In August 2025, Iryna Zarutska, a 23-year-old Ukrainian refugee who had come to the United States to escape the war, was stabbed to death on a Charlotte, North Carolina, light rail train. The man charged with her murder had been diagnosed with schizophrenia. His mother had sought to have him involuntarily committed. She was denied. His family said publicly afterward that the system had failed everyone, including their son.
The case drew national attention, but it was not an isolated incident. The Federal Transit Administration recorded 2,200 major assault injuries on public transit in 2023, the highest number in the history of federal data collection, with mental health crises and homelessness identified as leading contributing factors.
Something changed about fifty years ago, and the consequences are visible on almost every city street.
Beginning in the 1960s and accelerating through the 1980s, the United States systematically emptied its large psychiatric hospitals. The motivations were not unreasonable: the old institutions had genuine histories of abuse and neglect, new medications seemed to make community living possible, and civil liberties advocates argued that involuntary commitment was too easily abused. The hospitals closed. The community support systems meant to replace them never fully materialized.
Today, according to the U.S. Department of Housing and Urban Development, roughly one in five homeless Americans has a serious mental illness. The streets and jails became, in the words of researchers, the institutions.
Now, haltingly, a conversation is beginning. President Trump signed an executive order in 2025 aimed at expanding involuntary treatment options. New York State has reversed course, adding psychiatric beds and loosening commitment standards. The federal government is directing hundreds of millions of dollars into inpatient psychiatric care.
Whether any of it is enough, or the right approach, is a debate that is just getting started.
