Patient's outburst prompts action on security gaps in mental health hearings

Nov. 06--Moments after he heard a psychiatrist testify that he was a danger to himself and others, a 22-year-old Charlotte man with a history of mental illness lunged at a deputy.

He nearly got the deputy's gun before he was tackled by his own attorney during a court hearing inside Mecklenburg County's mental health hospital over the summer.

Now, that lawyer, Bob Ward, is warning about security gaps during the hearings at Behavioral Health Charlotte (formerly CMC-Randolph), a 66-bed mental health facility owned by Carolinas HealthCare System.

Mecklenburg County and CHS jointly ran the Billingsley Road facility until the hospital system bought it in 2012 as part of a lawsuit settlement.

Ward, an assistant Mecklenburg County public defender, has helped form a task force that will issue safety recommendations for the court hearings and enhance oversight in how mental health services are administered countywide.

The group hopes to find ways to improve the county's involuntary commitment hearings -- the setting for the August courtroom scuffle that, for Ward, raised concerns about the "safety, health and welfare" of the hospital's patients and workers. The Mecklenburg County Sheriff's Office, not the hospital, is responsible for the security during the hearings.

"Those of us working in this mental health 'system' fear that it will take a tragedy, or several, before real change takes place," Ward wrote in a letter to hospital, court, county and law enforcement officials.

The letter lists lags in the hearings process that, Ward wrote, could have "brought us...perilously close to a tragedy that would have put us in the national spotlight." Those lapses, he wrote, included:

--No security screenings after walking through the door.

--Only one deputy on hand with no backup.

--No panic button in the courtroom and no procedures to follow in case of a crisis.

The security gaps had not come up until recently, said Victor Armstrong, vice president and facility executive for Behavioral Health Charlotte. He said officials had been in talks about boosting security before the incident but the outburst with Ward's client kind of expedited the process.

[Soaring demand strains CMC psychiatric hospital]

There's been some progress: Armstrong said Carolinas HealthCare plans to issue personal alarms to personnel involved with involuntary commitment hearings.

And the Mecklenburg County Sheriff's Office, which provides security for all county courtrooms, has more deputies in those hearings, Major Daniel Johnson said.

When people feel abandoned or oppressed by the system, they act out.

Bob Ward, assistant Mecklenburg County public defender

But Ward feels more deputies won't solve the county's larger problem with serving the mentally ill.

"When people feel abandoned or oppressed by the system, they act out," he said. "We need something set up to monitor what's happening when things are working and what's happening when things are not working."

Courtroom scuffle

Deemed by some as "adversarial," involuntary commitment hearings are civil measures that determine if a mentally ill patient will be committed to a mental health facility. Each patient, called a respondent, gets a lawyer.

In Mecklenburg County, those hearings take place inside the courtroom at Behavioral Health Charlotte, where hospital technicians escort the patients and determine whether they should be restrained.

Deputies, who don't patrol the hospital, stand guard in the hearings while a District Court judge presides and decides whether the patient will be discharged or committed.

That was the scene Aug. 14 as Ward and his client listened to a psychiatrist testify that the man should be committed to the hospital for 30 days, followed by 90 days of outpatient treatment, Ward said.

But the commitment was dismissed when Ward said he found a procedural error in the case. Tempers flared when Ward's client learned another attempt to commit him would soon follow.

Watch for the gun, watch for the gun.

Bob Ward, quoting someone during courtroom scuffle

As he stood to leave the courtroom, the man jumped at Sonya Smith, the deputy, and forced her to the wall, according to a Charlotte-Mecklenburg police report.

Smith, 50, told police she hit her head on a picture frame and began to bleed. She said the man tried to grab her firearm but she managed to cover it, according to the report.

Ward told the Observer he grabbed his client's arm while the hospital technician tried pulling the man off the deputy, who eventually fell to the floor. Ward recalled someone shouting, "Watch for the gun, watch for the gun."

The struggle spilled from the courtroom to the hallway. It stopped when Ward tackled his client to the floor, he said. Smith, along with a social worker and the hospital technician, helped Ward hold the man down until he could be secured.

Ward sustained a small whelp on his left cheek, and has mild double vision out of one eye after Smith's baton accidentally hit him in the face, he said. Smith had small cuts on the left side of her head and right hand, according to court documents.

Police charged the man, who dropped Ward as his attorney, with assault on emergency personnel and assault on a government officer or employee, court documents show. He is scheduled to appear in court Nov. 20.

Reducing tension

Daniel Johnson, the Sheriff's Office major, said the scuffle was the first of its kind in the courtroom this year. It's "being used as an opportunity to improve overall service delivery to these sensitive proceedings," he said.

The Sheriff's Office has 74 deputies who oversee security in 35 county courtrooms. Typically, two deputies keep guard in each courtroom, with the exception of two initial appearance courtrooms in the Mecklenburg County Courthouse that require more.

Carolinas HealthCare employs its own security officers at the hospital outside of the courtroom.

Both the Sheriff's Office and Carolinas HealthCare have joined the newly formed task force, which has been meeting for weeks to draw plans to improve hospital and court hearing procedures.

The Mecklenburg County Sheriff's Office employs 74 deputies who provide security in 35 county courtrooms.

Chief Mecklenburg County District Court Judge Regan Miller -- who supervises the judges assigned to the task force -- would not say what new methods, if any, the committee is considering. But he did suggest video conferencing the hearings could resolve a lot of the security issues.

Ron Honberg, policy and legal director for the Virginia-based National Alliance on Mental Illness, said he doubts added security would curb violence since "these kinds of incidents occur quite rarely."

Instead, he said, it's best to reduce tension in commitment hearings and boost treatment for patients when they leave the hospital. "Sometimes (patients) reach this stage because (they) aren't getting the treatment in the community they need," he said.

[Charlotte'sHopeWay Foundation to offer residential, day treatment for people with mental illness]

North Carolina's laws for outpatient civil commitments are good but rarely used, according to a 2014 study from the Treatment Advocacy Center, a Virginia-based nonprofit that studies civil commitments. The center gave the state an "A" for the quality of its laws but a "C-minus" for how they're used.

So where's the disconnect?

Ward thinks the agencies that provide mental health services don't communicate enough: "I don't think the right people are getting the right message and making the right decisions about caring for the mentally ill," he said.

"Because it's nobody's job to take a look at what happens when things go wrong, we're not able to adequately respond to them."

Jonathan McFadden: 704-358-6045, @JmcfaddenObsGov

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