The main problem with mental illness in North Carolina is untreated suffering

Mental illness has become part of the legislative agenda in North Carolina. The violence we saw in Charlotte and Southport was undoubtedly horrific. But for all the extreme, violent suffering inflicted by a small number of profoundly ill people, there are thousands more North Carolinians suffering from untreated mental illness—posing no threat to anyone—and deliberately forgotten by the political elite.

This column aims to rebut harmful myths about mentally ill people in North Carolina and to outline the mental health crisis that has been festering in our state for decades.

House Speaker Destin Hall has proposed a Select Committee on Involuntary Commitment and Public Safety. The framing of this proposal is troubling—many people facing involuntary commitment are suicidal, not criminal. Still, few would argue that people like the perpetrator of the Charlotte stabbing should not be in secure treatment.

If Hall proceeds with this committee, he should appoint Representative Carla Cunningham as chair. The disability community’s mantra is “nothing about us, without us,” and Cunningham has courageously shared her family’s experience with involuntary commitment. She is far better suited to lead this conversation than a “law-and-order” Republican.

Despite periodic horrors, the overwhelming majority of mentally ill people in North Carolina are not violent. Our state is home to one of the world’s leading experts on this topic: Jeffrey Swanson, professor of psychiatry at Duke University. Swanson’s research shows that while a correlation between mental illness and violence exists, it is very small and overshadowed by other factors—especially gender. The single greatest risk factor for violent behavior is being male.

If you are mentally ill, you may be slightly more likely to commit violence than someone without a diagnosis. If you are male, you are vastly more likely to commit violence than a woman. Even within schizophrenia, most people live peacefully despite their challenges. Statistically, one is more likely to be struck by lightning than to be murdered by a person with schizophrenia.

The notion that mentally ill people are dangerous goes back millennia—to the writings of Augustine of Hippo in the 4th century, who speculated that madness was a curse from the Devil. Like racism or sexism, this stigma—what modern scholars call Sanism—has endured for
centuries despite overwhelming evidence to the contrary. The persistence of this belief harms millions of people who need compassion, not condemnation.

According to the National Alliance on Mental Illness (NAMI) North Carolina, 1.8 million North Carolinians—nearly 1 in 5 people—live with a mental illness. About 471,000 of them suffer from Serious Mental Illness (SMI), such as major depression, bipolar disorder, or obsessive-compulsive disorder. The tragedy is that many of these people are suffering without adequate care. North Carolina has become a mental health care desert.

The crisis is particularly severe in rural areas. While Raleigh, Durham, and Chapel Hill have abundant resources, 32 counties—a full third of the state—do not have a single psychiatrist. Limited broadband access also prevents many residents from using telehealth services. Thousands of North Carolinians—whose minds are every bit as deserving of care as anyone in the Triangle—are languishing without medication, therapy, or professional support. They pose no threat to anyone. They are the ones threatened by a lifetime of untreated
suffering because our state has abandoned them.

Conditions are scarcely more humane in psychiatric hospitals. A culture of fear and punishment toward mental illness has led some politicians—largely though not exclusively Republicans—to call for locking people away. But in North Carolina, many of these institutions are deeply unsafe.

In one public psychiatric hospital in eastern North Carolina, an 11-year-old girl was sexually assaulted. The crime, almost unthinkable in its cruelty, occurred in a facility meant for healing. Among the Triangle’s mental health community, Holly Hill Hospital carries the grim nickname: “Holly Hell.”

Involuntary commitment is often regrettable but sometimesnecessary—particularly in cases like the Charlotte stabbing. Yet beyond those extreme situations lies a deeper tragedy: across rural North Carolina, peaceful people with mental illness go without care. Medicaid patients face benefit cuts. Children are left to fend off trauma alone.

North Carolina likes to imagine itself, as our state toast says, as a place “where the weak grow strong.” But when it comes to mental illness, that promise remains heartbreakingly unfulfilled.