NC House committee hears testimony on guardianship difficulties

North Carolina’s involuntary mental health commitment system is under significant strain, increasingly overwhelming jails, hospital emergency rooms, and law enforcement, according to multiple lawmakers and experts involved in committee hearings. Lawmakers are now revisiting state laws as concerns intensify over gaps in the mental health system that affect public safety.

The House Select Committee on Involuntary Commitment and Public Safety has focused its recent meetings on evaluating both mental health system capacity and the legal processes for committing, treating, or releasing individuals.

After the killing of Charlotte resident Iryna Zarutska, lawmakers passed Iryna’s Law last year. The law imposed stricter pretrial release limits and expanded the role of mental health assessments in certain cases, further constraining the system.

Since Iryna’s Law passed, the legislature has escalated its focus on whether current policies adequately address the needs of individuals with severe mental illness and public safety concerns.

Continuing this examination, faculty from the UNC School of Government presented a case study at a March 18 committee meeting, illustrating how current laws operate in practice.

The example centered on a 36-year-old woman, Paula, experiencing homelessness who has been diagnosed with schizophrenia and a substance use disorder. 

In the case study, a court determined three years ago that Paula was incompetent. As a result, she lost the authority to make decisions about her property, health care, and finances. With no assets, Paula is currently under the guardianship of the county Department of Social Services. In the past six months, she has undergone two involuntary commitments, but there has been no sustained improvement, highlighting gaps in outcomes for individuals like Paula.

“What happens when that court adjudicated Paula as incompetent is they took away her authority to make decisions for herself that can be related to her property or her person, her health care, her finances,” associate professor Meredith Smith said. “They removed her authority to make decisions from her, and they gave it to someone else.”

Paula’s family — or another connected individual — can then file a motion seeking guardianship due to concerns about Paula’s living conditions. If approved, responsibility for Paula would shift from the county to her family member.

Associate Professor Mark Botts noted that while family guardianship can sometimes be a better outcome for the individual, that is not always the case.

“Maybe the guardian is doing all they can do, maybe they’re not. But even when they’re doing all they can do, there are limits, because you need Paula’s cooperation,” Botts said.

The discussion underscores a recurring problem: Individuals often cycle through involuntary commitment without lasting improvement. This has prompted lawmakers to question how to strengthen the system’s ability to intervene when someone with a mental illness poses a risk. 

Botts said the issue is more complicated than that.

Under Iryna’s Law, magistrates must consider whether there is reasonable cause to believe someone is dangerous, mentally ill, or poses a risk to others when deciding on pretrial release. If these conditions are met, the magistrate can issue an order to begin involuntary commitment.

However, as Botts noted, this does not guarantee the patient will complete the process or receive treatment.

“That doesn’t mean that they necessarily get to an inpatient facility. That doesn’t mean they will necessarily get treatment,” Botts said. “Even if they do get to the facility and get inpatient treatment, at some point, they’re going to be discharged.”

As the committee continues its work, lawmakers are expected to consider whether adjustments to commitment standards, guardianship authority, or system capacity are necessary to support the goals of Iryna’s Law.

“NC House committee hears testimony on guardianship difficulties” was originally published on www.carolinajournal.com.