Justice in Mental Health Act.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1044

Short Title: Justice in Mental Health Act. (Public)
Sponsors: Representatives Price, Belk, Prather, and Morey (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Rules, Calendar, and Operations of the House
April 27, 2026
*H1044-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO BUILD ADDI TIONAL CAPACITY IN S TATE PSYCHIATRIC HOS PITALS, 2
TO ESTABLISH REHABIL ITATIVE DISPOSITION AND COMMUNITY SAFETY 3
PROGRAMS, TO INCREAS E THE LIMIT ON SAFEK EEPER BEDS AND 4
APPROPRIATE FUNDS TO USE FOR COSTS RELAT ED TO THE ADDITIONAL 5
SAFEKEEPER BEDS, AND TO APPROPRIATE FUND S FOR GUIDANCE FOR 6
JUDGES ON IDENTIFYIN G BEHAVIORAL HEALTH RISKS AMONG 7
COURT-INVOLVED INDIVIDUALS. 8
Whereas, the General Assembly finds that timely access to appropriate behavioral 9
health evaluation, stabi lization, and treatment is essential to protecting public safety and 10
promoting the orderly administration of justice; and 11
Whereas, the General Assembly finds that insufficient capacity in State psychiatric 12
hospitals, workforce shortages, and gaps in commun ity-based treatment services contribute to 13
prolonged detention, delayed case resolution, and avoidable strain on courts, jails, and law 14
enforcement; and 15
Whereas, the General Assembly finds that stronger coordination between courts and 16
behavioral health pro viders, together with rehabilitation pathways and treatment -oriented 17
interventions, can reduce unnecessary confinement, and improve outcomes for court -involved 18
individuals while preserving public safety and civil liberties; and 19
Whereas, the General Assembl y further finds that prolonged waits for behavioral 20
health evaluation and treatment can cause individuals to remain in local confinement for extended 21
periods, exceeding 300 days in some cases, and that even a modest reduction in such wait times 22
can conservatively save counties tens of millions of dollars statewide over time in detention, 23
staffing, transportation, and related costs, thereby reducing upward pressure on property tax 24
payers who fund local public safety operations; Now, therefore, 25
The General Assembly of North Carolina enacts: 26
27
CLOSING GAPS IN THE MENTAL HEALTH-JUDICIAL NEXUS 28
SECTION 1.(a) By no later than January 1, 2027, the Administrative Office of the 29
Courts (AOC), in coordination with the Department of Health and Human Servives, Division of 30
Mental Health, Developmental Disabilities, and Substance Use Services (DMH/DD/SUS), shall 31
develop and disseminate enhanced guidance materials, and develop optional continuing 32
educational modules, for judges, magistrates, clerks, and other court personnel regarding the 33
identification of behavioral health risk indicators among court -involved individuals. These 34
guidance materials shall include all of the following: 35
General Assembly Of North Carolina Session 2025
Page 2 House Bill 1044-First Edition
(1) Evidence-informed indicators of escalating behavioral health crises. 1
(2) Risk patterns associated with untreated serious mental illness, substance use 2
disorders, or co-occurring conditions. 3
(3) Indicators associated with impaired reality testing, loss of impulse control, or 4
acute psychiatric decompression. 5
(4) Appropriate referral pathways for r ehabilitative disposition, crisis response, 6
or involuntary commitment where authorized by law. 7
(5) Best practices for balancing public safety, civil liberties, and clinical 8
appropriateness. 9
SECTION 1.(b) Nothing in subsection (a) of this section shall be construed to alter 10
the evidentiary standards required for involuntary commitment, detention, or criminal 11
adjudication. 12
SECTION 1.(c) By no later than January 1, 2027, the AOC and DMH/DD/SUS shall 13
jointly develop a statewide framework to strengthen rehabilitative disposition pathways between 14
district courts, superior courts, and community -based behavioral health providers. The 15
framework shall include all of the following: 16
(1) Standardized referral protocols for pretrial rehabilitative disposition into 17
treatment programs. 18
(2) Mechanisms for real -time communication between courts and local 19
management entities/managed care organizations (LME/MCOs). 20
(3) Expansion of mental health treatment courts where the AOC and 21
DMH/DD/SUS deem it feasible. 22
(4) Guidance on coo rdinating with jail administrators to identify individuals 23
appropriate for rehabilitative disposition. 24
(5) Data-sharing agreements consistent with the Health Insurance Portability and 25
Accountability Act of 1996 (HIPAA) and State privacy laws. 26
SECTION 1.(d) G.S. 122C-3(11) reads as rewritten: 27
"(11) Dangerous to self or others. 28
… 29
b. Dangerous to others. – Within the relevant past, the individual has 30
inflicted or attempted to inflict or threatened to inflict serious bodily 31
harm on another, or has acted in such a way as to create a substantial 32
risk of serious bodily harm to another, or has engaged in extreme 33
destruction of property; and that there is a reasonable probability that 34
this conduct will be repeated. Previous episodes of dangerousness to 35
others, when applicable, may be considered when determining 36
