“I don’t even know the lady…why would somebody stab somebody for no reason?”
That's what a homeless ex-con can be heard asking his sister during an August 28 jailhouse phone conversation they had while he was incarcerated. That career criminal is murder suspect Decarlos Brown Jr., who allegedly fatally stabbed 23-year old Ukrainian refugee Iryna Zarutska in what police said was a random attack on a North Carolina light rail train last August 22.
Brown’s family says he was a previously diagnosed schizophrenic who suffered from hallucinations and paranoia and was “hearing voices” prior to the attack. Brown was failed by the state, his younger sister added, saying that he was “not safe” to be released as he was a “high risk” and “not in his right mind.”
Brown’s mother confirmed his chronic mental health struggles but also believed the murder could have been prevented with a successful mental health intervention while he was previously incarcerated.
“The system failed him,” Brown’s mother told WSOC-TV, as she lamented what her son did to Zarutska. She later told CNN she tried to get Brown placed in a long-term mental care facility but legally couldn’t because she wasn’t his legal guardian.
President Donald Trump’s July 24 executive order, “Ending Crime and Disorder on America’s Streets,” comes too late to save Zarutska, but by targeting disturbed people like Brown it hopes to prevent another tragedy like hers from recurring by ending vagrancy, crime, and homelessness and restoring public order.
Specifically, the EO encourages states to enforce existing prohibitions on public illicit drug use, remove vagrants from city streets, and broaden civil commitment standards to allow for involuntary psychiatric hospitalizations, when necessary, to help those in need but who refuse to get treatment.
Pennsylvania politicians, guided by the EO’s edicts and objectives, should take this opportunity to drive down the homeless population by updating or broadening PA’s civil commitment legal standards, something public health professionals and mental health proponents have been advocating for years.
Homelessness remains a serious concern in Pennsylvania, affecting thousands across the state each year; according to the U.S. Department of Housing and Urban Development, approximately 13,375 people were homeless on any given night as of January 2022.
The epicenter lies in Philadelphia, where homelessness rose for a third straight year, up 5.2 percent in 2024 compared to the previous year, with a total of 4,725 homeless people, 976 of them believed to be unsheltered. Activists claim the real numbers are significantly higher, but there is no definitive way to confirm their unsubstantiated claims.
Regardless of the true number, addressing the needs of Philadelphia’s homeless population is a significant challenge for the city, where Census figures show nearly 23 percent of its residents live below the poverty line.
Homelessness has two distinct etiologies; one is financial while the other is an issue of addiction, dependency, and mental health. The President’s EO proves his administration understands this basic truth, something some Democrats refuse to accept.
It's no secret that mental health issues and substance abuse are prevalent among the homeless population. The National Coalition for the Homeless, for example, reports that approximately 20-25 percent of the homeless population in the U.S. suffers from serious mental illness, compared to 6 percent of the general population.
HUD defines serious mental illness as a mental illness that substantially limits independent living and is expected to be of long-lasting or indefinite duration. SMIs include conditions like bipolar disorder, major depressive disorder, and schizophrenia.
Here in Pennsylvania, the National Alliance on Mental Illness (NAMI) estimates that one in five of the more than 12,500 people in the commonwealth who are without homes have a serious mental illness. It’s even more prevalent in Philadelphia; while people with serious mental illness make up just under three percent of the adult population in Philadelphia, an estimated 40 percent of the city’s homeless population, most of whom are chronically homeless, have such a condition.
And although most people with serious mental illness are nonviolent, and are over ten times more likely to be victims of a violent crime than the general population, serious mental illness, if left untreated, does increase the risk for violent behavior towards oneself or others.
The American Civil Liberties Union, health policy advocates, and other civil libertarians are naturally having a total conniption over the president’s EO, arguing instead that those in need could be better served by making mental health services culturally competent enough — and universally applicable without preconditions — to better attract the indigent to utilize those resources they’d otherwise reject out of hand.
That would be true, however, but only if those suffering from serious mental illness willingly took advantage of available services. Unfortunately, approximately half of people with severe mental illness experience "anosognosia," or lack of insight, that impairs their ability to understand their illness and need for treatment. In fact, this lack of insight is the number one reason why patients often refuse psychiatric care.
Thus, no amount of “culturally appropriate" services will be enticing enough to those suffering from SMI and anosognosia, as they believe they are perfectly healthy and therefore don’t require any psychiatric care. Sadly, many of these same people wind up homeless, victimized, and/or incarcerated.
