Federal judge allows suit over jail mental health services to proceed

A federal judge will allow a lawsuit to proceed against a North Carolina state agency over mental health services provided to jail inmates.

The suit alleges that the Department of Health and Human Services “is responsible for, but has failed to provide timely and adequate capacity assessments and restoration services to pretrial detainees who are suspected of, or adjudicated to be, incapable to proceed to trial due to mental health disabilities or cognitive disabilities,” according to a June 2025 court order.

Affected inmates are known as “ITP detainees” because they are or may be incapable to proceed to trial.

US District Judge William Osteen’s order Monday refused a request from the group Disability Rights North Carolina to issue an injunction against DHHS. But Osteen endorsed a modified version of a magistrate judge’s 2025 order allowing portions of the lawsuit to move forward.

DRNC filed paperwork earlier in March seeking to pursue the case as a class-action lawsuit.

Osteen took over the case in August 2025. Monday’s order marked his first ruling in the dispute.

The judge rejected the portion of the suit claiming that DHHS policies created an illegal disparate impact.

“DRNC does not and cannot sufficiently allege the comparison necessary to establish a disparity; it cannot show that NCDHHS’ practices in managing the ITP system ‘has a more harsh effect’ on persons with disabilities than those without because no persons without disabilities qualify for ITP services in the first place,” Osteen wrote. “DRNC fails to sufficiently allege the necessary ‘causal connection’ — that is, a disparity — to make out a disparate impact claim.”

Osteen looked more favorably on DRNC’s claim that state health officials failed “to make a reasonable accommodation” for the ITB detainees.

“Here, DRNC’s allegations appear to raise the question of whether the North Carolina’s ITP system ‘waiting list’ moves at a reasonable pace,” the judge wrote. “That is, when a criminal defendant is designated as ITP and, therefore, requires assessment and subsequent treatment, whether the amount of time that criminal defendant must wait to receive these services is reasonable. Reasonableness is a fact-intensive and context-dependent question; there is no Fourth Circuit decision that clearly suggests what is reasonable in this context. Therefore, this claim presents issues which would benefit from further factual development and dismissal at the 12(b)(6) stage is not appropriate.”

While the case can move forward, Osteen explained why he would not issue an injunction.

“This court cannot find that DRNC has established that, at this stage, ‘an injunction is in the public interest,’” he wrote. “DRNC’s requested preliminary injunction implicates and could have an adverse impact on, among other things, North Carolina’s health system, particularly psychiatric hospitals and emergency departments, and its justice and public safety systems.”

“Additionally, given the complexities of, and the many actors involved in, the ITP system, this court does not fin[d] that, at this stage, the record before it supplies sufficient information to appropriately craft an injunctive order, if it wanted to,” Osteen added.

DRNC initially filed suit in April 2024. The group filed paperwork on March 16 seeking class-action status for the case.

Identified in a court filing as “the federally mandated protection and advocacy organization for people with disabilities in North Carolina,” DRNC is seeking to amend its complaint. The group is also asking Osteen to permit four additional inmate plaintiffs who would serve as representatives for a larger class.

The class would cover “[a]ll individuals with serious mental health and other cognitive disabilities charged with crimes who are or will be detained in North Carolina jails to await capacity evaluations or restoration services that the North Carolina Department of Health and Human Services (‘NCDHHS’) is statutorily required to provide,” according to a class-action motion.

The amended complaint focuses attention on House Bill 307, approved in October 2025. The legislation “will add to the bottlenecks in the waitlist for individuals awaiting evaluation or admission for involuntary commitment services that will ultimately impact detainees deemed incapable to proceed,” DRNC claimed in a court filing. The updated complaint alleges that HB 307 will “exacerbate” the original problems identified in the 2024 lawsuit.

The latest version of the complaint also attempts to address issues that prompted US Magistrate Judge Joe Webster to recommend dismissing part of the suit in 2025.

DRNC claimed in its initial suit that DHHS violated “the Fourteenth Amendment’s Due Process Clause, Title II of the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act.”

The lawsuit sought a preliminary injunction against DHHS and an oral argument in the case.

