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State policy should prefer mental health and substance abuse treatment to incarceration. To that end, we should invest in mental health courts to avoid locking up those who really need treatment.

North Carolina’s mental health system faces many challenges, including a recent reorganization and a chronic lack of funding. Those challenges have serious implications for public welfare. North Carolina emergency rooms see patients with mental health issues at double the national rate.1 There aren’t enough mental health facilities to accommodate everyone who needs treatment and many in need of help wind up in the criminal justice system. According to the state Division of Adult Correction and Juvenile Justice, about 12 percent of inmates in North Carolina prisons are mentally ill.A 2004 national survey found 56% of state prisoners had mental health problems.3

There aren’t enough mental health facilities to accommodate and treat all the people who need help, and mental health patients are increasingly likely to seek costly but inadequate emergency care or wind up in the criminal justice system. As incarceration rates continue to climb and funding stagnates or falls, correctional facilities are more and more likely to have inadequate mental health resources. More than half of mentally ill prisoners are re-incarcerated.4

One modern approach is mental health courts, or MHCs—specialized court dockets for defendants with mental health issues. Similar to drug courts, these courts are focused less on sentencing and more on “problem-solving.” MHCs are increasingly popular and proponents argue they alleviate strain on the traditional court system.

Mental health courts aren’t new to North Carolina. The state’s first mental health court in Orange County was authorized by the General Assembly as a pilot program in 2004.5 Five North Carolina counties – Brunswick, Forsyth, Guilford, Orange, and Mecklenburg – currently use mental health courts.6

According to the state court system to be eligible for the mental health courts, “offenders must have a mental health diagnosis or mental health treatment history, with priority given to defendants with severe and persistent mental illness (SPMI). Additionally, all eligible defendants are screened by the District Attorney who attends to public safety concerns.”7

1 The Centers for Disease Control and Prevention. (June 14, 2013). Emergency Department Visits by Patients with Mental Health Disorders — North Carolina, 2008–2010.

3 James, Doris J. and Lauren E. Glaze. 2006. “Mental Health Problems of Prison and Jail Inmates.” Bureau of Justice Statistic Special Report No. NCJ 213600. Washington, DC: US Department of Justice, Office of Justice Programs.

4 Amy Blank Wilson, Jeffrey Draineb, Trevor Hadley, Steve Metraux, Arthur Evans. (2011). Examining the impact of mental illness and substance use on recidivism in a county jail. International Journal of Law and Psychiatry.

5 The North Carolina Court System. "Mental Health Treatment Courts."

6 Ibid.

7 Ibid.