The plague of police misconduct has rightfully been in the public spotlight in recent months, but an important aspect of this problem and source of frequent conflict still needs much more attention: the challenge of enforcing civil commitment laws.
Involuntary civil commitment is a well-established and necessary system under which judges have the authority to order needed treatment for persons with mental illness who are considered dangerous to themselves or others.
Unfortunately, because of several factors, law enforcement encounters during involuntary civil commitment all too often lead to violence – especially for people of color.
To begin with, persons subject to civil commitment are often treated like persons accused of crime. They are typically taken into law enforcement custody and often handcuffed or restrained while in transit to treatment facilities and courthouses for commitment hearings. It’s the rare person that doesn’t find these custody and transport procedures disturbing and disrespectful of their dignity.
This situation is made even worse by the fact that police and other law enforcement officers typically receive limited training in working with persons with mental illness. The potential for injustice is further heightened by the endemic problems of racial discrimination, poverty and the social stigma associated with mental illness. In addition, persons of color are disproportionately subjected to involuntary civil commitment as a means to gain access to limited state-funded treatment because they often lack insurance.
Fortunately, reducing police encounters with persons in civil commitment is possible and can serve as an important step toward reducing potentially tragic law enforcement interactions. (As a corollary, reducing the rolls of the uninsured through Medicaid expansion would also greatly reduce the need for involuntary commitment when it’s used as a mechanism to access state-funded care.)
Recall that in medical emergencies, the majority of patients are transported by trained emergency medical personnel. Unfortunately, most cities and counties in North Carolina still rely on law enforcement to transport persons with mental illness under civil commitment; at times, local governments even initiate involuntary commitment to provide “free” transport of individuals who otherwise would sign into treatment voluntarily.
Such transport and long waits during evaluations are a major and unwanted drain on law enforcement officers. Families and friends are also often disinclined to pursue commitment to help their loved ones, fearing it could cause more harm than good.
To their credit, the North Carolina General Assembly and Gov. Cooper enacted reform legislation in the involuntary civil commitment process to reduce law enforcement involvement in civil commitment via Senate Bill 630 in 2018.
SB 630 sought to advance several critical innovations and to set another course while we await broader reforms. It asks counties to rethink their civil commitment custody and transportation plans. It asks them to seek alternatives such as secure transport services or ambulances. It also actively discourages unnecessary use of restraints or handcuffs while the persons are in custody and offers de-escalation training to officers.
Finally, because most civil commitment hearings for individuals require transport to public courthouses, the law now promotes use of video evaluations of persons in crisis to reduce the need for law enforcement transport. This avoids the painful and embarrassing specter of transporting individuals with mental illness, especially persons of color, children and the elderly, in handcuffs for their day in court.
Unfortunately, for all of the good ideas in SB 630, the state has yet to provide the necessary funding to fully implement it. To date, few counties have implemented video for use across the commitment process. The COVID-19 epidemic alone offers important reasons to reduce unnecessary law enforcement custody and transport.
The heightened attention to racial justice and the COVID-19 epidemic offer compelling rationales to encourage these humane and just reforms. We can and should champion the use of video commitment examinations and subsequent court hearings to enhance the privacy and dignity of civil commitment while we await other needed reforms to improve access to voluntary treatment such as Medicaid expansion. Video offers greater safety, privacy and enhances dignity for persons in crisis. Such changes offer a solid first-step in reforming involuntary commitment. Now is the time to hasten these needed reforms.
Dr. Marvin Swartz is a professor of Psychiatry and Behavioral Sciences in the Duke School of Medicine and a faculty member of the Duke Law, Center for Science and Justice.