The image is sick and I can hardly get out of bed for a week. You finally have the power to go to the doctor. But when you expect compassionate care, you are stripped, your belongings taken away, handcuffed, and taken behind a police car to a hospital miles away from your hometown. This is done daily for North Carolina citizens suffering from mental illness. Patients arrive at the most vulnerable clinics, emergency clinics, and emergency rooms, seek help, and are treated like criminals.
The pandemic has highlighted a crack in North Carolina’s mental health care system. As the rates of anxiety, depression, and substance use increase, the shortage of providers, community resources, and hospital beds becomes even more acute. Due to the chronic lack of funding and fragmentation of the mental health care system, many citizens are at a loss as to where to get help. Many people go to the emergency room in despair or crisis because they have no other place to turn.
Healthcare providers are striving to support, involuntarily commit, or “IVC” these patients for psychiatric treatment. Upon involuntary hospitalization, the patient is placed in a locked psychiatric unit and cannot leave without the approval of a doctor. To unknowingly commit someone in North Carolina, the doctor must determine that the patient is “dangerous to himself or others.” Involuntary hospitalization deprives doctors of their individual rights and empowers them to detain them at a psychiatric institution against their will.
Unfortunately, involuntary hospitalization has been adopted by desperate healthcare providers as a surefire way to get treatment for patients. Local resources and hospital bed waiting lists are very long, but if patients are “IVC” they will hit the queue. In North Carolina, IVC use has increased by 91% over the last decade as it is the last effort to provide the care needed to patients.
Involuntary hospitalization of a patient is considered “dangerous to oneself or others” from a legal point of view. This means that they lose their personal freedom against their will. If they need to move to another facility, it is done by police, in handcuffs, and behind a police car. Involving the police in the transportation of these citizens treats them as if they had done something wrong. They did not violate the law – they simply came to the doctor for help.
Deprivation of an individual’s rights is traumatic for the patient. They seek help during their most vulnerable times and are treated as if they were “dangerous” rather than compassionate. This trauma reduces the likelihood that the patient will reach out for help in the future. When I meet a patient after hospitalization, it can take months for the patient to be honest with me for fear of being “IVCed” again.
In addition, involving law enforcement agencies in the transport of patients further perpetuates the stigma surrounding mental illness. Handcuffed patients reinforce the detrimental stereotype that people with mental illness are at risk. Also, law enforcement involvement in transportation is costly.
Transportation by law enforcement agencies may be required. For example, if the patient is hearing hallucinations, but in most cases this is not necessary. From college students experiencing depression to grandparents with dementia, psychiatric patients have very different needs and past experiences. In the current system, any of these patients are at risk of unjustified involuntary hospitalization.
The pandemic has taught us the importance of mental health care. Making a mentally ill person a criminal only creates more barriers to caring for the patient. Some states have passed legislation that allows shipping companies to transport patients with involuntary involvement, leaving law enforcement agencies to their primary mission. It’s time for North Carolina to treat patients and law enforcement with the right respect and allow involuntarily devoted citizens to be transferred with dignity.
Megan Pruette, MD, is an assistant clinical professor of psychiatry at the University of North Carolina at Chapel Hill Medical College.