Sheriffs want out of transporting of psych patients

By Taylor Knopf

When two sheriff’s deputies showed up at the hospital room of John Noel’s husband, Chris, he thought he was being arrested. No one had told him they were coming. 

The deputies handcuffed Chris and escorted him to the back seat of a patrol car, according to Noel. Driving away from the hospital, Chris asked the officers if they were taking him to prison. They ignored his questions. 

(NC Health News verified Chris’ identity and chose not to identify him by his real name due to the ongoing stigma of mental illness and involuntary commitment.)

The officers were taking Chris from the emergency department at Duke Regional Hospital in Durham to Holly Hill Hospital, a psychiatric facility in Raleigh under an involuntary commitment order. 

Meanwhile, Noel was at home and had no idea. Had he known about the order, Noel says he would’ve tried to prevent it or driven Chris to Holly Hill himself.

Involuntary commitments are ordered by a judge when a person is determined to be a danger to themselves or others. In most North Carolina counties, a commitment order triggers a call to law enforcement to transport the patient to a hospital to be evaluated or to an available psychiatric bed. The nearest opening could be located at a hospital several hours away.

Amid local and national conversations about “defunding the police,” this practice is getting a new look. Even law enforcement officials are asking if some of the roles assigned to them — such as transporting mental health patients and responding to mental health crises — should be done by professionals with a different set of skills. 

Increasingly, sheriffs across North Carolina appear to be agreeing with mental health advocates on this point. 

Transporting psychiatric patients

More and more patients have found themselves handcuffed in the back of a police car over the last several years. NC Health News reported a 91 percent increase in involuntary commitment petitions over the decade prior to the pandemic, far outpacing population growth in the state. 

North Carolina counties are required by state law to provide secure transportation for psychiatric patients under an involuntary commitment order. In most counties, sheriffs’ departments are tasked with this job. 

But many sheriffs say they do not want this responsibility anymore.

In March, the NC Sheriffs’ Association released an updated report on “law enforcement professionalism” in response to the national protests and conversations about the responsibilities of law enforcement that erupted after the death of George Floyd

Among the list of changes and requests, the sheriffs ask state lawmakers to pass legislation removing their role of transporting patients under involuntary commitment. The sheriffs said that mental health professionals should be transporting these patients and they also ask for more state funding for substance use and mental health treatment.

Eddie Caldwell, general counsel to the NC Sheriffs’ Association. Photo courtesy of the NC Sheriffs’ Association

“I believe that it is the general feeling of the law-enforcement community that persons with mental health needs should more appropriately receive the services that they need from mental health professionals and mental health facilities rather than from law-enforcement officers or the county jail,” Eddie Caldwell, general counsel to the NC Sheriffs’ Association, told NC Health News in an email.

Caldwell has previously explained how transporting patients under involuntary commitment orders strains those sheriffs’ departments with fewer resources, especially when they have to drive patients hours across the state. 

The request from the sheriffs’ association could be a pivotal point for North Carolina’s involuntary commitment process, which advocates say currently compounds the trauma for many patients by involving law enforcement. However, there’s a concern that county officials may shift transit responsibilities from deputies to contracted security companies that have less oversight than government agencies.

‘Felt like a prisoner’

One night in February, Noel and Chris were getting ready for bed at their home in Durham when Noel said his husband suddenly seemed to be in a “parallel universe.” He was restating claims from a past psychotic episode and trying to leave the house carrying a backpack full of mustard to fix a problem at a six-figure job he no longer had, Noel recalled.

Noel said they needed to go to the emergency room, and Chris — who was recently diagnosed with type 1 Bipolar disorder — didn’t argue and went willingly. 

What Noel didn’t expect was five days to pass before he heard Chris’ voice, calling from Holly Hill. Noel claims that no one at Duke Regional or Holly Hill would confirm where his husband was during the five-day interval. 

Chris described how confused he was when officers handcuffed him and put him in the back of a cruiser. He said he felt like a prisoner and asked Noel, “why did you put me here?”

“It really just broke my heart that he went through that,” Noel told NC Health News later. “I was both angry and crying at the same time. I just felt like I had failed him somehow.”

In 2019, counties were tasked with rethinking how they transported patients like Noel’s husband after a state law went into effect aimed at reforming parts of the involuntary commitment process. County leaders met and most submitted updated transportation plans to the state health department. 

NC Health News reviewed those plans and previously reported that most counties chose to continue using local law enforcement for patient transportation. A very small number opted to contract with private security companies or local EMS to transport patients. 

Opting for private security guards

Mental health advocates are concerned that as counties and behavioral health management groups look for alternatives to police transports that more will default to contracting with G4S, a private security company already used by a couple of counties. The state of Virginia recently awarded G4S a $7 million contract to transport nearly half of its mental health patients under involuntary commitment instead of law enforcement.

“Having off duty police officers or security guards transporting is not what is meant by an alternative to police transport,” said Cherene Allen-Caraco, director of Charlotte-based Promise Resource Network, a mental health services agency run by people with lived experiences of mental illness, incarceration, homelessness and substance use. 

Founder and CEO of Promise Resource Network Cherene Allen-Caraco is flanked by peer support specialists and local law enforcement officials at the ribbon-cutting ceremony for the mental health agency’s peer-run respite in Charlotte. Photo credit: Taylor Knopf

Allen-Caraco advocates for non-coercive, non-restrictive mental health treatment and support. She doesn’t want to see more patients transported by private security officers, who she said receive little pay or training for the role. She also pointed to an incident last year in Charlotte when a G4S security guard was charged with sexual assault of a minor after allegedly raping a 14-year-old girl he was transporting to the hospital under an involuntary commitment. 

G4S has been transporting mental health patients since 2012, according to a spokesperson for Allied Universal, which acquired G4S last year. 

“Allied Universal employees entrusted with this role go through enhanced training focused on healthcare essentials, de-escalation, safe driving and safety near or around stairs. Additionally, Allied Universal has a certified Mental Health First Aid Trainer on staff to train all new hires in this role. Allied Universal employees also receive training from third parties and client-specific training on working with individuals with autism and other conditions,” a spokesperson wrote in an email to NC Health News

A number of North Carolina counties’ updated transportation plans included a clause with an option to use a contractor like G4S in the future. Other plans had details about using officers of the same gender as the patient when possible or officers in plain clothes rather than full uniform. 

A handful of plans went so far as to lump together prisoners and mental health patients in their transportation plans. And in some cases, the transportation of incarcerated people and psychiatric patients looks very similar.  

Criminalizing mental health

Nine years ago, sheriff deputies loaded Susan Silver’s daughter, Anne, into a prisoner transport van and drove her from an emergency department in Wilmington to a psychiatric bed two hours away in Greenville. It was the same kind of vehicle Silver would see sitting outside the courthouse each weekday. 

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