reasonable probability of futur e dangerous conduct. In determining 37
whether there is a reasonable probability that conduct creating a 38
substantial risk of serious bodily harm will be repeated, the court may 39
also consider evidence of a pattern of behavior established by 40
competent evidence demonstrating recurring loss of volitional control, 41
including repeated expressions or manifestations that the individual 42
believes they are not in control of their actions, when such behavior, 43
viewed in context, reasonably indicates escalating instability t hat 44
materially increases the risk of serious bodily harm to another. Clear, 45
cogent, and convincing evidence that an individual has committed a 46
homicide in the relevant past is prima facie evidence of dangerousness 47
to others. Nothing in this sub-subdivision shall be construed to lower 48
the burden of proof required under this Chapter, to authorize a finding 49
of dangerousness based solely on verbal statements absent 50
General Assembly Of North Carolina Session 2025
House Bill 1044-First Edition Page 3
corroborating evidence, or to diminish any procedural protections 1
otherwise required by law." 2
SECTION 1.(e) There is appropriated from the General Fund to the AOC, the sum 3
of five million dollars ($5,000,000) in nonrecurring funds for the 2026 -2027 fiscal year. 4
Beginning in the 2026-2027 fiscal year, there is appropriated from the General Fund to AOC the 5
sum of one million dollars ($1,000,000) in recurring funds. Funds appropriated in this section 6
shall be used to implement the requirements of this section, including any of the following: 7
(1) Development and dissemination of guidance and tr aining materials under 8
subsection (a) of this section. 9
(2) Information technology upgrades and secure data -sharing infrastructure 10
necessary to facilitate coordination between courts and behavioral health 11
systems under subsection (c) of this section. 12
(3) Establishment or expansion of regional coordination between courts and 13
behavioral health providers under subsection (c) of this section. 14
(4) Administrative costs associated with rehabilitative disposition framework 15
implementation under subsection (c) of this section. 16
SECTION 1.(f) No later than December 1, 2027, and annually thereafter, the AOC, 17
in cooperation with DMH/DD/SUS, shall provide a report to the Joint Legislative Oversight 18
Committee on Justice and Public Safety, the Joint Legislative Oversight Com mittee on Health 19
and Human Services, and the Fiscal Research Division on the status of appropriations contained 20
in this section, including (i) expenditures made pursuant to this section, (ii) progress toward 21
implementation of this section, and (iii) measur able outcomes related to rehabilitative 22
disposition, detention reduction, and recidivism. Additionally, no later than December 1, 2027, 23
the AOC, in cooperation with DMH/DD/SUS, shall provide a report to the Joint Legislative 24
Oversight Committee on Justice and Public Safety and the Joint Legislative Oversight Committee 25
on Health and Human Services on the status of the framework developed under subsection (c) of 26
this section, including all of the following: 27
(1) The number of court-involved individuals diverted to treatment. 28
(2) Changes in pretrial detention rates for individuals with serious mental illness. 29
(3) Impacts on recidivism. 30
(4) Identified statutory or operational barriers requiring further legislative action. 31
SECTION 1.(g) Subsection (d) of this section becomes effective December 1, 2026, 32
and applies to determinations of dangerousness made on or after that date. The remainder of this 33
section becomes effective July 1, 2026. 34
35
REHABILITATIVE DISPOSITION AND COMMUNITY SAFETY PROGRAMS 36
SECTION 2. Beginning in the 2026-2027 fiscal year, there is appropriated from the 37
General Fund to DMH/DD/SUS, the sum of two hundred twenty -four million dollars 38
($224,000,000) in recurring funds. These funds shall be used to create, expand, or otherwise 39
support, in coordinat ion with AOC, behavioral health treatment capacity and related 40
court-support initiatives intended to (i) increase timely access to appropriate behavioral health 41
evaluation, stabilization, and treatment services, (ii) reduce delays in case processing associated 42
with unmet behavioral health needs, and (iii) improve public safety outcomes, including all of 43
the following: 44
(1) Crisis response and clinical stabilization capacity, including mobile crisis 45
services, crisis receiving and observation services, and short-term stabilization 46
services. 47
(2) Community-based assessment, treatment, and recovery services, including 48
outpatient services, intensive outpatient services, medication management, 49
peer support, care coordination, and continuity-of-care services. 50
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Page 4 House Bill 1044-First Edition
(3) Judicially Managed Accountable Recovery Courts (JMARCs) and other 1
court-associated clinical services and continuity supports that facilitate timely 2
evaluation and appropriate treatment engagement, including clinical 3
