North Carolina leaders last year approved new rules for handling criminal suspects who may need psychiatric care — prompting a dispute between hospitals and law enforcement groups over a new requirement for mental evaluations.
The rules were designed in part to restrict judges from releasing repeat violent offenders and some people with mental illness back on the street after an arrest. The law bans cashless bail for some suspects and allows judicial officials to consider a suspect’s entire criminal history, not just convictions, when setting bond amounts.
The new law requires that certain defendants — those who have undergone an involuntary commitment within three years of their arrest for a violent crime, or who judicial officials believe to be a danger to themselves or others — must be transported “to a hospital emergency department or other crisis facility” for a psychiatric evaluation.
The mandated location of those evaluations is now under scrutiny.
Hospital leaders say they don’t want the suspects evaluated in emergency departments because they could endanger patients and hospital staff. Instead, hospital leaders suggest conducting the evaluations in jails. Sheriffs oppose that idea, saying hospitals are more appropriate settings for evaluating someone’s health.
The groups have been pleading their cases to the state House Select Committee on Involuntary Commitment and Public Safety, created last year to review North Carolina’s laws for handling people with mental illness. The committee plans to publish recommendations on how legislators can improve the state’s laws, said state Rep. Tim Reeder, a Pitt County Republican and physician who co-chairs the committee.
“It’s going to require all of us to be creative and not just say, ‘It can’t be me,’” Reeder told WRAL. “Let’s problem-solve this for the protection of the public, but also making sure that the alleged assailant is properly taken care of.”
Mental health in the criminal justice system has come into focus locally following the suspected murder last week of a teacher at Ravenscroft School in Raleigh — at least the second high-profile murder case in the state in which the charged suspect had a documented history of criminal activity and mental health issues.
Reeder’s committee is scheduled to meet again Wednesday — its first meeting since the Raleigh killing.
North Carolina legislators first turned their attention to the state’s procedures for handling people with mental illness following the August death of Iryna Zarutska, a 23-year-old Ukrainian who moved to Charlotte in 2022 and was fatally stabbed on the city’s train. The General Assembly passed the new mental health procedures as part of a larger judicial reform package titled, “Iryna’s Law.”
Zarutska’s accused killer, DeCarlos Brown Jr., had been diagnosed with schizophrenia and suffered hallucinations and paranoia that his family hoped to find treatment for, his sister told CNN.
Ryan Camacho — charged in the Jan. 3 killing of Ravenscroft teacher Zoe Welsh at her Raleigh home — has a documented history of mental illness. His mother, Cynthia, petitioned the courts for guardianship over him saying her son was “delusional at times,” court records indicate. And several judges in his criminal cases ordered mental evaluations at the time of his sentences.
One of the committee members, Rep. John Torbett, R-Gaston, told WRAL last week that mental health in the criminal justice system should have been a bigger focus for the legislature years ago. He’s hoping 2026 will bring meaningful, if overdue, changes to help the state keep more people in mental hospitals when they pose a danger to others.
Many of the changes Iryna’s Law made to the rules around involuntary commitment, however, have been put on hold while legislators consider tweaks to the law.
The committee, he said, will “look at taking care of those folks with mental health that are out there that just really shouldn’t be out on the street. And perhaps look at a kinder, gentler way to reposition those folks in what we used to call sanitariums, but, just basically take care of their needs by getting them out of society. Because they can’t make it in society.”
Mental health hot potato
State lawmakers enacted Iryna’s Law in early October. Later that month, they passed legislation postponing the implementation date of the mental evaluation portion until the end of 2026. Then on Nov. 13, during the committee’s first meeting, hospital representatives spoke out against the new rule.
“Community hospitals are not designed to serve as long-term holding facilities nor are they secure for serving defendants that are charged with a violent crime,” said Nicholle Karim, who leads policy development for the North Carolina Healthcare Association, the primary lobbying group for the state’s hospitals.
Emergency departments are already crowded and chaotic for a number of reasons, hospital representatives said. People visit emergency departments for emergencies and, sometimes, for nonemergency medical issues that could be addressed by primary care providers or at urgent care centers. Some emergency rooms are crowded because the hospital has a shortage of beds elsewhere in the facility.
