When and How to Involuntarily Commitment someone in NC

By Melissa D.L. Jacobs, MSW, LCSW

The longer we live the more we understand that a life crisis can come at any moment. There may come a time where a loved one is experiencing a mental health crisis and needs emergency mental health treatment. When the loved one is willing to seek treatment, the crisis can become a little easier to manage. However, when the loved one refuses to accept treatment or even acknowledge they need treatment, then the crisis can become severely overwhelming. In North Carolina, there is an option for loved ones in this situation to initiate treatment without the consent of those needing treatment. This process is called Involuntary Commitment or more commonly referred to as, Petition. The Involuntary Commitment process can be initiated so that the individual in a mental health crisis can received a mental health evaluation by a Physician and/or eligible Psychologist. In a few counties in NC there are specially trained Masters Level Clinicians (i.e. Psychiatric Nurse, Certified Addiction Specialists or Licensed Clinical Social Worker) who can complete the first evaluation for Involuntary Commitment. These Masters Level Clinicians have been specially trained to complete the evaluations under a pilot program for the state. More often than not, however, the first evaluations are completed by a Psychiatrist. So how do you know if you can initiate the process for Involuntary Commitment? The simplest answer is there must be a dangerousness factor, and it should be real and imminent. For instance: - serious suicide threat - suicide attempt - threats to kill others - attacks on others that caused or could have caused injury - attacks on others that caused or could have caused death. The terms most often used to describe these behaviors are, Suicidal or Homicidal. There are times, in a mental health crisis where the person may not be suicidal or homicidal and still need an evaluation. In these cases, there is severe mental illness that is impairing the functioning of the individual to the point where the person is considered a danger to self or others if immediate treatment is not given.

When there is severe mental illness to the point of dangerousness, it most often is due to psychosis. Dictionary.com defines psychosis as, mental disorder characterized by symptoms, such as delusions or hallucinations, that indicate impaired contact with reality. A high percentage of involuntary commitments are initiated due to what is called a psychotic break or episode. Another reason the petition process could begin would be due to an individual abusing substances and being a danger to self or others. However, its important to know that abusing substances in and of itself is NOT a criterion for commitment. Unfortunately, many people want to force their loved ones into obtaining substance abuse treatment, but that cannot be done. If an involuntary commitment is issued for substance use, there has to be evidence of dangerousness to self or others. The commitment process can be initiated by anyone with first hand knowledge about the situation. It doesnt have to be a relative. It could be a neighbor, pastor, teacher, family doctor, etc. The person requesting the commitment is often called, the petitioner. To have first hand knowledge implies that the petitioner has seen or heard the individual make threats, behave in bizarre manners, etc. One thing that loved ones must know when initiating the commitment process for involuntary hospitalization is that taking out a petition does not mean the person will automatically be involuntarily committed and sent to a hospital. The initiation of the commitment process only allows the magistrate to issue a custody order. This custody order allows the police to take the person into their custody for immediate transport to the nearest mental health facility or hospital where they can be examined by a qualified examiner. The petition issued by the magistrate is good for a period of 24 hours to allow the police the opportunity to locate the individual for pickup. If the individual cannot be found during the 24 hours, and the mental health crisis persists, another request would need to be made to the magistrate to issue a new petition. To initiate the process for involuntary commitment, the individual with first hand knowledge must present to the magistrates office. A petition cannot be issued over the telephone. During business hours the civil magistrate handles petitions and in many counties after-hours, the criminal magistrate will issue the petitions for involuntary hospitalization. The Involuntary Commitment process is a good resource for those who desperately need assistance in a mental health crisis to obtain a face-to-face evaluation for their loved ones.