After Decarlos Brown Jr. was arrested in late August and accused in the fatal stabbing of a Ukrainian refugee aboard a Charlotte light rail train — a killing that has drawn statewide and national attention — a capacity evaluation was quickly ordered by the court. The evaluation is the first step in a process that could determine whether Brown is mentally competent to stand trial. The result will begin to inform how the case moves forward.
Brown, 35, reportedly has schizophrenia and was homeless at the time of the killing. In a recorded jail phone call with his sister, obtained by ABC News after his arrest, he tells her that “material in his body” was controlling him at the time of the attack on 23-year-old Iryna Zarutska.
Seven months earlier, during a January encounter with law enforcement — when he was charged with a low-level misdemeanor for repeatedly calling 911 — Brown similarly told officers that “he believed someone gave him a ‘man-made’ material that controlled when he ate, walked, talked, etc.”
A previous psychiatric evaluation had been court ordered in July for Brown to appear at Alliance Health for the local forensic evaluators to assess his “capacity to proceed” to trial on the charge of misusing 911.
That evaluation never happened, court records show.
This time, Central Regional Hospital in Butner, the only state facility that conducts capacity to proceed evaluations, is performing the assessment. The forensic evaluation includes interviewing Brown and reviewing relevant records such as school, medical and criminal files.
Having the capacity to assist in one’s defense is fundamental to the U.S. justice system, said Charlotte defense attorney Jason St. Aubin. North Carolina statute prohibits anyone from being “tried, convicted, sentenced, or punished” if he or she is incapable of proceeding.
When someone is deemed incapable of proceeding, that indicates the person is so mentally impaired that they can neither comprehend the court proceeding before them nor rationally work with an attorney to help in their defense. The determination also halts legal proceedings, which puts the case at a standstill until the defendant’s capacity is restored.
“Our courts don’t want to punish people or hold people accountable if during that process, they’re basically unable to understand the nature of those proceedings,” said St. Aubin, who has represented clients who have been deemed incapable to proceed. “At that point, they would be unable to assist in their own defense, and any judgment obtained against them, or any defense they may have had could be impacted by their lack of understanding.”
The number of people being referred by the courts for capacity evaluation has been ballooning in North Carolina, taxing a system that is straining to keep up.
Last year, more than 2,600 capacity evaluations were completed, according to N.C. Department of Health and Human Services data provided to NC Health News. It’s a 33 percent increase in evaluations over the past five years — without an increase in resources to make those assessments.
Approximately 60 percent of individuals evaluated in 2024 — over 1,500 people — were deemed incapable of proceeding to trial and needed capacity restoration services.
“That’s one of the biggest problems in the system — demand has gone up significantly,” said Robert Cochrane, DHHS’ statewide director of forensic services.
Brown’s capacity status will be determined
Brown is being held without bond at the Mecklenburg County Detention Center. He faces a first-degree murder charge in state court, and federal prosecutors have charged Brown with causing death on a mass transportation system. Both charges could carry the death penalty.
Brown’s competency status has not yet been determined. Brown’s public defender did not respond to NC Health News’ request for an update. A spokesperson for the Mecklenburg County District Attorney’s Office said he could not provide information beyond the public court filings.
The results of Brown’s initial evaluation could be many weeks away. During the most recent fiscal quarter, the average time for a forensic evaluation to be completed at Central Regional Hospital was 69 days from the time of request, according to DHHS data provided to NC Health News. Cochrane said this timeframe is mostly driven by staffing limitations. The hospital has eight to ten people conducting evaluations Monday through Friday, he said, and they struggle to keep up with the “overwhelming number of referrals.”
Once the forensic evaluation report is completed with the evaluator’s findings, a capacity hearing will be held for the court to determine whether Brown is competent to proceed. If Brown is deemed capable of proceeding to trial, the case will move forward. However, if Brown is found to be incapable of proceeding, he then must undergo court-ordered treatment, which involves a combination of medication, individual therapy and legal education. These services aim to stabilize a person’s psychiatric symptoms and boost their understanding of the legal system so that trial proceedings can continue.
