Carolina Criminal Defense & DUI Lawyer UpdatesThe relationship between mental health and the criminal justice system in North Carolina exposes structural challenges that extend 
far beyond the walls of the courtroom. While jails are traditionally viewed as holding facilities for criminal defendants accused of crimes, it is not uncommon for people experiencing acute mental health crises to be booked into jail rather than admitted to a psychiatric or substance use treatment facility equipped to provide appropriate care.
For criminal defense lawyers and other legal professionals working in big cities like Charlotte, a significant portion of the criminal court docket touches mental health in some form—often not because the court is the proper venue, but because no better options exist. All too often, jails and courtrooms serve as a kind of revolving door for people suffering from chronic mental illness. Someone in crisis may be arrested on a low-level charge, detained, and later released, only to return to custody days or weeks later under similar circumstances.
Some defendants are charged with misdemeanors such as public intoxication, trespassing, shoplifting, or simple drug possession. Others may face more serious felony allegations, including felony assault or breaking and entering. In certain cases, the defendant may be found legally incompetent to stand trial and must wait for mental health treatment before their case can proceed.
In those instances, they’re not serving sentences. Some may remain in custody for extended periods, not because they’ve been sentenced, but because they are awaiting competency evaluation and the administration of medications, court hearings, or decisions on unresolved charges. The delay may be procedural rather than punitive — and it reflects a lack of timely access to appropriate mental health services, not a completed sentence.
The reasons people with mental illness end up in jail are not always obvious, especially to those outside the system. It is not simply a matter of bad choices or bad luck. Instead, it reflects a combination of policy gaps, procedural delays, and systemic constraints that leave few viable alternatives. Understanding how this happens requires looking at the structure of North Carolina’s behavioral health system, the role of local courts, and the limitations placed on jails, sheriffs, and defense attorneys who are not mental health providers but are often left to manage its consequences.
At Powers Law Firm, we handle serious criminal defense matters and also contribute to broader conversations about law and public policy in North Carolina. To speak with someone about a criminal case or to learn more about how these issues affect court proceedings, call 704-342-4357.
The Mental Health Criminal Justice System in North Carolina
North Carolina’s criminal courts regularly encounter defendants with serious mental health needs. In some cases, they stand accused of non-violent, low-level offenses like trespassing, disorderly conduct, or minor property crimes. These behaviors may stem directly from untreated psychiatric and/or substance abuse symptoms—paranoia, hallucinations, or impaired judgment—rather than deliberate criminal intent. But once an arrest occurs, the system often shifts from treatment to custody. Even where jail is clearly not the right environment, it may be the only facility available.
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For more serious offenses, mental health issues often complicate—not necessarily eliminate—prosecution. A defendant may have been impaired at the time of the alleged offense but still legally competent to stand trial. In some instances, the accused’s mental state raises concerns about their ability to understand the nature and object of the criminal charges or assist in their own defense in a meaningful fashion. At that point, the court may order a formal evaluation to determine whether the defendant is legally competent to proceed.
This is where the process becomes slow and increasingly complex. If someone facing criminal charges is found incompetent, the next step under North Carolina law is attempting “restoration.” That may require treatment in a hospital or designated mental health facility. But those placements are limited, at best. State psychiatric hospitals operate under severe capacity constraints, and there are often far more defendants waiting for restoration than there are available beds. Priority is given to those with the most extreme mental health issues, those with the potential of hurting themselves or others if not immediately treated. The result is that a defendant may sit in a county jail for weeks—or months—waiting for a transfer, even after being found unfit to participate in their own case.
How North Carolina Manages Mental Health Crises in the Criminal Justice System
North Carolina General Statute Chapter 15A-1002 provides the framework for determining whether a person is competent to stand trial. A defendant is considered legally incompetent if, due to mental illness or intellectual disability, they are unable to understand the nature and object of the proceedings or to assist in their own defense in a rational manner. While a legal finding, a medical diagnosis can play an important role in the determination. The standard focuses on functional ability within the context of the court process.
When a question of competence arises, the court may order an evaluation by a qualified forensic examiner. These evaluations are often performed through the state’s network of Local Management Entities/Managed Care Organizations (LME/MCOs), which are responsible for coordinating behavioral health services. In some cases, evaluations are conducted in the jail itself; in others, the defendant must be transported to an off-site location.
In North Carolina, Local Management Entities/Managed Care Organizations (LME/MCOs) are designated by state law as the public system entities responsible for managing, coordinating, and overseeing behavioral health services (including mental health, developmental disabilities, and substance use disorder services) for Medicaid and state-funded recipients.
Legal Authority:
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G.S. § 122C-115.4 and G.S. § 122C-116: These statutes establish the framework for the LME/MCO system and delegate the responsibility for managing publicly funded behavioral health services to these regional entities.
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North Carolina Department of Health and Human Services (NC DHHS) also confirms the role of LME/MCOs on its official site, describing them as the “primary managers of public services for people with mental illness, intellectual/developmental disabilities, and substance use disorders.”
Each LME/MCO contracts with the state to provide or coordinate services such as:
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Outpatient psychiatric treatment
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Emergency and crisis services
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Competency evaluations
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Restoration-to-competency services
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Residential and community-based treatment
If the court finds the defendant incompetent, it may order restoration services. The goal is to restore competence so that the case can proceed. Restoration may involve medication management and psychotherapy. In North Carolina, inpatient psychiatric services, including competency evaluations and restoration, are provided by the state’s regional psychiatric hospitals: Central Regional Hospital in Butner, Broughton Hospital in Morganton, and Cherry Hospital in Goldsboro.
