NC lawmakers to probe Raleigh murder case as part of review of state mental health procedures

A legislative committee plans to comb through the details of a Raleigh murder case as part of its review of the state’s procedures for treating people with mental health problems. 

Legislators last week asked the House Select Committee on Involuntary Commitment and Public Safety to look into how judicial officials handled Ryan Camacho, who is charged with murder in the Jan. 3 death of Ravenscroft teacher Zoe Welsh at her Raleigh home. 

Camacho has a documented history of mental illness. When he faced breaking-and-entering charges in a separate incident last year, prosecutors asked during that hearing to have Camacho committed to a mental hospital — a request that was denied by Wake County Judge Louis Meyer. 

“How could a person who was found to not be competent to proceed to trial … be released not involuntarily committed, even at the request of the district attorney?” Republican state Reps. Erin Paré and Mike Schietzelt of Wake County wrote in a letter to committee members. 

Meyer hasn’t responded to a WRAL’s requests for comment. A lawyer for Camacho declined to comment Wednesday. 

The committee plans to track down the requested information, state Rep. Hugh Blackwell announced in opening remarks Wednesday. Blackwell, R-Burke, co-chairs the committee. 

“It’s our intention — we don’t have it scheduled yet, when we’ll do that — but it’s our intention to look at the circumstances that were involved to see if those would maybe further inform us on areas that the committee might choose to make recommendations on,” Blackwell said. 

State Rep. Tim Reeder, a Pitt County Republican and physician who co-chairs the committee with Blackwell, previously told WRAL he wasn’t sure if the committee would share its findings from the Camacho case.

The committee is conducting a sweeping review of the state’s procedures for treating North Carolinians who have mental illness. 

North Carolina legislators turned their attention to the state’s procedures for handling people with mental illness following the August death of Iryna Zarutska, a 23-year-old Ukrainian who moved to Charlotte in 2022 and was fatally stabbed on a city train. The General Assembly passed the new mental health procedures as part of a larger judicial reform package titled, “Iryna’s Law.”

DeCarlos Brown Jr., had been diagnosed with schizophrenia and suffered hallucinations and paranoia that his family hoped to find treatment for, his sister told CNN. Some of the changes Iryna’s Law made to the rules around involuntary commitment, however, have been put on hold while legislators consider tweaks to the law. 

In the committee’s November meeting, hospital representatives took issue with a new rule requiring certain defendants — those who have undergone an involuntary commitment within three years of their arrest for a violent crime, or who judicial officials believe to be a danger to themselves or others — to be transported “to a hospital emergency department or other crisis facility” for a psychiatric evaluation. 

Hospital leaders said they don’t want the suspects evaluated in emergency departments because they could endanger patients and hospital staff. Instead, hospital leaders suggested conducting the evaluations in jails. Sheriffs oppose that idea. At the committee’s December meeting, the North Carolina Sheriffs’ Association said hospitals are more appropriate settings for evaluating someone’s health.

The legislature’s pursuit of reforms to the state’s mental health safety net is attracting interest from across the state. Kathy Merritt drove from Wayne County to Raleigh Wednesday to attend the committee meeting. Merritt works in Goldsboro at Cherry Hospital, a state-run psychiatric facility. Her son also deals with mental illness. 

“I want to see mental health reform and help for people that are suffering with mental health issues,” Merritt said. She shares a common interest with the committee members, she said.

“I don't want to see a continuous cycle of: You're going into a hospital, you're being discharged, and you end up back into the same situation,” she said. 

Outpatient commitments

Wednesday’s meeting was the committee’s third and featured presentations on outpatient commitments, wherein mental health patients can receive treatment in the community instead of being committed involuntarily to a hospital. Committee members are interested in methods for treating people with mental illness in ways that don’t involve stays in psychiatric facilities, Reeder has said. 

Outpatient commitments can reduce aggressive behaviors in people with severe mental illness, said Marvin Swartz, a Duke University professor of psychiatry and behavioral sciences. 

However, Swartz said there isn’t enough research to know whether outpatient commitments are proven to prevent major acts of violence, which are also much more rare. Further, he said, studies have shown that outpatient commitments are only effective if the patient is also receiving intensive care. Intensive care often features therapy sessions, mental health education, and medication management.

“We’ve shown that people who get outpatient commitment but don’t get intensive treatment don’t get any better at all,” Swartz said.

North Carolina judges utilize outpatient commitments but their orders often lack the specificity needed to ensure a patient’s compliance, said Carrie Brown, the chief psychiatrist for the state Department of Health and Human Services.

Outpatient commitments are only appropriate for a limited number of people, Brown said, adding that legislators should amend state law if they want to encourage the practice.

For instance, lawmakers should expand the amount of time judges can keep someone under an outpatient commitment order from 90 days to 180 days. Brown said some psychiatric medications don’t take full effect until after 90 days, so it would be helpful for medical providers to be able to closely monitor patients for a longer period of time. The state should also strengthen the laws so that people who don’t comply with outpatient commitment orders face immediate action. 

“Because of the lack of specificity and the lack of accountability and enforcement, [outpatient commitment] is not used effectively in North Carolina,” Brown said. “When you have noncompliance, there needs to be a choice: reengage in community treatment right now, or it results in hospitalization.”

State Rep. Carson Smith, R-Pender, told WRAL that he likes the idea of using outpatient commitments but he took issue with Brown’s explanation of who would qualify for them. Brown said outpatient commitments should be used with people who have declined treatment for their mental illness and could pose a violent risk to the community. 

Smith questioned whether people who have refused treatment in the past would comply with the terms of a judge’s outpatient commitment order. He also expressed concern about releasing people into the community who could pose a risk of violence. Still, Smith said he agreed with Brown’s recommendations for changing the law.

“Not being able to have teeth to force medication I think is something probably that needs to be looked into,” Smith said. 

The committee's next meeting is scheduled for Feb. 11.