Restoring a person’s capacity can be a slow process.
“If a person is found to be incapable during any of the initial evaluations, then you’re basically guaranteed, in a case like this or any serious felony that even doesn’t result in death, that it will last a period of several years,” St. Aubin said. He explained that he is still working on a case from 2020 in which a client with schizophrenia and autism has had capacity issues.
More criminal defendants are being declared incapable to proceed in North Carolina. They wait an average of 165 days — more than five months — before being admitted to one of three state-run psychiatric hospitals for capacity restoration treatment, according to DHHS.
A DHHS spokesperson told NC Health News on Sept. 23 that 165 patients are receiving capacity restoration services at one of North Carolina’s state-run psychiatric hospitals — occupying about 27 percent of the approximately 600 staffed beds. Another 130 people have been deemed incapable to proceed and are waiting for admission to a state psychiatric hospital to begin capacity restoration treatment.
“Some of the sickest people that you’ll find when they come through the criminal justice system are found incapable to proceed,” Cochrane said. “Our hospitals are dealing with some very challenging cases with these individuals and trying to help them. So it’s no surprise that it takes months (to restore a person’s capacity). ... I do feel for the people who have to wait for treatment, but I don’t think the treatment that we provide in North Carolina is a day longer than anybody needs. It gets them to the place where they can go back and have their day in court and resolve their criminal situation.”
What does it mean to be ‘incapable to proceed’?
A person’s capacity to proceed can be questioned at any time during a criminal case — by the defense, judge or prosecutor. Most people deemed incapable of proceeding have a psychotic illness, such as schizophrenia, Cochrane said. However, having a diagnosed mental illness alone is not sufficient to be deemed incapable to stand trial.
“Plenty of individuals with schizophrenia are found or deemed capable to proceed,” Cochrane said. “It’s just those who are particularly acutely ill or experiencing acute symptoms are the ones that oftentimes are deemed incapable.”
For example, he said active hallucinations and delusional beliefs that interfere with someone’s ability to communicate effectively or think clearly enough to work with an attorney could lead one to be deemed incapable to proceed. Other conditions, such as intellectual disabilities or a traumatic brain injury, that lead a person to struggle with retaining information and comprehension could also affect their capacity to proceed.
When a person is deemed incapable of proceeding, that sets off a process of trying to restore their capacity — something that needs to happen for their case to move forward.
“I think one of the complexities is people think this is a way to, like get out of their trial, or they conflate it with insanity — and that’s not it,” said Apryl Alexander, director of UNC Charlotte’s Violence Prevention Center who previously conducted capacity evaluations and ran an outpatient capacity restoration program in Colorado. “This process is really to ensure a person’s due process rights and making sure that they understand what’s going on in trial, because we don’t want things like a mistrial happening.”
“A majority of people who are found incompetent to stand trial are restored to competency,” she added. “They eventually go back to trial, back to their court case and proceedings continue.”
Increased demand for capacity restoration
Historically, capacity restoration has only been provided in state psychiatric hospitals in North Carolina, which has led to a growing share of these facilities' limited bed space to be occupied by people involved in the criminal justice system who have been deemed incapable of proceeding. In fiscal 2016, these patients made up 10 percent of the total annual admissions to the state’s psychiatric hospitals. In fiscal 2024, it was 28 percent.
!function(){"use strict";window.addEventListener("message",function(a){if(void 0!==a.data["datawrapper-height"]){var e=document.querySelectorAll("iframe");for(var t in a.data["datawrapper-height"])for(var r,i=0;r=e[i];i++)if(r.contentWindow===a.source){var d=a.data["datawrapper-height"][t]+"px";r.style.height=d}}})}();
This is as hundreds of community members in mental health crises wait weeks or even months in emergency rooms for an opening in a state facility.
North Carolina’s three state-run psychiatric hospitals — Cherry, Central Regional and Broughton — have a total bed capacity of 910. However, chronic staff shortages limit the beds in operation to about 600 despite widespread need, according to DHHS.
