North Carolina Invests in Mental Health Crisis Transportation

A new program provides non-law enforcement transport from ER to inpatient care.

Reviewed by Michelle Quirk

Key points

• Relying on law enforcement to transport mental health patients criminalizes psychiatric crises.
• The use of law enforcement restraints during transfers unduly traumatizes mental health patients.
• North Carolina has announced a $20 million investment in non-law enforcement transportation programs.

I was admitted to an inpatient mental health facility in March 2020. Over the previous year, my bipolar I disorder had caused me to swing from a severe manic episode to a deep and treatment-resistant depression. I struggled to get out of bed and went for days without the energy to shower or even change clothes.

I hadn't been able to work for months, and the many projects I had taken on at the height of my mania now sat abandoned. I had previously been resistant to the prospect of inpatient treatment, but when I lost my partnership with the law firm where I practiced, I couldn't deny that it was what I needed.

My girlfriend took me to a local mental health clinic and crisis stabilization center. They found a bed for me at an inpatient facility two hours away and said that they'd arrange for transport.

As I've written before, it was the beginning of what felt more like incarceration than voluntary commitment. Although I was cooperative and nonviolent, and I wasn't threatening to hurt myself, I was informed that I'd have to be transported in the back of a law enforcement vehicle while in handcuffs attached to a chain around my waist.

Within the cramped, stuffy, steel mesh cage, I sat at an angle so that I would have room for my knees and legs. I shifted my wrists and arms to allow the handcuffs and chain to settle before finding the least uncomfortable position to rest my hands. Then I closed my eyes and tried to focus on my breathing as I skirted the edge of a panic attack for the next two hours. (In addition to my bipolar I disorder, I also have an anxiety disorder and complex posttraumatic stress disorder.)

Use of Law Enforcement for Mental Health Patient Transfers

Historically, a lack of resources led to a common practice of relying on officers from police and sheriffs’ departments to transport mental health patients between facilities. Unfortunately, the general misconception that all mental health patients are automatically a danger to themselves and others often results in patients in crisis being treated like criminals under arrest. In particular, the use of law enforcement restraints unduly traumatizes mental health patients who are already in crisis and can convert a compliant patient into a combative one (particularly among those on the autism spectrum).

In addition, having law enforcement professionals without adequate medical training responsible for restrained patients who may medically decompensate during transport can expose those professionals and their departments to significant liability risk.

North Carolina Invests in Non-Law Enforcement Transportation for People in Mental Health Crisis

On December 20, 2024, the North Carolina Department of Health and Human Services (NCDHHS) announced a $20 million investment in non-law enforcement transportation for those experiencing a mental health crisis. This approach provides trauma-informed transportation from emergency rooms to inpatient treatment for people in mental health crisis and aims to decriminalize and destigmatize the process of seeking mental health care.

"Knowing a person may be transported in police custody can be a deterrent for people reaching out for the care that they need," said Kelly Crosbie, MSW, LCSW, director of the NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services. "We want people and families feeling comfortable reaching out for mental health crisis support when they need it."

The initiative is part of a broader $835 million commitment by NCDHHS to transform North Carolina’s behavioral health system. The new program will initially operate in two regions of the state, which will be identified through a competitive request for proposal process.

"This program helps people experiencing a mental health crisis receive safe transportation to the inpatient care that they need," said NCDHHS Secretary Kody H. Kinsley. "People in crisis need health care, not handcuffs."