Senate committee substitute to the 3rd edition makes the following changes.  Makes conforming changes to act’s long title.

Section 1.

Changes the entity tasked with studying relevant statutes, judicial and clinical practices, and available technological resources to identify areas for systemic improvement in the involuntary commitment (IVC) process in the State from the team comprising the Department of Health and Human Services (DHHS), the Department of Information Technology (DIT), the Administrative Office of the Courts (AOC) to the NC Collaboratory (Collaboratory). Makes conforming changes. Requires a progress report to be submitted to the specified NCGA committee by December 1, 2026. With a final report due by March 1, 2027 (was, February 1, 2027). Now requires the study to develop proposed clinical workflows, transport guidance, and bench cards, as specified (was, just clinical workflows).

Section 2.

Removes provisions requiring DHHS and the North Carolina Sheriff’s Association (Association) to develop a plan for using telehealth to complete the first examinations of individuals in county jails. 

Adds provisions requiring the Association to develop a proposal for a pilot program for the Association using telehealth to complete the first examinations of individuals in county jails, including jails willing to participate in the pilot program. Requires the Association to submit the proposal to the specified NCGA committees by March 1, 2027.

Section 6.5 (was, Section 7).

Modifies the scope of the task assigned to DHHS, the Association, and the NC Healthcare Association (new) so that these entities are now requires to study the listed matters related to the development of a Behavioral Health Statewide Central Availability Navigator Updates, instead of implementing the updates. Removes effective date and instead requires DHHS to submit a report to the specified NCGA committee by March 1, 2027. Renumbers the remaining sections accordingly. 

Section 7.

Now requires the Collaboratory to submit a progress report to the specified NCGA committees on its study of the differing legal standards governing involuntary commitment and incapacity to proceed to identify statutory revisions that would enhance each system's effectiveness and advance public safety for all individuals involved by December 1, 2026, with the final report now due on March 1, 2027.

Section 8.

Clarifies the scope of the study pertaining to the “revolving door” so that it also includes reporting on what has been examined and reported pursuant to SL 2025-27.

Section 9.

Changes the entity responsible for studying behavioral health care in jails from the Department of Adult Corrections and the Association to the Collaboratory. Includes the Association as one of the relevant stakeholders that should be consulted with as part of the study. Requires a progress report by December 1, 2026, with the final report due to the specified NCGA committee (was, committee and division) by March 1, 2027.

Section 10.

Requires the Collaboratory to seek the assistance of UNC Health in its study on the feasibility of improving the provision of services at Broughton Hospital, Central Regional Hospital, and Cherry Hospital (collectively, the Hospitals). Authorizes UNC Health to make recommendations for the final report. Requires a progress report by December 1, 2026, with the final report due to the specified NCGA by March 1, 2027.

Section 11(b).

Modifies the evaluation of a respondent’s history of declining or nonadherence to treatment prong of the evaluation under GS 122C-263 (under the provisions requiring a recommendation of outpatient commitment) so that it also has to include one of the now four enumerated repeated incarcerations, violations, or hospitalizations occurring in the relevant past (was, just a single incarceration, violation, or hospitalization, not repeated occurrences).

Modifies the inpatient commitment order that is authorized under GS 122C-274 so that it must be issued upon finding by clear, cogent, and convincing evidence that the respondent is mentally ill and dangerous to himself, as defined in GS 122C-3(11)a., or others, as defined in GS 122C-3(11)b. Specifies that a finding of noncompliance with an outpatient commitment order creates a rebuttable presumption that the respondent is dangerous to himself, or others. (was, requires a nexus between the respondent's past conduct and the reasonable probability of the respondent's future dangerousness to self or others).

Section 13.

Adds the following new content.

Specifies in GS 15A-532 that pretrial release of a defendant found incapable to proceed is governed by Article 26 (bail) of GS Chapter 15A along with Article 56 (incapacity to Proceed) of the Chapter.

Amends GS 15A-1001 as follows. Makes conforming changes, including to the statute’s title. Makes technical changes. Declares the State’s policy that persons found to be incapable to proceed should be provided with capacity restoration services whenever feasible and appropriate and that such services should be carried out in as efficient and timely a manner as possible in order to meet the ends of justice for victims, for the public, and for those persons who stand accused of crimes. Lists three services that are considered capacity restoration services, on educational instruction on the criminal justice system, psychoeducational instruction, and other mental health services. Provides civil immunity for an individual, facility, agency, or entity, or officials, staff and employees of these individuals and entities, responsible for the custody, transportation. examination, admission, management, supervision, instruction, treatment, or release of a defendant, unless they are grossly negligent.

