Involuntary Treatment in North Carolina: How It Works

This article provides a basic overview of North Carolina’s involuntary commitment procedures and does not substitute for legal advice. If you are planning on filing a petition for involuntary commitment or defending against a petition being filed, we would recommend consulting with an attorney or your local legal aid office.

What Is Involuntary Treatment?

Involuntary treatment refers to psychiatric or substance use treatment ordered by a court for a person who did not give their consent to it, or who is not able to make that decision themselves.[1]

In North Carolina, this process is known as involuntary commitment, often abbreviated as IVC. Involuntary commitment can apply to those experiencing a mental health crisis or those with a substance use disorder meeting certain legal requirements.[2]

In contrast to voluntary admissions, where someone willingly enters a psychiatric hospital or treatment program on their own, involuntary commitment is reserved for circumstances where a person’s mental illness or substance use disorder has made them a danger to themselves or others, and they cannot or will not seek treatment on their own.

The Legal Framework Behind North Carolina’s Involuntary Commitment Law

North Carolina’s involuntary commitment statutes can be found in Chapter 122C of the North Carolina General Statutes, the state’s Mental Health, Developmental Disabilities, and Substance Abuse Act.[3]

This law establishes both the criteria a person must meet for commitment and the formal steps needed to safeguard the rights of respondents (the legal term for the person the petition is being filed against) during this process.

The laws governing involuntary commitments were developed to strike a balance between providing rapid access to treatment for persons in crisis and ensuring that no person loses their freedom without undergoing a judicially supervised process. Because of this, Chapter 122C mandates multiple medical exams and a hearing before a judge, as opposed to permitting a single person to order commitment on their own.[4] [5]

How Involuntary Commitment Works in North Carolina

Typically, the involuntary commitment process follows these general steps:

1. Emergency Petition

The process usually begins with an emergency petition, which may be filed by a family member, friend, police officer, or other concerned party, and reviewed by a magistrate or clerk of superior court.

The petitioner must detail the specific behaviors showing the person exhibits symptoms of mental illness or has a substance use disorder and is dangerous to themselves or others.

2. Custody Order

If the magistrate finds reasonable cause to conclude that the statutory elements have been satisfied, they then sign a custody order.

This order directs a police officer to take the respondent into custody and deliver them to a 24-hour facility such as a psychiatric hospital emergency department for an initial medical exam.

3. First and Second Examinations

On arrival at the 24-hour facility, a commitment examiner, typically a doctor or licensed clinician, performs an initial medical examination to determine if the respondent meets the statutorily required elements for continuing commitment.

If so, the respondent is typically transported for a second medical exam by a qualified professional, typically at a psychiatric hospital, within a specified number of days.

4. District Court Hearing

Before proceeding to district court, both medical examinations must confirm that the respondent meets all statutorily required elements for commitment. At the district court hearing, the judge will review the evidence presented, which might include sworn testimony from the commitment examiner, family members, or crisis service personnel.

According to North Carolina law, clear, cogent, and convincing evidence, a high legal standard, must be established prior to ordering commitment. Respondents have the right to an attorney or to be assigned counsel if they do not have one.

5. Commitment Outcome

Depending on the outcome of the district court hearing, the judge may order commitment at a psychiatric hospital or outpatient commitment that requires the person to follow a treatment regimen outside of a hospital setting.

When outpatient commitment is ordered, respondents’ treatment plans are often coordinated through their respective local management entity/managed care organization (LME/MCO), the regional entity responsible for managing public behavioral health services in North Carolina.

Who’s Involved in the Involuntary Commitment Process?

Many people and organizations participate in the process of involuntary commitment in North Carolina.

• Respondent – The person the petition is about.
• Petitioner – The person who submits the petition to have someone involuntarily committed. In North Carolina, this can be anyone with knowledge of that person’s condition, including a family member, friend, neighbor, law enforcement officer, employer, or other concerned party
• Clerk of superior court or magistrate – Reviews the original petition submitted by the petitioner.
• Commitment examiners and qualified professionals – Conduct the medical examination(s) of the respondent.
• Mobile crisis teams – May be dispatched to assist during a behavioral health emergency before a petition is filed.
• District court judge – Presides over the commitment hearing.
• Local management entity (LME)/managed care organization (MCO) – Coordinates outpatient plans and provides access to ongoing psychiatric or substance use services.

Benefits and Challenges of Involuntary Treatment

Involuntary treatment can save lives for those with severe mental illness or substance use disorder who are unable to recognize their own need for help. It can intervene in a potentially dangerous pattern, provide temporary stabilization in a crisis situation, and provide access to a psychiatric hospital or treatment program that the person would likely never have attended voluntarily.

However, there are significant drawbacks associated with involuntary commitment.

Being taken into custody by law enforcement and held at a 24-hour facility can be extremely intimidating and, for many people, traumatic, even if it was medically required. The court process surrounding civil commitment can also be overwhelming for family members and friends. There’s no guarantee that someone will continue treatment after a court-ordered outpatient commitment ends, and civil commitment should never be considered a form of long-term care. It works best as a bridge into a sustained, ongoing treatment plan, rather than a single, isolated event.

Getting Support During a Mental Health or Substance Use Crisis

North Carolinians can call or text 988 to reach the Suicide and Crisis Lifeline, a 24-hour hotline that links callers with trained crisis counselors who will provide guidance throughout their crisis experience.

Mobile crisis teams operate in several counties across the state, including Wake County, and are able to physically visit individuals experiencing a mental health emergency. In many cases, the goal of these mobile crisis teams is to prevent involuntary commitment by stabilizing the individual through intervention and connection with local resources.

As important as addressing the crisis itself is the impact of what happens following involuntary commitment. New Waters Recovery in Raleigh, North Carolina, provides medical detoxification, residential drug rehab, and psychological evaluation for individuals transitioning from an acute crisis or hospital environment back into their daily life. Our staff assists clients and families in identifying suitable post-commitment interventions, either continuing psychiatric care and substance use treatment or receiving outpatient support locally.

If you would like more information about involuntary treatment in North Carolina or about what treatment could look like for someone you love, reach out today.

Frequently Asked Questions About Involuntary Treatment in North Carolina