North Carolina legislators say criminal suspects who might need psychiatric treatment should undergo mental evaluations in county jails — not emergency departments, as outlined in the “Iryna’s Law” judicial reform package passed last year.

The House Select Committee on Involuntary Commitment and Public Safety on Tuesday announced several recommendations for improving the state’s procedures for treating criminal suspects who have a history of mental illness. 

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The recommendations come about six months after the North Carolina General Assembly enacted legislation known as “Iryna’s Law” in an attempt to keep more suspects off the streets while awaiting trial. The package was named after Iryna Zarutska, a 23-year-old Ukrainian who moved to Charlotte in 2022 and was fatally stabbed on a city train in August. Her suspected killer, DeCarlos Brown, was deemed incapable of proceeding in a state trial last week following a mental evaluation. He also faces federal charges.

The report released by the House committee Tuesday calls for a variety of changes that could affect medical professionals, the state Department of Health and Human Services, and others involved in the involuntary commitment process. The committee needs to incorporate its recommendations into legislation — and for state lawmakers to approve the legislation — in order for them to become law. 

Among the committee’s recommendations:

  • Lawmakers expand the number of medical providers who are eligible to perform psychiatric evaluations of criminal suspects.
    • State-funded regional behavioral health management companies — known as local management entities or managed care organizations, or LME-MCOs — implement ways to use mobile crisis units in the state’s involuntary commitment process.
      • DHHS develops a special plan for increasing patient capacity at state-run psychiatric facilities.

        The committee also addressed concerns about Iryna’s Law raised by hospital leaders. The North Carolina Healthcare Association — the primary lobbying group for the state’s hospitals — last year pushed back on a new rule requiring certain defendants to be transported “to a hospital emergency department or other crisis facility” for a psychiatric evaluation. Bringing criminal suspects into hospitals can be dangerous for medical providers and their patients, hospital representatives told lawmakers at the committee’s meeting in November. 

        Committee members agree. In its report, the committee said “using telehealth to complete the first examination of the involuntary commitment process (IVC) in jails would address several issues facing the state, its custodial institutions, and the overall efficiency of its mental health systems … [including] long wait times to see providers, transportation issues, logistical issues, and safety concerns.”

        North Carolina’s sheriffs control county jails. Eddie Caldwell, a spokesman for the North Carolina Sheriffs’ Association, said in December that the group would oppose any new proposal for jails to provide initial mental health evaluations and diagnoses. On Tuesday, Caldwell said the association is willing to accommodate the committee’s recommendation — because it only applies to suspects who are already in custody. 

        “The sheriffs are comfortable in having the telehealth evaluations done while the inmate’s in the jail. That promotes public safety, because then you don't have to take an inmate who is in jail, out of jail into the community and into the hospital,” Caldwell told WRAL. 

        Caldwell said sheriffs would, however, oppose an effort to house telehealth evaluations for anyone who’s not facing criminal charges. “Folks who are not already in custody should not be brought into the jail to have their IVC evaluation done, and this proposal doesn't change that,” he said.

        In a statement to WRAL, the North Carolina Hospital Association said it supports the committee’s work: “NCHA will continue to work in partnership with law enforcement, mental health leaders, and state leaders to ensure those in the criminal justice system who need mental health care receive treatment in the most secure setting.”

        The committee’s recommendations enjoyed bipartisan praise from lawmakers Tuesday, though some said the recommendations don’t go far enough.

        The dispute between hospital leaders and sheriffs was “one of the biggest points of contention” amid the committee’s review of North Carolina’s involuntary commitment procedures, said Rep. Marcia Morey, D-Durham. Morey praised committee leaders for addressing the issue, but said the state should also boost wages for employees at the state’s psychiatric facilities —- where beds are going unused the state lacks the staff to monitor them.

        “The immediacy of the issues and the problems are front and center throughout this entire process, and the number one thing seems to be funding,” Morey said.

        State Rep. Tim Reeder, a physician who cochairs the committee, said he plans to continue searching for ways to improve the state’s involuntary commitment procedures. But he disagreed with Morey’s assessment of why the state’s psychiatric facilities face staffing shortages. 

        “For the staffing of state facilities, we have funded positions. Their struggle is finding bodies with which to do it,” Reeder said, referring to the state’s search for qualified employees. 

        Reeder said the recommendations, when adopted, will "help ensure that those people in crisis get help before they reach a point where they may harm themselves or others, through a more effective and efficient system.”

        North Carolina Gov. Josh Stein, a Democrat, signed Iryna’s Law last year after criticizing it as flawed. Stein said lawmakers should have provided more resources for programs focused on people with mental health issues. And in February, Stein signed an executive order creating new strategies for better coordination between the state’s behavioral health and criminal justice systems. 

        Stein’s office issued a statement to WRAL, saying the governor was “pleased to see lawmakers taking a hard look at involuntary commitment across the state.” 

        Stein and Republican state lawmakers have been at odds over funding for Medicaid, the government-funded health insurer for people who are young, impoverished or disabled. Stein’s office said the governor is “eager to work with lawmakers to strengthen our behavioral health system and fully fund Medicaid, the nation’s largest payer for behavioral health services,” adding: “Governor Stein knows that when we get people in crisis they care they need, people are safer as a result.”

        DHHS leaders are reviewing the committee’s recommendations, the agency told WRAL in a statement, adding: “We are committed to ensuring everyone can receive the care that is right for them, at the right time and in the setting that is most appropriate for them.”

        Crimes in the state capitol have put a spotlight on the committee’s work.

        State lawmakers in January called on the committee to investigate the judicial system’s treatment of Ryan Camacho, a Raleigh man charged with killing Ravenscroft teacher Zoe Welsh at her home. Camacho has a documented history of mental illness. In December, when he faced breaking-and-entering charges in a separate incident, a Wake County judge denied prosecutors’ request to have Camacho committed to a mental hospital.

        “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?” Republican state Reps. Erin Paré and Mike Schietzelt of Wake County wrote in a letter to committee members.

        Reeder has said the committee is looking into Camacho’s case. Warrants obtained by WRAL Tuesday show that, after investigators took Camacho into custody, he “made an utterance” about Welsh’s death, indicating he knew how Welsh died.