Gov. Josh Stein signed an executive order on Thursday aimed at strengthening North Carolina’s behavioral health and criminal justice systems, after a series of tragedies linked to mental illness across the state.
The governor mentioned the murders in Charlotte, Raleigh, and Southport as he stood beside state officials, doctors, law enforcement, and prison officials during the announcement at the governor’s mansion.
“Our hearts break for the families and friends who lost a loved one,” Stein, a Democrat, said. “Of course, the vast majority of people with mental health challenges don’t pose any risk, they don’t pose risk to others, they may not even pose risks to themselves, although sometimes they do. However, a small minority of people who are experiencing paranoid delusions can pose a risk to public safety when their serious mental illness goes untreated.”
He called for more access to care, and said the killings have shown that the state’s system needs to work better for everyone involved.
The executive order directs the Department of Health and Human Services (NCDHHS), Department of Public Safety (NCDPS), the Department of Adult Correction (NC DAC), and the Office of State Human Resources (OSHR) to work together to strengthen the behavioral health and criminal justice systems in the state, with a focus on when people are in crisis in different stages: when a person experiences a behavioral health crisis before any crimes are committed, during incarceration, and when individuals reenter communities after serving time.
Stein said the co-responder model should be expanded to help when someone is in crisis. Normally, when a person calls 911, the police respond to the call. But, the governor said that may take an officer away from fighting crime elsewhere. Instead, he would like to see social workers and mental health professionals respond to such calls instead, possibly having a social worker at the 911 center working with operators to determine who should answer the call.
The governor also called for strengthening the relationship between 911 and 988, the Suicide and Crisis Hotline, which is intended to divert mental health calls away from 911, and that there is more awareness of 988 to the general public.
Stein also stressed that the state’s involuntary commitment process needs to be improved.
“Involuntary commitment is a needed resource for folks who are struggling with mental health issues or substance use who might hurt themselves or others, and voluntary commitment, or IVC as it is known, those petitions are increasing, but we don’t have enough beds to treat all of the people who need them,” he said. “So I’m directing the Department of Health and Human Services to consult broadly and to recommend IVC reforms for the state. I applaud the efforts by the House IVC committee and the North Carolina Collaboratory.”
A House Select Committee on Involuntary Commitment and Public Safety met last month to discuss the mental health system in North Carolina, specifically, outpatient commitment vs. inpatient commitment, both involuntary and voluntary, and what can be done to improve outcomes.
Stein called on NCDHHS and NC DAC to collaborate on standardizing and improving the state’s existing treatment management program in the Department of Corrections, and includes NCDPS and NCDHHS to provide recommendations on creating a juvenile specific mental health crisis (NCDPS handles the juvenile population) unit while they are in youth development centers.
He noted that 75% of people entering the prison system have substance use issues, 40% have mental health issues, and those numbers are even higher for juveniles, with 98% having at least one mental health diagnosis.
Eventually, 90% of those who are incarcerated will leave prison, making it imperative, the governor said, to get treatment while they are behind bars.
Stein said reentry support needs to be strengthened once people do leave prison. He said18,000 people will leave a state prison this year and come back into the community.
“If people do not have the support that they need in place when they get out it’s all the more likely they will repeat the behaviors that led them to getting incarcerated in the 1st place,” the governor said.
“I’m directing DAC and DHS to recommend strategies on improving and expanding supports for people with mental health conditions who are leaving custody, whether it’s getting them connected to healthcare services, housing, or job opportunities,” he said. “These strategies will further the state’s ongoing Reentry 2030 goals.”
The executive order also directs the Office of State Human Resources to work with NC DAC, NCDHHS and NCDPS to identify and expand recruitment efforts, implement retention programs, address staffing shortages and make policy recommendations, including increasing pay for workers in public safety, behavioral health, law enforcement, and correctional systems.
“At the Department of Adult Correction, we have a vacancy rate of nearly 50% for correctional officers,” Stein noted. “One out of two positions is unfilled, and it shouldn’t be a surprise, frankly, when starting correctional officer pay in North Carolina is 49th in the country. At DHHS, even though there is a long wait list of people needing inpatient treatment, in North Carolina, a quarter of our inpatient units that could serve as many as 300 people sit empty simply because we don’t have the staff to serve them.”
The governor, while complimentary about finding common ground with legislators on several of these issues, reiterated the need for the General Assembly to fully fund Medicaid, as he had done late last year before legislators went home without a new budget in place.
Senate Leader Phil Berger, R-Rockingham, and House Speaker Destin Hall, R-Caldwell, issued a joint statement in November saying that Stein’s demand was unconstitutional and unnecessary.
Legislators noted that when they allocated an additional $600 million to address the Medicaid rebase, NCDHHS “decided to use $100 million of that to cover administrative costs, not services.” They also cited public comments from the DHHS secretary acknowledging that Medicaid funding was sufficient “for Medicaid to operate uninterrupted until April 2026.”
Kelly Crosby, Director of NCDHHS’ Division of Mental Health, Developmental Disabilities, and Substance Use Services, said the executive order will build upon initiatives that NCDHHS has already taken, including the opening of six new behavioral health urgent cares, a new community crisis center, two new peer respite centers, four new co response teams and have expanded a program called Mobile Outreach Response Engagement and Stabilization (MORES) which is a crisis team specifically for adolescents and their families, and additional programs.