Amends GS 15A-1002 (determination of capacity to proceed) so that the court must ensure a record of the determination is transmitted to the National Instant Criminal Background Check System if it finds that the defendant is incapable of proceeding. Makes conforming changes. Sets forth requirements for reports on capacity submitted so that it must include the examiner's opinion whether the defendant is capable or incapable to proceed with all relevant observations and findings. Requires the examiner to report on five listed matters if they determine that the defendant is not capable to proceed. Specifies that if the examiner is unable to provide any of the required opinions, recommendations, or findings, the reasons must be clearly stated in the report. Provides for remote video examinations, as described.

Makes the following changes to GS 15A-1003 so that it sets forth a procedure upon finding that a defendant is incapable to proceed (was, referral of incapable defendant for civil commitment proceedings). Clarifies that a defendant incapable to proceed who is accused of committing a violent crime as described can only be taken to a 24-hour facility as space is available (currently, no mention of available space). Removes provisions for court order if defendant is not subject to involuntary commitment. If the court has found that the defendant is incapable of proceeding but likely to regain that capacity, requires the court to order the defendant to participate in a capacity restoration program, subject to five listed conditions, including duration of enrollment and location of program. Allows the court to waive the capacity restoration requirement if no capacity restoration program is reasonably available to the defendant, or if the court finds that the defendant is expected to gain capacity in the foreseeable future without the need for capacity restoration services, or for other good cause shown. If the court finds that the defendant is not reasonably likely to gain capacity to proceed in the foreseeable future, specifies that the court cannot order the defendant to receive capacity restoration services but instead must consider whether dismissal of the charges is required. Allows for supplemental hearings on this issue. Authorizes the court to determine if a defendant has a mental illness and is either a danger to self or others or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness and therefore meets the criteria for involuntary civil commitment. Allows for a custody order based on those findings. Provides that proceedings thereafter are subject to Part 7 of Article 5 of GS Chapter 122C, subject to the six listed conditions.   

Removes provisions of GS 15A-1004 (orders for safeguarding of defendant and return for trial) and replaces the statutory content with content pertaining to the examination and reports required for a defendant lacking capacity, as follows. Requires the clerk to obtain reports every sixty days on a defendant’s progress in a capacity restoration program, as described, including a separate report if the defendant is not a suitable candidate for capacity restoration services, requires capacity restoration in a different setting, or poses an unnecessary risk of danger to program personnel. When a defendant is found incapable to proceed and is placed in the custody or care of a hospital, institution or provider through a proceeding for involuntary civil commitment, requires the court’s orders to contain four listed requirements, including reports to the clerk of any expected discharge from commitment. When a defendant found incapable to proceed is placed in the secure custody of a designated person or organization as a condition of release, directs the court to require the supervising person or organization to report to the clerk immediately if it appears that the defendant has gained capacity to proceed. The court may also require a periodic report to the clerk from the supervising person or organization as to the condition of the defendant and the defendant's likelihood of gaining capacity to proceed, to the extent the person or organization is qualified to do so.

Removes the text of GS 15A-1006 (return of defendant for trial upon gaining capacity) and replaces that text with provisions pertaining to the return of defendant for supplemental hearing and trial upon gaining capacity; discharge and return of defendant from involuntary commitment, as follows. Requires the clerk to provide written notice to the district attorney and the defendant’s attorney within 72 hours of receiving notice that a defendant has likely gained capacity to proceed to trial. Provides for further written notice to the sheriff, as described, if the defendant is accused of committing a violent crime and regains capacity to proceed. Sets out requirements for supplemental hearings and trial. 

