The John Locke Foundation has a couple of articles that discuss the legislative response to the murder on Charlotte’s light rail. Among other things, the General Assembly decided that there must be “mental health evaluations for an expanded range of arrestees”.
The state of North Carolina already had an involuntary commitment law. If a health care provider certifies that a person is a danger to other people, the courts can commit them to a mental health inpatient facility for treatment. The General Assembly is suggesting we need more of this.
There are a couple of issues, however.
First, it can be extremely difficult for even a board-certified psychiatrist to predict when a patient will become violent. Yet, many of these evaluations take place in hospital emergency rooms where the providers are even less prepared to make this determination.
Second, what is the standard of proof? “Preponderance of the evidence” suggests a greater than 50 percent likelihood of becoming violent. The criminal standard– “beyond reasonable doubt”– would be much more difficult to prove. This is important because the process takes away people’s liberty. It seems likely the “greater than 50 percent likelihood” is the standard used, although that might differ from one mental health provider to another in terms of how they interpret their own responsibilities and how they should be carried out.
Third, these folks often don’t take their medicines. Even if they are treated inpatient for a period of time, they are subject to relapse once they are released if they are non-compliant with their treatment or if their condition worsens.
The North Carolina Medical Society says emergency physicians are concerned:
Physicians and emergency department leaders report several unintended consequences under the current language:
- Safety & staffing risks: Individuals charged with violent crimes may remain in EDs for extended periods while awaiting psychiatric clearance. which places additional strain on limited secure spaces and increases risk for staff.
- Limited crisis resources: North Carolina’s network of crisis facilities is already stretched, leaving EDs as the default destination.
- Clinical and legal uncertainty: Conducting reliable psychiatric exams on newly arrested patients can be complex—particularly when answers can determine custody status.
- System burden: Boarding of these patients can further delay care for other medical emergencies.
There is no questions that emergency departments tend to get dumped upon with a wide range of situations that do not necessarily justify care in the ER. This is but one of them.
We live in an imperfect, fallen world. Perhaps it would be better to commit the mentally ill for institutionalization on a long term basis when they cannot manage their own affairs and provide for their own support. That would capture a great number of these violent cases.
That is, after all, how these issues were handled years ago.
TC, you propose indeterminate institutional housing of the mentally ill. Surely you don’t mean all arrestees. The Locke recommendation that ” North Carolina needs to implement a statewide, systematic guide for magistrates to use when assigning bail to an arrestee and mandate that all magistrates conduct criminal background checks (including prior charges, arrests, and convictions) on all arrestees brought before them.
These reforms can protect the public, reduce disparities and eliminate any racial or other biases in bail decisions, and strengthen trust in the justice system. They will not only allow more transparency and accountability within our justice system, but they will also help make North Carolina a safer place to be.”
No, I don’t mean all arrestees, Fred. I think the Locke recommendations are good. But to the extent that the medical community has to make determinations of risk, there will always be critical gaps.