However, the demand for beds far exceeds the supply. Many defendants found incompetent must wait in jail until space becomes available. During this time, they may not be receiving adequate treatment. Jail staff are not equipped to provide long-term psychiatric care, and the environment can exacerbate symptoms of mental illness. In some instances, the wait can extend for weeks or longer, creating a situation where a defendant is effectively detained without trial and without treatment.
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The challenge does not end once restoration begins. Even after competence is restored, delays in the legal process, transportation back to jail, or further procedural issues may lead to prolonged detention.
Relevant Law: N.C. Gen. Stat. § 15A-1003(c)–(d)
When a defendant is found incompetent to proceed and unlikely to regain competency in the foreseeable future, North Carolina law does not allow continued detention without proper legal justification. The statute outlines the following steps:
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Dismissal Required Absent Civil Commitment
If the court determines that restoration is not reasonably foreseeable, it must dismiss the charges unless the State requests a short delay to initiate civil commitment proceedings under Chapter 122C. -
Temporary Civil Custody Permitted During Commitment Process
If the State pursues civil commitment, the defendant may be held temporarily while an evaluation or placement decision is pending—but only under civil authority, not as part of continued criminal detention. -
Dismissal Required if Commitment Is Not Granted
If the defendant is not civilly committed or the petition is denied, the criminal charges must be dismissed. Continued incarceration based solely on a lack of available placement is not permitted under North Carolina law.
The Broader Impact on Jails, Courts, and Public Services
County jails in North Carolina have increasingly become de facto mental health facilities. Sheriffs across the state have raised concerns about housing large numbers of detainees with untreated psychiatric conditions.
Eddie Caldwell, general counsel to the North Carolina Sheriffs’ Association, has publicly stated that many sheriffs believe individuals with mental health needs should receive services from mental health professionals and facilities, rather than being housed in county jails. He emphasized that the current system strains law enforcement resources and is not conducive to proper care for those with mental illnesses.
Additionally, Assistant Chief Deputy Becky Cauthran of the Gaston County Sheriff’s Office estimated that approximately half of the jail’s inmates have psychiatric problems. She noted that some individuals require more treatment than the detention facility can provide, highlighting the challenges jails face in managing inmates with serious mental health issues.
These concerns have led to initiatives such as jail-based capacity restoration programs, working to provide mental health treatment within detention centers to reduce the burden on state psychiatric hospitals and expedite the legal process for defendants deemed unfit to stand trial.
Furthermore, the North Carolina Sheriffs’ Association has advocated for the removal of law enforcement from the transportation of individuals under involuntary commitment, suggesting that mental health professionals should assume this role to ensure appropriate care and reduce the strain on sheriff’s departments.
Jail officers are not licensed mental health professionals, but they are regularly tasked with managing suicidal behavior, psychosis, and medication compliance. This creates serious safety concerns for both staff and inmates, diverting resources away from the jail’s core custodial mission.
Defense attorneys and prosecutors also face challenges. Criminal defense lawyers may struggle to communicate effectively with clients who are experiencing active symptoms. Prosecutors may face pressure to move cases forward while also knowing that continued detention serves neither the interest of justice nor the defendant’s well-being. Judges must balance competing obligations: protecting the defendant’s rights, maintaining public safety, and managing limited court and jail resources.
From a policy standpoint, the system is strained at every point. Behavioral health services are fragmented, with variation in resources between counties. Some areas have access to crisis response teams, diversion programs, and community-based outpatient treatment. Others do not. For defendants without private insurance or consistent access to care, too often jail becomes the fallback—not because it is suitable, but because it is available.
This creates a circular dynamic. A defendant experiencing a mental health crisis behaves in a way that draws law enforcement’s attention. They accused may be arrested, often on a low-level charge. The jail, lacking alternatives, holds them. Courts become involved, but evaluations and restoration take time. Meanwhile, the underlying psychiatric condition remains untreated and, in some instances, deteriorates. Even if the charge is eventually dismissed or reduced, the damage—psychological, legal, financial—has already been done.
What This Means for Criminal Defense Laweyrs, Legal Professionals, and Public Policy
Understanding how and why people with serious mental health conditions end up in jail is not just a matter of sympathy or advocacy—it is necessary for informed legal practice. Attorneys, judges, and law enforcement officers regularly encounter defendants whose primary barrier to release or resolution is not legal complexity but a lack of adequate services. Without alternatives to incarceration, the courtroom becomes the bottleneck through which mental health issues are forced to pass.
Recent efforts in North Carolina have tried to address some of these issues. Some judicial districts are experimenting with mental health court dockets. Others are working with local LME/MCOs to improve access to outpatient restoration. But statewide, there is no uniform solution. The challenges vary by county, by charge, and by the resources available at any given moment.
For those working within the system, the question is not whether to address these issues, but how to do so. Courts are not mental health providers. Jails are not hospitals. Yet in practice, these institutions are where mental health crises are managed—and often, contained. This tension is likely to persist unless the broader behavioral health infrastructure expands in ways that give law enforcement, courts, and families real options before a person ends up in custody.
Powers Law Firm provides representation in serious criminal cases and participates in ongoing discussions about legal and policy issues across North Carolina. If you’re facing a criminal charge and want to know whether we’re available to help, call 704-342-4357.