NC mental health patients shouldn’t be handcuffed and treated like criminals

Image being sick, barely able to get out of bed for a week. You finally get the strength to go to the doctor. But just when you expect compassionate care, you are stripped, your belongings are taken away, you’re put into handcuffs, and then transported to a hospital many miles away from your home town in the back of a police car. This is done every day to North Carolina citizens suffering with mental illness. Patients arrive at doctor’s offices, urgent care clinics, and emergency rooms at their most vulnerable, asking for help, and are treated like criminals.

The pandemic has highlighted the cracks in the mental health care system in North Carolina. The lack of providers, community resources, and hospital beds has become even more acute as the rate of anxiety, depression, and substance use has increased. Chronic lack of funding and fragmentation of the mental health care system has left many citizens at a loss for where to get help. Many people go to the emergency room in desperation or crisis because they have nowhere else to turn.

Providers, in an effort to help, involuntarily commit, or “IVC,” those patients to psychiatric treatment. Once involuntarily committed, a patient is placed in a locked psychiatric unit and is not permitted to leave unless approved by a physician. To involuntarily commit someone in North Carolina, a physician must determine that the patient is a “danger to himself or others.” Involuntary commitment gives doctors the authority to strip a person of their personal rights and hold them against their will in a psychiatric facility.

Unfortunately, involuntary commitment has been coopted by desperate providers as a sure-fire way to get treatment for a patient. The wait list for community resources and hospital beds is exceedingly long, but if the patient is “IVCed” they get bumped up in the line. The use of IVC has increased 91% in North Carolina over the past decade, as it is a last ditch effort to get patients the care they need.

Once a patient is involuntarily committed they are considered “a danger to themselves or others” in the eyes of the law. This means they lose their personal freedoms against their will. If they need to move to a different facility, it is done by police, in handcuffs and in the back of a police car. Involving the police in transporting these citizens treats them as if they have done something wrong. They did not break a law – they simply came to a physician asking for help.

Having personal rights taken away is traumatizing for patients. They seek help at their most vulnerable time and they are treated not with compassion, but as if they are “dangerous.” This traumatization makes it less likely for patients to reach out for help in the future. When I see a patient after hospitalization, it can take months for the patient to be honest with me because of fear of being “IVCed” again.

Additionally, involving law enforcement in the transportation of patients further perpetuates the stigma surrounding mental illness. Handcuffing patients reinforces harmful stereotypes that people with mental illness are dangerous. And law enforcement involvement in transportation is expensive.

Transportation by law enforcement is necessary in some cases – for example, when a patient is hearing command auditory hallucinations – but not the vast majority of cases. From college students experiencing depression to grandparents with dementia, psychiatric patients vary greatly in their needs and past experiences. In the current system, any of these patients are at risk of unwarranted involuntary commitment.

The pandemic has taught us the importance of mental health care. Criminalizing the mentally ill only creates more barriers to care for patients. Some states have passed legislation allowing transportation companies to transport patients under involuntary commitment, leaving law enforcement to their primary mission. It is time for North Carolina to treat patients and law enforcement with the respect they deserve and allow involuntarily committed citizens to be transported with dignity.