Webster recommended in 2025 against issuing an injunction or holding an oral argument. He also recommended dismissing the portion of the complaint dealing with Title II of the ADA and the Rehabilitation Act. He would have allowed DRNC to continue to pursue claims linked to “violations of substantive and procedural due process under the Fourteenth Amendment.”

“Taking the facts as alleged in the Complaint as true, the undersigned concludes that DRNC has alleged a plausible substantive due process Fourteenth Amendment claim that NCDHHS is violating the rights of ITP detainees to be free from incarceration by subjecting them to prolonged confinement in county jails while they await ITP or IVC examinations and/or treatment at a state psychiatric hospital or other appropriate integrated settings,” Webster wrote. “The claim is grounded in a liberty interest in freedom from incarceration, reasonable conditions of safety and mental health care, and timely restorative treatment.”

“The undersigned also concludes that DRNC has alleged a plausible procedural due process claim against NCDHHS,” Webster wrote.

The 2024 lawsuit contended that people with mental health issues sat in North Carolina’s county jails for months before getting required services.

“Under the Fourteenth Amendment’s Due Process Clause, a person with a mental health disability who is charged with a crime and detained ‘solely on account of his incapacity to proceed to trial cannot be held more than the reasonable period of time necessary to determine whether there is a substantial probability that he will attain that capacity in the foreseeable future,’” DRNC lawyers wrote.

“In violation of this bedrock principle, North Carolinians with serious mental health disabilities and other cognitive disabilities are languishing in jails for months, and in some severe cases, years at a time,” the complaint continued. “Their prolonged detention extends well beyond what is reasonable under the circumstances for an evaluation and determination of whether they possess the requisite mental capacity to proceed to trial.”

The lawsuit aimed “to reduce the profoundly harmful and unconstitutionally prolonged detention times.”

DHHS “is systemically violating the Fourteenth Amendment, [Americans With Disabilities Act], and [Rehabilitation Act] by failing to provide capacity assessments and restoration services to pretrial detainees who are suspected of, or adjudicated to be, incapable to proceed (collectively, “ITP detainees”), in a timely and adequate manner,” according to the complaint.

Disability Rights pointed to two main problems. First, people “who have been charged with a crime and had their capacity to stand trial questioned often spend months waiting for a capacity assessment by Local Management Entities/Managed Care Organizations (“LME/MCOs”) or Central Regional Hospital (“Central Regional”).”

“Second, individuals in North Carolina who have been charged with a crime, adjudicated incapable to proceed to trial, and ordered to a state psychiatric hospital to undergo an involuntary commitment examination or capacity restoration services wait months for bed space necessary to receive these court-ordered services,” the complaint alleged.

Detainees “wait an average of two months for their capacity assessment to be completed and nearly five months for treatment at a state psychiatric hospital,” according to the suit.  In contrast, the average wait time for a capacity assessment in Virginia is seven days.

Because of long wait times, some “detainees spend more time in pretrial detention awaiting a capacity assessment and subsequent treatment than they ever would receive as a sentence if convicted.”

The number of state beds for mental health treatment had dropped from 892 to 453 over seven years, the lawsuit argued. Of the remaining beds, “about 35% are occupied by individuals who are ready for discharge but unable to leave,” according to the suit. “Most often in these instances, individuals who are ready for discharge are unable to be discharged because of a lack of appropriate services available in the community.”

Disability Rights blamed DHHS for failing to ensure “that LME/MCOs fulfill their statutory and contractual duties to develop and maintain adequate provider networks in the community.”

“County jails are intense and stress-inducing environments, generally not suitable for those diagnosed with any kind of debilitating ailment, let alone severe mental health disabilities,” the lawsuit contended. “Prolonged detention in such environments can lead ITP detainees to experience a further decline in mental health, which can result in self-harm and threats to ITP detainee safety.”

“This is a statewide crisis. NCDHHS’s mismanagement and failure to provide essential mental health services on a timely basis exacerbates existing problems and inflicts cruel and unusual pain and suffering on ITP detainees who wait at length for the services NCDHHS is legally obligated to provide,” Disability Rights’ lawyers argued.

“Federal judge allows suit over jail mental health services to proceed” was originally published on www.carolinajournal.com.