evaluation capacity, referral coordination, case management supports, and 4
service navigation supports implemented in collaboration with the courts. 5
(4) Other evidence -based behavioral health initiatives that reduce court delays 6
associated with unmet behavioral health needs and improve public safety 7
outcomes. 8
9
STATE PSYCHIATRIC HOSPITAL BEDS AND STAFFING 10
SECTION 3.(a) There is appropriated from the General Fund to the Department of 11
Health and Human Services, Division of Mental Health, Developmental Disabilities, and 12
Substance Use Services (DMH/DD/SUS), the sum of three hundred twenty million four hundred 13
thousand dollars ($320,400,000) in recurring funds beginning with the 2026 -2027 fiscal year to 14
be used for hiring or contracting staff to facilitate the operation of State psychiatric hospitals. 15
SECTION 3.(b) There is appropriated from the General Fund to the Office of State 16
Budget and Management (OSBM) the sum of one hundred eighteen million dollars 17
($118,000,000) in nonrecurring funds for the 2026 -2027 fiscal year to be allocated and used as 18
provided in this subsection. OSBM shall allocate these funds to DMH/DD/SUS to be used to 19
build increased capacity in the State psychiatric hospitals, provided that OSBM shall not transfer 20
these allocated funds to DMH/DD/SUS until DMH/DD/SUS has certified that be d capacity in 21
the State psychiatric hospitals has been filled or is expected to be filled within 90 days. The funds 22
appropriated in this subsection shall not revert but shall remain available until expended. 23
SECTION 3.(c) There is appropriated from the General Fund to DMH/DD/SUS the 24
sum of thirty -five million six hundred thousand dollars ($35,600,000) in recurring funds 25
beginning in the 2026-2027 fiscal year to be used for hiring or contracting staff to facilitate the 26
operation of increased capacity of Sta te psychiatric hospitals built as a result of the funds 27
provided in subsection (b) of this section. If, at the end of each fiscal year, OSBM has not 28
transferred funds under subsection (b) of this section, these funds shall revert. 29
SECTION 3.(d) Funds appropriated in subsections (a) and (c) of this section may be 30
used for initiatives that improve workforce stability and retention, including preceptor programs, 31
structured onboarding, staff training, supervisory development, employee assistance supports, 32
and workplace safety improvements, provided that funds shall not be used for bonuses except as 33
part of a retention plan approved by the Department of Health and Human Services. 34
35
INCREASE LIMIT ON SAFEKEEPER BEDS AND PROVIDE ADDITIONAL 36
FUNDING 37
SECTION 4.(a) G.S. 162-39(e) reads as rewritten: 38
"(e) The number of county prisoners incarcerated in the State prison system pursuant to 39
safekeeping orders from the various counties pursuant to subsection (b) of this section or for 40
medical or mental health treatment pursuant to subsection (d) of this section may not exceed 200 41
500 at any given time unless authorized by the Secretary of Adult Correction. The Secretary may 42
refuse to accept any safekeeper and may return any safekeeper transferred under a safekeeping 43
order when this capacity limit is reached. The Secretary shall not refuse to accept a safekeeper 44
because a county has failed to pay the Department of Adult Correction for services rendered 45
pursuant to this section." 46
SECTION 4.(b) There is appropriated from the General Fund to the Department of 47
Adult Correction (DAC) the sum of ninety million dollars ($90,000,000) in nonrecurring funds 48
for the 2026-2027 fiscal year to be used for any nonrecurring costs incurred from implementing 49
the increase of county prisoners incarcerated in the State prison authorized under G.S. 162-39(e), 50
as amended by subsection (a) of this section. Beginning in the 2026 -2027 fiscal year, there is 51
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House Bill 1044-First Edition Page 5
appropriated from the General Fund to the DAC the sum of sixteen million dollars ($16,000,000) 1
in recurring funds to be used for any operational costs or other recurring costs incurred from 2
implementing the increase of county prisoners incarcerated in the State prison authorized under 3
G.S. 162-39(e), as amended by subsection (a) of this section. 4
5
REPORTS 6
SECTION 5. No later than July 1, 2027, the Department of Health and Human 7
Services, Division of Mental Health, Developmental Disabilities, and Substance Use Services, 8
in coordination with the Administrative Office of the Courts, shall provide a repo rt to the Joint 9
Legislative Oversight Committee on Justice and Public Safety, the Joint Legislative Oversight 10
Committee on Health and Human Services, and the Fiscal Research Division on the status of the 11
appropriations contained in Sections 2 and 3 of this act, including (i) cost -savings to the court 12
system, (ii) reductions in case loads, (iii) reductions in the State's incarcerated population, and 13
(iv) any impacts on recidivism. An updated report shall be provided no later than December 1, 14
2027, and annually thereafter. 15
16
EFFECTIVE DATE 17
SECTION 6. Except as otherwise provided, this act is effective when it becomes 18
law. 19