Willowbrook, 50 years on: mental health policy and public safety collide in the Charlotte stabbing debate

A deadly attack on a Charlotte, North Carolina, subway line has intensified a nationwide discussion about how to treat people with serious mental illness, reviving questions that once led to the closure of Willowbrook State School and a broad shift away from large psychiatric institutions.

U.S. officials and others say the August 22 death of Iryna Zarutska, a 23-year-old Ukrainian refugee, after she was stabbed on a city train by a homeless man described as having paranoid schizophrenia, underscores concerns about danger to self or others among some individuals with mental illness. The suspect, 34-year-old Decarlos Brown, has a long crime record, including felony arrests, and Brown’s jailhouse interview with his sister, obtained by the Daily Mail, suggested he believed foreign materials had been implanted in his brain. Critics argue the case highlights failures in treatment access and the need for safer forms of management for those deemed dangerous; supporters caution against conflating dangerous behavior with a broad diritto to compel treatment.

Five decades earlier, Geraldo Rivera helped illuminate conditions inside Willowbrook State School in Staten Island. In 1972, his televised investigation showed crowded wards, neglect, and children with developmental disabilities living in unsanitary, isolating conditions. The reporting helped trigger landmark lawsuits and a national reexamination of care standards for people with intellectual and developmental disabilities (IDD). Willowbrook’s exposure is widely credited with accelerating deinstitutionalization and moving many individuals into community-based care rather than large, centralized facilities that housed thousands of residents at once. The school, opened in 1948 and originally intended for up to 4,000 residents, grew to house as many as 6,000 during its peak.

A new discourse on mental health policy now centers on whether and how to use compulsory treatment tools when public safety is at risk. In July, then-President Donald Trump issued an executive order titled Ending crime and disorder on America’s streets. The directive urged the easing of existing restrictions on civil commitment and directed the Attorney General to seek reversals of judicial precedents and consent decrees that limit forcible institutionalization for individuals deemed dangerous or unable to care for themselves. In New York City, Mayor Eric Adams subsequently proposed allowing involuntary hospital transport and admission for people who pose danger to themselves or others amid concerns about on-street episodes and violence linked to substance use disorders.

The national debate sits against a backdrop of historical policy shifts. During the mid-20th century, psychiatric care was concentrated in large inpatient facilities. By the mid-1980s, the number of Americans housed in psychiatric hospitals had fallen dramatically—from more than 500,000 in 1955 to fewer than 100,000—reflecting a broad push toward deinstitutionalization and community-based services. Some estimates indicate that between 2000 and 2018, New York state reduced inpatient psychiatric beds by about 12 percent, a trend mirrored in other states. Critics warn that the retreat from hospital care contributed to the current reality in which some individuals with untreated health issues end up in prisons or on city streets, underscoring the complex balance between public safety and civil rights.

Geraldo Rivera, who has long described Willowbrook as his life’s work, argues that society must protect both vulnerable individuals and the broader public. He contends that while the Willowbrook exposure was essential to ending abusive practices, the pendulum has swung too far toward closing facilities and dispersing care, sometimes without adequate community supports. Rivera has emphasized that developmentally disabled individuals are not the same as those who are acutely mentally ill or dangerous, insisting that there should be dedicated spaces for those who need intensive treatment while avoiding unnecessary confinement of non-violent patients. He also notes the paradox of modern care: while some patients thrive in community settings, others who are homeless or deeply ill have limited options when facilities are full or unwilling to take them in, a problem that critics say requires targeted solutions rather than broad policy shifts.

Advocates and policymakers alike acknowledge that the Willowbrook era marked a turning point in recognizing civil rights for people with disabilities, but the current debate underscores a persistent tension: ensuring safety for the public while safeguarding the dignity, rights, and appropriate care needs of individuals with severe mental illness or developmental disabilities. As the nation grapples with high-profile cases and evolving care models, many public health experts stress the importance of data-informed policies that separate the needs of the developmentally disabled from those of individuals with acute psychiatric conditions who may pose a danger, and that expand access to voluntary, community-based treatment and support services. Rivera’s broader takeaway is that a compassionate approach to care must be paired with safeguards to protect both individuals and communities, a balance that remains central to the health policy conversation today.