Calls for Urgent Change in Public Report that Follows Year-long Investigation
FOR IMMEDIATE RELEASE
May 27, 2025
North Carolina’s involuntary commitment (IVC) process is significantly overused, misused, and harmful, each year resulting in tens of thousands of children and adults languishing in overwhelmed Emergency Departments for days or weeks on end, without court-appointed lawyers or adequate mental health treatment, stuck in a civil process intended to be the last resort but that has become “the easy button,” according to a public report Disability Rights North Carolina (DRNC) issued today.
For more than a year, DRNC focused intensively on NC’s IVC procedure – a civil, legal process of detaining and hospitalizing a person against their will based on an allegation of severe mental illness – and how it plays out on the ground. Using DRNC’s federally-mandated access authority, DRNC staff monitored emergency departments (EDs) across the state and interviewed people with lived experience and their families directly affected by IVC, as well as hospital officials, mental health advocates, and legal scholars.
NC collects very little data about the IVC process, so it is difficult to fully analyze where adjustments to law or policy should be made to prevent its wrongful, wasteful, abusive or inefficient use. From data that is reported, we know that of the tens of thousands of petitions for IVC each year, at least 63 percent over the past six years did not result in an order for involuntary commitment, indicating the person detained did not meet the criteria for forced hospitalization.
This report explores the evolution of North Carolina’s IVC policy and its impact. Past IVC policy and case law reflect an approach once rooted in meaningful due process with the protection of individual rights as a primary concern.
Over time, shifts in policy and culture have advanced administrative convenience over due process rights to the point that one psychiatrist describes IVC as “the easy button.” Rather than avoiding unnecessary commitments as required under the Americans with Disabilities Act (ADA), there is an ease with which IVCs are routinely initiated and prolonged. We rely on costly ED and psychiatric hospital care instead of care in communities that costs far less and is more effective – without violating personal and familial liberty.
“We urgently need changes to make people stop and acknowledge the potential harms of IVC before rushing into it,” said Virginia Knowlton Marcus, CEO of DRNC. “People and families are needlessly suffering. Our systems are needlessly suffering. Costs are soaring without positive results. We must act swiftly to ensure people can get the help they need when and where they need it, and not wind up subjected to forced hospitalization in expensive, ill-equipped facilities.”
As an agency that champions the rights of people with disabilities, DRNC focused on the legal status of people under custody orders in the ED. We also focused on what happens to people under IVC while they are in EDs, suffering, waiting, and getting no actual mental health treatment beyond the administration of drugs.
ED staff were candid in DRNC’s monitoring visits, sharing their frustrations and the myriad issues they face while doing their best to manage their limited capacity and provide care and treatment for people with mental health disabilities and people with medical emergencies.
This report brings together the very real harm to children and adults thrown into NC’s IVC process and the very real successes of kids and adults who survived this system – not because of their IVC but in spite of it. DRNC is making findings and recommendations for policy, practical, and cultural change that prioritize mental health recovery, reduce forced hospitalizations, and create a mental health service landscape that is trauma-informed, effective, healing, and that minimizes fraud, waste, and abuse.
Reform will require a determined effort from various stakeholders, including state and local elected officials; policy makers within NC’s Department of Health and Human Services; healthcare provider agencies and hospitals; among others – and must include and center people with lived experience in the creation of solutions.
Finally, it is vital to understand that the answer to this crisis isn’t to increase the number of psychiatric hospital beds; the answer is to ensure kids and adults can get the mental health services and treatment they need, when and where they need it. Simply put, NC needs robust mental health services in our communities. We must prevent crises from happening to begin with. We must keep people healthy, in their homes, in their communities, where they can thrive and be successful.
Key Findings
North Carolina’s IVC process is marked by systemic overuse, misuse, and harm:
- Lack of Due Process
People are detained in EDs under civil custody orders without appointed legal representation or timely judicial oversight. They remain in legal limbo, often for days, weeks, or months, awaiting psychiatric placement.
- Traumatic Detention
Individuals—including some young children—are subjected to strip searches, physical restraints, forced medication, handcuffs and shackles in transport, and long periods in EDs, some noisy, harshly lit, and chaotic, with little to no treatment.
- Harm to Families and Communities
The IVC process often excludes parents and guardians from decisions, disrupts lives, causes job loss and financial hardship, and consumes law enforcement and hospital resources unnecessarily. These damaging experiences make some people reluctant to seek out psychiatric care when needed.
- Systemic Failures
The process lacks adequate data tracking and evaluation. However, from the scant data that does exist, we know that at least 63% of IVC petitions over the last six years have not resulted in actual commitments, highlighting widespread inappropriate use. This affects tens of thousands of people in NC each year.
- Misuse
IVC is sometimes used by nursing homes and assisted living facilities to expel residents, by family and friends as a form of control, and by providers as a means of shifting care responsibilities—rather than addressing mental health needs compassionately and effectively.
Key Recommendations for Change
To address this crisis and rebuild a more humane and responsive, less abusive and wasteful system focused on care and healing, DRNC makes five key recommendations:
- End Misuse and Overuse of IVC
- Mandate specialized training for magistrates
- Require crisis screenings by mobile crisis teams before magistrates issue custody orders
- Ensure alternatives like the NC Peer Warmline, 988 crisis line, or mobile crisis teams are considered first
- Penalize misuse, including repeated or frivolous petitions
- Reduce Harm During Transport
- Replace law enforcement transport with trained, non-coercive transport
- Eliminate unnecessary use of shackles, uniforms, and marked cars
- Require trauma-informed training for all transporters and give families the option to transport loved ones
- Reduce Harm in Facilities and Courts
- Provide immediate legal representation once a custody order is issued
- Amend NC law to eliminate successive petitions
- Involve supportive guardians and children’s parents in care decisions and court processes
- Allow a parent or legally responsible adult chosen by the child to be present if a minor is strip searched
- Shorten the timeline for court hearings from 10 to 5 days
- Mandate trauma-informed care and strengthen oversight of facility practices
- Build Out Evidence-Based Alternatives
- Expand peer support and non-coercive crisis response models like HEART in Durham
- Prioritize community-based prevention and treatment
- Involve people with lived experience in designing solutions – peer support works
- Collect and Share Critical Data
- Require detailed reporting on IVC processes, outcomes, and costs
- Establish public-facing dashboards to ensure transparency and accountability
- Use data to inform policy and identify breakdowns in care
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About Disability Rights North Carolina
Disability Rights North Carolina is the federally mandated protection and advocacy (P&A) system in North Carolina, dedicated to advancing the rights of all people with disabilities, of all ages, statewide. DRNC is an independent, 501(c)(3) nonprofit organization and a member of the National Disability Rights Network. Learn more about Disability Rights North Carolina at disabilityrightsnc.org.
Contact:
Corye Dunn, Director of Public Policy
919-371-6403
corye.dunn@disabilityrightsnc.org