Reeder noted during the meeting that a law enforcement officer, Roger Smith, was fatally shot during an altercation at a WakeMed emergency department in Garner on Nov. 8. Benji Martin, 29, is charged with Smith’s death. Friends told police that Martin was “acting erratically” the night prior to the incident. Martin’s attorney has said that Martin was trying to “seek help” when he entered the WakeMed Garner Healthplex and did not bring a gun to the facility, according to court documents.
The state’s shortage of beds at psychiatric facilities — particularly those designed for children — can also leave pediatric patients stranded in emergency departments for months, said Johana Troccoli, associate vice president for behavioral health for the Duke University Health System.
Troccoli in November asked legislators to reconsider laws that could place violent patients near children and other medical patients.
“Requiring defendants to be assessed at the [emergency department] as currently provisioned in Iryna’s Law, potentially alongside those children, alongside those employees who have been subjected to workplace violence, will make a strained process impossible to manage,” Troccoli said.
Karim, the spokesperson for the health care association, suggested that lawmakers consider using telehealth and other technology to conduct the evaluations at local jails.
Sheriffs’ group responds
Eddie Caldwell, a spokesman for the North Carolina Sheriffs’ Association, pushed back on the idea at the legislative committee’s December meeting.
Caldwell said the association, which represents sheriffs across the state, supports Iryna’s Law and the new evaluation requirements. However, he said the association opposes any sweeping requirement that would require North Carolina jails to provide initial mental health evaluations and diagnoses.
Prisons and jails have become de facto mental health facilities over the last decade or so, advocates for mental health care say. Caldwell says they were never designed to accommodate people suffering a mental crisis and deputies aren’t trained to handle all medical emergencies. He pointed out that some behavioral symptoms can be caused by physical ailments — problems that are easier to identify in a medical facility.
Hospitals “have labs, specialists, X-rays, MRI machines, medications that jails don’t have,” Caldwell said. “So they are better equipped to do those first examinations, because they can do the mental health part and the physical part much more efficiently and much more thoroughly than it can be done in the jail.”
As for using telehealth for mental evaluations, Caldwell said the efforts to conduct telepsychiatry in jails have yielded mixed results.
“Some defendants aren’t interested in being evaluated and they don’t want to come out of their cell in order to be evaluated,” Caldwell told House lawmakers in December.
“Sometimes it’s because they’re paranoid,” he said. “They don’t trust the cameras. They think they’re being surveilled … [or there] are other things that relate to their mental health condition that make it difficult.”
A top focus
Reeder, the committee chairman, works in emergency departments and agrees that they’re not ideal settings to bring criminal defendants who need mental evaluations. He expects legislators to suggest changes to that rule but isn’t sure what exactly the committee might recommend instead.
Reeder wants to continue gathering feedback from those in the law enforcement, judicial and medical communities before drafting new legislation. Reeder said the committee on Wednesday plans to hear presentations on outpatient commitments — orders judges can give in which a patient receives mental health treatment in their community under specific conditions.
“What we’re trying to do in these initial committee steps is level-set so that everybody has an understanding of the different perspectives,” Reeder said.
In the meantime, Reeder and his committee are being asked to hunt down relevant details in the Raleigh murder case.
Camacho had been arrested for breaking-and-entering last year, but a judge dismissed the charges in December after a mental competency exam. Prosecutors asked during that hearing to have Camacho involuntarily committed at a mental hospital, but that request was denied by Judge Louis Meyer, according to District Attorney Lorrin Freeman. Meyer didn’t respond to a WRAL request for comment.
Republican state Reps. Erin Paré and Mike Schietzelt of Wake County are asking committee members to find out: “How could a person who was found to not be competent to proceed to trial … be released not involuntarily committed, even at the request of the District Attorney?” the lawmakers wrote in a letter to committee members.
Reeder said the committee plans to track down the requested information, but he’s not sure if the findings will be shared during a committee meeting. Reeder said he doesn’t want to create policy based on individual cases. The General Assembly is only in session for a handful of months out of the year. Reeder wants to make sure the committee uses its time as effectively as possible.
“The system that we have for taking care of people with mental illness is not functioning well right now,” Reeder said. “Let’s stay focused and come up with some actionable steps that improve the system as we go forward.”