‘Iryna’s Law’ to increase demand on strained NC mental health system, officials say
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- Iryna’s Law will increase demand for involuntary evaluations and inpatient beds.
- State official says hospitals must expand capacity and optimize patient discharges.
- Sheriffs cite transport delays, inpatient bed shortages and jailed patients lacking care.
A North Carolina law known as Iryna’s Law is expected to increase the number of people who need behavioral health services, adding pressure to an already strained mental health system, according to a top official with the North Carolina Department of Health and Human Services.
“When you think about Iryna’s Law, we are fully expecting, along with other inpatient hospitals, to see an increase in demand,” said Karen Burke, DHHS deputy secretary for facilities and licensure, during a legislative committee meeting on Wednesday about the involuntary commitment process.
House Bill 307 or Iryna’s Law was passed this year after the August stabbing death of Ukrainian refugee Iryna Zarutska on a Charlotte light-rail train. The man charged in the killing, DeCarlos Brown Jr., has a history of mental illness and had cycled through North Carolina’s courts and jails for years.
The law tightened the rules governing whether people charged with certain violent crimes can be released while awaiting trial, and requires more arrested individuals to undergo mental health evaluations to determine whether they should be hospitalized involuntarily.
Under the law, a judge or magistrate must order a mental health evaluation through the involuntary commitment process — the legal process that places someone in a treatment facility even if they do not want to go — if:
- A defendant is charged with a violent offense and has been subject to an involuntary commitment order within the past three years.
- A defendant is charged with any offense and the court has reasonable grounds to believe the person is a danger to themselves or others.
The arresting officer would be required to immediately transport — or ensure that the defendant is transported — to a hospital emergency department or other crisis facility capable of conducting the initial evaluation.
To handle increased demand, Burke said the state will need to move patients through the system more efficiently, expand capacity and rethink how state psychiatric hospitals operate.
“We’re going to need to optimize our discharges. We’re going to need to operate more beds, and then we’re going to have to be creative about our operational structure that we have currently in place,” she said.
Burke said state psychiatric hospitals are already operating near capacity, with some beds not open due to a lack of staff, persistent staffing shortages, long patient stays, and patients who are ready for discharge but cannot leave because appropriate placements are unavailable.
Sheriffs’ Association stance
Challenges faced by sheriffs and other law enforcement officials, who are often responsible for carrying out involuntary commitment custody orders, could also be exacerbated under the law.
Eddie Caldwell Jr., executive vice president and general counsel for the North Carolina Sheriffs’ Association, said the association supported Iryna’s Law because it believes the law seeks to address long-standing problems in both public safety and behavioral health. But he pointed to persistent challenges sheriffs face in carrying out the involuntary commitment process, many of them tied to limited treatment capacity and gaps in the state’s mental health system.
Caldwell said Iryna’s Law responds to “catch and release policies that allow dangerous criminals to come into the criminal justice system and immediately get released back on the street to commit more crimes,” as well as the large number of people in jails who are struggling with untreated mental health and substance use disorders. Many of those individuals, he said, might not be incarcerated at all if their medical needs were addressed.
“We support adequate state funding to accomplish this — in particular for state mental health hospitals — so the folks who have mental health issues and need the help of mental health professionals can get that in a state hospital, rather than being confined in a jail where they’re not able to get those services,” Caldwell said.
Caldwell said sheriffs also support placing people who need to be held in secure custody in facilities that can both safely confine them and provide appropriate mental health care — something he said county jails are not equipped to do.
“Jails are not hospitals, and they cannot become hospitals. They are custody facilities, and they can do a minimum amount of assistance to the folks that are in the jails,” he said. Caldwell described the challenges sheriffs face when carrying out the involuntary commitment process.
He said that when a magistrate issues an involuntary commitment order, law enforcement is generally responsible for transporting the respondent to a medical facility for a first examination.
Respondents cannot be detained in jail before that examination, even if telepsychiatry is available, and officers must take them to a medical facility.
Officers are often required to remain long enough to ensure appropriate supervision, Caldwell said, which can mean extended waits if a physician or psychologist is not immediately available or if the hospital lacks on-site security. After the first examination, doctors may order additional treatment at a 24-hour facility.
But Caldwell said a shortage of inpatient psychiatric beds can leave respondents waiting in emergency departments for long periods for a bed in a 24-hour facility. He said it can also take hours — and sometimes days — of repeated phone calls by law enforcement to locate an available bed at a facility.
“So what happens is the IVC respondents don’t get this treatment and service that they need,” he said.
“And sometimes in that process, they are released into the community without getting the treatment — the service — that they need,” he said. “And of course, that then creates a likelihood that law enforcement is going to be picking that same person up again, either as an IVC respondent or as a person with IVC needs, but who has committed a crime and is a criminal defendant, and then the cycle just continues,” he said.