Removes the prior content thereof, and makes the following changes to GS 15A-1007 (supplemental capacity hearings). Requires the district attorney to calendar the matter for a hearing within 30 days of receiving notice that the defendant has regained capacity to proceed. Allows for supplemental hearings on capacity. Requires the case to be calendared for trial as soon as possible. Specifies that continuances beyond sixty days of the calendared trial date should only be granted in extraordinary circumstances, as specified. Allows for further capacity restoration services to be ordered if reasonably available as specified. Requires the court to hold a supplemental capacity hearing if any of the following four events occur:

1. When the defendant has been ordered to participate in a capacity restoration program and the program has not reported to the clerk that the defendant has gained capacity to proceed prior to the end of the defendant's enrollment period.
2. Every four months if the court has previously waived the requirement for capacity restoration services.
3. Every four months if the defendant has been found not likely to gain capacity within the foreseeable future and the charges have not already been disposed.
4. When it appears to the court that any of the conditions for disposition have been met.

Allows for the court to hold supplemental hearings on motion or of its own accord. Permits the court to take any action at supplemental hearing that it could have taken at the original hearing, including the three specified.

Provides for a referral for civil commitment proceedings in GS 15A-1008 upon motion by the district attorney prior to dismissal of criminal charges and a court order containing the required findings. Authorized temporary detention of the defendant.

Enacts new GS 15A-1010, providing as follows. Prohibits compelling a defendant found incapable to proceed to trial from taking medication to gain or maintain capacity. Allows the court to order, however, compelled medication of an uncooperative defendant to gain or maintain capacity to proceed, upon either the State or court’s motion, if the court finds by clear and convincing evidence all of the following based on circumstances presented that are specific to the defendant in question: (1) the defendant is charged with a serious offense against the person or property, and there are no apparent special circumstances lessening the importance of the government’s interest in bringing the defendant to trial, (2) the proposed treatment is reasonable and appropriate for the defendant’s mental health condition and its proposed use is consistent with accepted medical standards, (3) the proposed treatment will not cause an unnecessary risk to the defendant’s physical or mental health, (4) the proposed treatment is necessary insofar as it is substantially likely to render the defendant competent for trial, and less intrusive means would not further this interest, and (5) the proposed treatment is substantially unlikely to have side effects that undermine the fairness of the defendant's trial. Requires a licensed medical profession to supervise the administration of any ordered treatment, but the course of treatment must be reviewed and authorized by the court and the court may impose any other conditions necessary to protect the defendant’s rights to ensure the safety of others. Allows the order to provide multiple alternative courses of treatment in the medical professional’s discretion. Allows the court to amend previous compelled medication orders upon motion of the district attorney, defendant’s attorney, the court’s own motion, or upon notice by the treatment provider that a change in the course of treatment is warranted. Specifies that the statue does not preclude medical treatment of person involuntarily committed. Subjects treatment ordered under the statute to the immunity provisions in GS 15A-1001(e).

Amends GS 122C-54 by amending what must be included in a report by a facility who conducted a court-ordered mental exam of a defendant in a criminal case, so that it must contain all of the matters listed in new GS 15A-1002(b3).

Amends GS 122C-256 by adding and defining the term IBCRP (inpatient-based capacity restoration program). Specifies that IBCRPs are offered by inpatient psychiatric facilities with expertise to provide capacity restoration programming; and requires that the programs be available within the state psychiatric hospital system. Specifies that inpatient treatment is intended for defendants that are likely to benefit from inpatient level of care but who may or not meet involuntary commitment criteria.

Requires DHHS to adopt guidelines by December 1, 2026, for treatment of individuals who are referred under GS 15A-1003 to a detention center capacity restoration program, community-based capacity restoration program, or inpatient based capacity restoration program, incorporating best practices to restore the individual’s capacity to proceed to trial in criminal court. Requires the guidelines to be published on DHHS’s website.

Amends GS 122C-273 by adding that the administration of medication under a court order for a criminal defendant found incapable to proceed to trial is governed by GS 15A-1010.

Applies to any initial or supplemental capacity hearings conducted on or after December 1, 2026.

Section 14.

Amends Section 1(j) of SL 2025-93 by delaying the effective date of GS 15A-533(b1) (which provided that if a defendant is (1) charged with a violent offense and the judicial official determines that the defendant has previously been subject to an order of involuntary commitment within the prior three years, or (2) charged with any offense and the judicial official has reasonable grounds to believe the defendant is a danger to themselves or others, then the judicial official must set conditions of pretrial release in accordance with the Article and issue an order that includes specified requirements on examination and commitment) from December 1, 2026, to July 1, 2028. Also amends Section 9.5(b) by delaying the effective date of changes to GS 122C-266, inpatient commitment; second examination and treatment pending hearing, from December 1, 2027, to July 1, 2028.