What happens when someone in mental distress goes to the ER? NC Health News

Editor’s note: This article references self harm and suicide. Please use caution when reading. There are several mental health support resources listed at the end of this article.

By Taylor Knopf

When a loved one is experiencing a mental health crisis, families often go to their local emergency room for help.

This can set off a cascade of events that most people are unaware of and, quite frankly, blindsided by. NC Health News regularly receives emails and calls from families in different stages of this process who are either in shock about what’s happening or angered by the treatment — or lack of treatment — their loved one is receiving.

Family members often feel helpless. As health journalists, we often find ourselves answering their questions about the mental health system and explaining the applicable state and federal laws so people know what to expect — and what is and isn’t normal. For these families and individuals, being armed with information demystifies the process and helps them make informed decisions when advocating for themselves and their loved ones during a mental health episode.

This article attempts to explain North Carolina’s mental health laws as they are written. However, mental health legal experts and advocates routinely hear from people across the state whose experiences do not reflect the allowances under state law. 

The law can be nuanced and complicated, and medical providers and law enforcement officers are not always aware of all of the provisions. North Carolina’s mental health laws are contained in General Statutes Chapter 122C. It’s a long statute with many subsections, several of which are referenced throughout this article.

The contents of this article are not intended to substitute for medical or legal advice. 

NC Health News would like to thank mental health legal expert Mark Botts, associate professor of public law and government in the School of Government at UNC Chapel Hill, for his consultation and guidance on this article. 

Is the patient a danger to themselves or others? 

One key factor that hospital staff will determine when a patient shows up in their emergency room in mental health distress is whether the patient is a danger to themselves or others.

The definition of “danger to self or others” is outlined in North Carolina state law under General Statute 122C-3(11) as someone who has recently demonstrated behavior that falls into one of the following descriptions:

  • Being “unable, without care, supervision, and the continued assistance of others not otherwise available, to exercise self-control, judgment, and discretion in the conduct of the individual’s daily responsibilities and social relations, or to satisfy the individual’s need for nourishment, personal or medical care, shelter, or self-protection and safety. There is a reasonable probability of the individual’s suffering serious physical debilitation within the near future unless adequate treatment is given… A showing of behavior that is grossly irrational, of actions that the individual is unable to control, of behavior that is grossly inappropriate to the situation, or of other evidence of severely
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