Frustrated by defendants languishing in their jails, three sheriffs bring mental health treatment behind bars
By Rachel Crumpler
A handful of men in orange jumpsuits gather around tables in a specialized unit on the second floor of the Mecklenburg County Detention Center.
They turn their attention to a whiteboard with the words “defendant,” “judge,” “defense attorney,” “district attorney,” “jury” and other legal terms written on it.
A mental health clinician is there to lead a group lesson on the roles and responsibilities of court personnel. It’s one of a series of sessions the men will participate in that’s focused on their mental health and on boosting their understanding of the legal system.
The men are there because they have been deemed “incapable of proceeding,” meaning they are so mentally impaired that they can neither understand the court proceedings before them nor rationally work with an attorney to help in their defense. These men’s issues range from having intellectual disabilities that lead them to struggle with retaining information to those with psychotic symptoms, such as active hallucinations and delusional beliefs, that interfere with their capacity to proceed to trial.
For most criminal defendants in North Carolina jails, this designation leads to a monthslong wait for a bed in a state-run psychiatric hospital to become available so they can then begin receiving mental “capacity restoration” services that are intended to help them get well enough to go to court.
REad more coverage of capacity restoration services
NC defendants with mental illness wait months in jail for court-ordered treatment
by Rachel Crumpler
February 27, 2025February 27, 2025
On average, these jail detainees wait 173 days — nearly six months — before being admitted to one of three state-run psychiatric hospitals for treatment, according to statistics from the N.C. Department of Health and Human Services.
But this group of men, instead of waiting for a scarce hospital bed, is receiving those services inside the detention center. They are taking part in the state’s first jail-based capacity restoration program — a partnership between DHHS and the Mecklenburg County Sheriff’s Office.
The goal? To move people more quickly through the capacity restoration process.
Growing trend
Mecklenburg’s 10-bed unit has served 60 people since the program’s launch in December 2022, said Anna Abate, program administrator for North Carolina’s detention-based RISE (Restoring Individuals Safely and Effectively) capacity restoration programs.
Early results are promising. Data shows the Mecklenburg jail program has been able to help about 80 percent of participants regain the psychological capacity to stand trial.
The program will expand this month to accommodate up to 25 people, including some criminal defendants from other counties.
Providing capacity restoration in jails is part of the state’s effort to meet the increasing demand for such services. Tackling this problem also has the potential to reduce wait times for everyone in the state by reducing the load at North Carolina’s overburdened state psychiatric hospitals, which have historically been the only setting to provide this care.
The state’s second detention-based capacity restoration program — in Pitt County — started serving people on Feb. 24. And a third is expected to start in the coming weeks in Wake County.
“Unfortunately, a lot of individuals with mental health end up in the criminal justice setting and will end up in a detention center,” Abate said. “So while they’re here, rather than just kind of waiting for a bed at the hospital, it’s great to have this option that they can go ahead and get this treatment for capacity restoration.”
The Mecklenburg County Arrest Processing Center in Charlotte. Some people who are arrested and held in jail are too ill to proceed to trial and require capacity restoration services. Credit: Rachel Crumpler / NC Health News
Toll of long waits
Jails are on the front lines of North Carolina’s capacity restoration challenges. Long waits for treatment take a toll on criminal defendants in jails; they often deteriorate during the limbo period. They also take a toll on jail staff who are not adequately trained for the long-term management of people with serious mental health issues.
As of the end of January, 157 people in jail were on the waitlist for a spot in a state hospital for capacity restoration services, according to data shared with NC Health News.
Sheriff Garry McFadden took office in December 2018. He stands at the entrance of the capacity restoration unit inside the Mecklenburg County Detention Center. Credit: Rachel Crumpler / NC Health News
Mecklenburg County Sheriff Garry McFadden told NC Health News that a handful of people in his detention center have been there since he took office in December 2018, stuck in a cycle of mental decompensation — waiting to go to trial.
“We don’t know all the factors, but for us, it’s a lot of work, because when these people are here — housed here for that long — they get discouraged,” McFadden said. “They don’t care, and then they act out.”
Eddie Caldwell, executive vice president and general counsel at the North Carolina Sheriffs’ Association, said detainees deemed incapable to proceed are some of the most expensive and difficult to manage.
“Jails are not meant to be prisons — they’re not for holding folks for a long period of time,” Caldwell said. “They’re designed to get them in, get their court case heard and get them out.
“[These inmates] occupy a bed in jail at considerable expense to the county for a reason that could be solved otherwise,” he continued. “It’s difficult to deal with inmates who have mental health issues when you don’t have adequate mental health professionals to both deal with them and try to help them. The problems fall on the sheriffs when these defendants can’t get the help that they need.”
Untreated mental illness often results in disruptive behavioral issues, such as violent outbursts or throwing feces that jail staff have to confront, McFadden said. Ultimately, that can prompt jail staff to place defendants ruled incapable of proceeding to trial into solitary confinement to protect themselves and others around them. But research shows that this isolation often further exacerbates mental health issues.
“As they await their day in court, it only further contributes to the decay of their mental well-being,” Pitt County Sheriff Paula Dance said. “It’s just a snowball effect. It only goes downhill when we are not addressing the root cause, which is the mental health of these inmates and their inability to be able to help themselves or their attorneys to resolve their cases.”
She said she has five detainees who have been deemed incapable to proceed in her detention center — one who has already waited seven months for a hospital bed.
Jails are up-front about not having adequate resources to care for the high volume of mentally ill people who cycle through their doors. Nine in 10 jails in the Southeast routinely have no psychiatrist on site, a 2023 study by UNC researchers found.
Trying something different
Managing detainees ruled incapable to proceed has always been challenging for jails, but they’ve been increasingly strained in recent years as the number of those detainees has swelled.
In 2024, more than 2,600 criminal defendants had their capacity evaluated — marking a 33 percent increase in evaluations over the past five years. About 60 percent of those individuals — more than 1,500 people — were deemed incapable of proceeding to trial and needed capacity restoration services.
The result is that a growing share of the limited bed space in North Carolina’s state psychiatric hospitals is occupied by people involved in the criminal justice system.
Welcome to Billionaire Club Co LLC, your gateway to a brand-new social media experience! Sign up today and dive into over 10,000 fresh daily articles and videos curated just for your enjoyment. Enjoy the ad free experience, unlimited content interactions, and get that coveted blue check verification—all for just $1 a month!
Account Frozen
Your account is frozen. You can still view content but cannot interact with it.
Please go to your settings to update your account status.
Open Profile Settings