Involuntary Commitment

Involuntary commitment is a legal process which mandates emergency medical care for someone’s behavioral health condition. Each state has an involuntary commitment process, and North Carolina’s law has not been updated in decades, leaving it unclear and subject to misuse. Changes to the law bring practices up to date and ensure patients receive the right care at the right time in the right setting. Click below to learn more about the changes made in Senate Bill 630: Revise IVC Laws that impact the involuntary commitment process.

People may be involuntarily committed when symptoms of a mental illness or substance use disorder escalate to the point of endangering themselves or others. In North Carolina, anyone who has first-hand knowledge of the individual’s behavior or state of mind can complete a petition in front of a magistrate.

If a magistrate believes the information on the petition meets the legal criteria for involuntary commitment, they will order a custody order for the individual to be transported to a facility to receive an examination by a commitment examiner.

Changes made by SB630:

Transportation Agreements

Community crisis plans will include transportation agreements, which outline who transports a patient under a custody order. In addition, the crisis plan must identify trainings, such as de-escalation strategies, for people designated to provide transportation during an involuntary commitment order. Those individuals identified in the transportation agreement are required to participate in identified trainings, with the exception of law enforcement.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 8. § 122C-202.2. LME/MCO community crisis services plan; commitment examiners; transporting agencies; training; collaboration.

Restraints During Transportation

While restraints during transportation should be reasonably determined by the officer as necessary for the safety of the person, every effort will be made to not restrain a child under the age of 10 years old. Information about the use of restraints during transportation will be shared with receiving facility upon request.

Transportation agreements, developed by cities and counties, outline who is responsible for providing transportation under an involuntary commitment order. Private personnel or agencies, along with county or city law enforcement officers, may be designated to provide parts or all of the transportation under an involuntary commitment order.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 19. § 122C-251. Custody and transportation.

Once the individual is transported to a facility, the commitment examiner completes a thorough assessment of the individual. The commitment examiner will recommend one of the following at the completion of the assessment: involuntary commitment, outpatient commitment, or termination of the order.

Changes Made by SB630:

Community Crisis Plans

Community crisis plans will identify one or more facilities to complete the first examination and health screening. Facilities may include facility-based crisis centers, behavioral health urgent cares, or acute hospitals. If the site identified in the plan is not available, the patient will be transported to another alternative non-hospital location if one exists in the community. If a alternative non-hospital location is not available, the patient will be transported to a hospital.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 8. § 122C-202.2. LME/MCO community crisis services plan; commitment examiners; transporting agencies; training; collaboration.

Electronic Filing of Records

Commitment examiners may submit the affidavit through electronic submission

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 22. § 122C-261. Affidavit and petition before clerk or magistrate when immediate hospitalization is not necessary; custody order.

Health Screening

During the first examination, patients must receive a health screening. The health screening may take place face-to-face or through telemedicine equipment. The health screening tool will be created by NC Department of Health and Human Services (DHHS) with input from commitment examiner professionals.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 24. § 122C-263. Duties of law enforcement officer; first examination.

Commitment Examiners

Certified Commitment examinershave been expanded to include the following professionals: licensed clinical social workers, licensed professional counselors, master’s level or higher nurse practitioners, physician’s assistant, and master’s level licensed clinical additions specialists (substance use only). DHHS will continue to certify commitment examiners, which lasts three years. Physicians and psychologists continue to be qualified to perform the commitment examinations regardless of certification by DHHS.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 25. § 122C-263.1. Secretary’s authority to certify commitment examiners; training of certified commitment examiners performing first examinations; LME/MCO responsibilities.

Changes Made by SB630:

Transportation to Treatment Facility

Once a 24-hour facility is identified for a second exam and treatment, agencies named in the transportation agreement must respond to a transport request within six hours. Law enforcement agencies must respond within six hours to the extent feasible.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 24. § 122C-263. Duties of law enforcement officer; first examination.

If after the first examination the patient meets criteria for an involuntary commitment, the patient is transferred to a 24-hour facility where a second exam occurs by a physician. If the patient still meets criteria for an involuntary commitment, the patient receives treatment and is held in the 24-hour facility until a court hearing.

Changes Made by SB630:

Transportation to Treatment Facility 

Once a 24-hour facility is identified for treatment, agencies named in the transportation agreement must respond, to the extent feasible for law enforcement, to a transport request within six hours.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 24. § 122C-263. Duties of law enforcement officer; first examination.

Sharing Medical Information

Allows for sharing confidential information between facilities and sheriff if the patient is receiving treatment for a mental illness, substance use, or intellectual and developmental disability from either the county jail or the facility.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 5. § 122C-55. Exceptions; care and treatment.

Transfers

If a patient receiving treatment at a facility is transferred to an acute care hospital solely for medical purposes, the treatment facility must hold the bed for the patient for a minimum of twelve hours.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 9. § 122C-206. Transfers of clients between 24-hour facilities; transfer of clients from 24-hour facilities to acute care hospitals.

A hearing is held in district court within 10 days after the person is taken into custody under a custody order. The most recent custody order should be used to determine the hearing date.

Changes Made by SB630:

Medical Records

Limits the scope of medical records released to legal counsel without a court order.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 4. § 122C-54. Exceptions; abuse reports and court proceedings.

In Unit Hearings

Hearings should be conducted within the facility in a manner approved by the chief district court judge. A hearing may be held by audio and video transmission.

SB 630: Revise IVC Laws to Improve Behavioral Health (SL 2018-33) Section 29. § 122C-268. Inpatient commitment; district court hearing.

After court ordered treatment, patients are discharged from a facility. Many individuals will receive ongoing treatment from a community provider. However, due to workforce shortages, insurance coverage, and inconsistent service array, many individual and families do not have access to treatment, thus putting them at a higher risk for another crisis episode.

Many people experiencing a mental illness or substance use disorder achieve recovery in non-hospital, community-based settings. NCHA supports a full array of treatment options for individuals, increased insurance coverage for people with a behavioral health disorder, and consistent high-quality outpatient services.

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