state officials, legal experts, and families confront a reliance on emergency rooms, law enforcement, and court orders during mental health crises. Critics argue that current practices frequently leave patients and caregivers sidelined, confused, and reluctant to seek help in the future.
State leaders have begun pursuing reforms aimed at curbing unnecessary commitments, expanding voluntary treatment options, and strengthening follow-up care. Earlier this month, a committee convened by the N.C. Department of Health and Human Services, which includes attorneys, law enforcement personnel, crisis providers, juvenile justice officials, hospital administrators, judges, lawmakers, and peer support specialists, gathered to tackle these ongoing challenges in the state’s psychiatric crisis system.
Families Sidelined in Crisis Care
The systemic friction is highlighted by personal accounts from across the state. Earlier this month, Jacob Dehart sought emergency help in Winston-Salem after his teenage daughter attempted to harm herself. Days later, when she was approved for admission to a psychiatric facility, a uniformed law enforcement officer transported the vulnerable teen in a marked car. Dehart reported that he and his child’s mother were shut out of decision-making throughout the process.
“From the beginning, I wanted everything to be voluntary and cooperative and let us have kind of a say in it,” Dehart said. “But we feel like we were ignored.”
Dehart stated that hospital staff repeatedly told him his daughter would be “transferred,” a term he interpreted as an ordinary move between medical facilities rather than the initiation of an involuntary psychiatric commitment. When he attempted to ask questions, he felt social workers were reading from a script and treating his inquiries as interruptions. Seeking clarity, Dehart contacted Mark Botts, an associate professor at the UNC School of Government and a legal expert on involuntary psychiatric commitment. Botts trains health providers and magistrates across North Carolina on protocols when an individual is deemed a danger to themselves or others, circumstances where state law permits a custody order that temporarily suspends certain rights.
Putting Botts on speakerphone with a hospital social worker, Dehart learned that because the parents were consenting to inpatient treatment, the facility could pursue a voluntary admission instead. “They cannot treat her without the parents’ consent for treatment, and consent for treatment to be truly informed requires the decision maker to have information,” Botts explained later. “It’s maddening. Imagine if it was not a mental health crisis, but some other physical health emergency — they wouldn’t push the parents aside like this.”
Despite real-time guidance from a legal expert, the family’s efforts did not alter the outcome. The following day, an officer arrived to transport the teenager to a psychiatric facility. Such transports often involve wrist shackles in the back of a sheriff’s vehicle, a standard procedure that many families and law enforcement agencies object to due to its traumatizing impact on patients and the strain it places on law enforcement departments. Dehart successfully persuaded the officer not to use handcuffs, but noted the heavy emotional toll of the trip. “The transfer itself with the police, that was hard for everybody,” Dehart said. “I mean, honestly, she’s going to need counseling for that before we can address what the issue was.”
Officials Address Systemic Patterns
State administrators acknowledge that such experiences are widespread. Over the past several years, NC Health News has received dozens of messages and calls from families across North Carolina describing similar situations. During the inaugural gathering of the N.C. DHHS committee, Kelly Crosbie, director of mental health for the agency, noted that she receives calls from families facing identical dilemmas at least twice a month.
“The story is always the same,” Crosbie said. “It’s either their minor child or adult child that they voluntarily took to the hospital, and then they were [involuntarily committed]. And I don’t understand that dynamic. I’m not hospital-blaming. I have no idea why. But they also don’t understand why. They’re so baffled, and it’s very hard to tell them I can’t do anything about that.”
Robert Broughton, an attorney with the N.C. Department of Justice and a member of the committee, also offered observations based on his professional experience regarding why these dynamics persist within emergency and legal frameworks.
Reforming the Psychiatric Crisis Response
As state leaders, advocates, and practitioners search for pathways to reduce unnecessary involuntary commitments and bolster community-based support, stakeholders continue to evaluate the legal, medical, and operational barriers that complicate mental health interventions. The state’s ongoing committee sessions serve as a primary forum for addressing these systemic bottlenecks and identifying legislative or administrative solutions for North Carolina families.