The Trump administration apparently understands this conundrum, as Trump’s executive order encourages the use of involuntary civil commitment and psychiatric institutional care for individuals with SMI who pose a danger to themselves or the public.
Each state sets its own civil commitment rules, but they must comply with federal laws and constitutional rights. Typically, civil commitment is limited to cases where an individual’s mental illness creates a significant risk of harm to themselves or others.
This last point has been the subject of significant controversy and debate, however, since determining exactly when an individual has reached the threshold for civil commitment is often purely subjective, and may differ from state to state.
Here in Pennsylvania, both the “severely mentally disabled” and “clear and present danger” standards are utilized to establish a threshold for involuntary civil commitment.
Pennsylvania law holds that a person is considered severely mentally disabled when his capacity to care for his own personal needs “is so lessened that he poses a clear and present danger of harm to others or to himself.” A “clear and present danger,” in turn, exists when within the past 30 days the person has "inflicted or attempted to inflict serious bodily harm” on another and that there is a “reasonable probability” that such conduct will be repeated.
A “clear and present danger” also exists when a mentally disabled individual presents a danger to themselves, usually by demonstrating that within the last 30 days they have failed to provide for their own basic needs without assistance, and that there’s a reasonable probability “death, serious bodily injury, or serious physical debilitation would ensue” unless adequate treatment is rendered within the next 30 days.
Critics argue the state’s psychiatric civil commitment laws offer insufficient hope of assistance to anyone who isn’t actively suicidal or homicidal, and thus considered an imminent danger to themselves or others, but who may still be currently psychotic and in desperate need of treatment. Since such individuals wouldn’t be considered breaching the state’s “imminent threat” standard, they would thus be left to their own devices, often to mentally deteriorate to the point of requiring psychiatric treatment, either voluntarily or involuntarily.
Pennsylvania’s statutes have also been criticized for requiring probability that death, serious bodily injury, or serious physical debilitation will occur within 30 days to trigger an involuntary civil commitment, based exclusively on whether such harms have occurred within the prior 30 days, but without reference to an individual’s treatment history.
That history could include a prolific and well documented clinical case of noncompliance with psychiatric treatment, and subsequent harm to the patient and/or anyone else resulting from that noncompliance.
The Treatment Advocacy Center (TAC), a mental health advocacy and educational organization founded in 1998 by Dr. E. Fuller Torrey, has looked extensively into states’ civil commitment standards and rated them accordingly based upon the quality of each state’s inpatient commitment laws and assisted outpatient treatment availability.
Pennsylvania gets a grade of no higher than "C+" from the TAC, unfortunately, mostly based upon the state's “imminent danger” standard. The TAC therefore makes three major recommendations to reform the state’s civil commitment laws to help those in the greatest need but who might not be eligible for such help: 1) Remove requirements that harm be both ‘clear and present’ (i.e. imminent) and of unreasonably severe harm; 2) clarify the probability of future dangerousness requirement based exclusively on the 30-day “look-back” window but without reference to a patient’s treatment history; 3) remove the requirement for unreasonably severe harm to meet the criteria for grave disability; and add psychiatric deterioration criteria or amend grave disability criteria to include it.
PA lawmakers should take note of these suggested reforms and make the appropriate changes to the Mental Health Procedures Act of 1976 , as it is the original law from which the state statutes governing psychiatric civil commitment are derived.
As the Iryna Zarutska tragedy has made abundantly clear, leaving mentally disturbed individuals on our city streets to become an imminent danger to themselves or others is neither “empowering” to the afflicted or showing “compassion” to the homeless. That’s because many of these same individuals would never consciously choose such an existence for themselves if it wasn’t but for the nature of their own illness (no rational person would), an illness that in many cases the afflicted can’t even recognize.
In such tragic scenarios then it’s up to informed, compassionate individuals to better comprehend the true nature of serious mental illness to better serve the indigent while protecting the innocent.
We should start by reforming our civil commitment laws here in the commonwealth according to TAC’s guidance, especially by removing the ‘clear and present’ (i.e. imminent) danger) standard, clarify the probability of future dangerousness requirement based exclusively on the 30-day “look-back” window, and removing the “unreasonably severe harm” requirement to meet the criteria for grave disability.
The president’s order is a good first start, but without follow-through at the state and local levels it will soon be relegated to the dustbin of forgotten ideas and well-meaning policies that went nowhere.
Those afflicted with severe mental illness shouldn’t be so easily forgotten, at least until the next senseless tragedy awakens us from our complacency.
Richard F. Kosich is a freelance writer, community organizer, and Chair of the Conshohocken Borough Republican Committee (CBRC). Opinions are his own.
