A North Carolina House committee reviewing laws on involuntary mental health commitment will examine the death of Raleigh teacher Zoe Welsh, allegedly killed earlier this year by a man with a history of mental illness and criminal charges.
The House Select Committee on Involuntary Commitment and Public Safety was formed following the 2023 death of Iryna Zarutska under similar circumstances. Its focus is on evaluating the process for forcibly committing individuals with serious mental illnesses and recommending potential policy changes.
At the request of Republican Reps. Erin Paré and Mike Schietzelt of Wake County, the committee will investigate the events leading up to Welsh’s death. Ryan Camacho, who had been diagnosed with schizophrenia and had a long criminal record, is accused of attacking her at her home on Jan. 3.
Weeks before the incident, a Wake County District Court judge found Camacho incapable of standing trial on a misdemeanor charge but denied a prosecutor’s request to involuntarily commit him.
“What additional tools would assist law enforcement and the courts in preventing horrific crimes like this from occurring in the future?” the lawmakers asked in a Jan. 6 letter, which Paré posted to social media.
Committee co-chair Rep. Hugh Blackwell said the panel will examine whether the findings from Welsh’s case should inform legislative recommendations.
In 2023, lawmakers passed Iryna’s Law, requiring judicial officers to initiate involuntary commitment proceedings in certain pretrial circumstances and revised pretrial release protocols.
During a Jan. 10 meeting, the committee heard testimony from mental health experts about involuntary outpatient commitment—court-ordered treatment outside of hospitals. This approach has shown positive outcomes in other states, including New York, according to Dr. Marvin Swartz, professor of psychiatry at Duke University.
Swartz noted that North Carolina lacks data on use of outpatient commitment since 2001, when public mental health services were largely transitioned to private providers. He said patients under these orders often voluntarily take prescribed medication even though they cannot be forced to do so.
“These are rare occurrences,” Swartz said, referring to violent acts involving individuals with serious mental illnesses. “Crafting a policy objective that recognizes that this happens rarely… is really tough.”
Dr. Carrie Brown, chief psychiatrist at the North Carolina Department of Health and Human Services, said outpatient commitment is most effective for individuals who repeatedly avoid voluntary treatment or are frequently hospitalized or arrested. She said the system faces several challenges, including vague court orders and a shortage of mental health providers.
To address repeated hospitalizations and incarcerations, the state is launching Forensic Assertive Community Teams (FACT) in five regions. Brown said these teams would provide intensive management and called for a centralized oversight body.
She also emphasized the need to raise awareness among judges that outpatient commitment may be an option when inpatient criteria are not met.
Some lawmakers are looking at ways to increase capacity in state psychiatric hospitals. Rep. Donna White said that about 300 hospital beds remain unfilled due to staffing shortages and called for strategies to recruit qualified personnel. “It’s the state’s responsibility to treat those patients,” she said.
Blackwell said the committee could offer initial recommendations during the legislature’s upcoming short session but noted that broader changes would require more time.