As of Sept. 23, just over one-quarter of the patient population in state psychiatric hospitals are people deemed incapable of proceeding to trial, with many more waiting months in jail for a bed to start receiving capacity restoration treatment. During this limbo period, criminal defendants often deteriorate because jails are ill-equipped to address serious mental health needs — even as they have increasingly become de facto mental health institutions.
“If we had [more staff] in place, then we would be able to take in a lot more of the folks on the wait list, so people would be getting care a lot faster than they currently are,” Cochrane said.
These psychiatric beds generally do not turn over quickly because capacity restoration can be a slow process. On average, a person receives capacity restoration services for approximately 120 days in a state hospital before they are deemed restored or non-restorable, according to DHHS.
When someone’s competency has been restored, the court is notified and the legal process resumes. However, there are infrequent cases when someone is deemed non-restorable. In these cases, evaluators determine that someone is not getting better despite treatment and believe there is not a path for them to improve enough to gain the needed capacity. Generally, such cases involve a traumatic brain injury or intellectual disability, Cochrane said.
Expanding capacity restoration beyond state hospitals
The state’s strained psychiatric hospitals can’t meet all the demand for capacity restoration services. Even if they could, Cochrane said, many people don’t need the level of care offered in a hospital setting. That’s why state health officials have recently expanded capacity restoration services outside state hospitals, allocating just over $9 million to stand up and support three jail-based and three community-based capacity restoration pilots.
The new settings are aimed at serving people more quickly and more economically. According to DHHS, hospitalization is the most expensive way to provide capacity restoration, costing about $1,200 a day, compared to $400 in jail.
Cochrane said all the capacity restoration settings deliver the same array of treatment, including individual therapy, group therapy, education sessions on the legal system and medication management.
So far, Cochrane said, jail-based and community-based capacity restoration options are not used enough. He said he’s working to change that, because he thinks these settings can help make North Carolina’s restoration process more efficient — and, importantly, ease some of the burden on state psychiatric hospitals.
“We’re really trying to plug these alternatives, so that we can have an impact on the wait times, waitlists and get people in the right level of care,” Cochrane said.
As of Sept. 23, 14 people are receiving capacity restoration services inside one of the three jails with RISE (Restoring Individuals Safely and Effectively) capacity restoration programs. However, 45 total slots are available — meaning two-thirds of the beds are unfilled.
The Mecklenburg County Detention Center became the first jail to launch a capacity restoration program in December 2022 in partnership with the state health department. Earlier this year, sheriffs in Pitt and Wake counties followed suit — motivated in part by their frustration of seeing people’s mental health deteriorating in their jails while waiting for a hospital bed. The Mecklenburg and Pitt program beds are also available to people deemed incapable to proceed housed in other jails who can be transported to one of the programs — a point that Cochrane is working to stress to sheriffs across the state.
The average time spent receiving jail-based capacity restoration services is 55 days, according to DHHS.
A ‘competency crisis’
Demand outpacing available space for court-ordered capacity restoration is happening across the country, contributing to what experts have deemed a national “competency crisis.”
Cochrane said the way North Carolina’s capacity restoration system functions has cascading effects across the justice and health care systems.
“It impacts not just our state hospitals,” Cochrane said. “It impacts the courts. It impacts the jails and the sheriffs and the work they have to do with these severely mentally ill people who have to sit there and wait months to get to a hospital. It impacts emergency departments too — people in EDs who need IVC [involuntary commitment for forced psychiatric treatment] to one of our state hospitals. There aren’t any other choices. They have to wait.”
In response to the killing on the Charlotte light rail, Republican state lawmakers on Sept. 23 passed a bill dubbed “Iryna’s Law.” The legislation includes provisions to toughen pre-trial release and require judges to order more mandatory mental health evaluations. However, the legislation did not provide more funding to bolster mental health services. Gov. Josh Stein has not yet taken action on the bill.
Some critics argue that if it becomes law, it will not address the root issues that lead people with mental illnesses to cycle between the community and the criminal justice system and could worsen the strain already on the state’s overburdened mental health system.
“If you don’t have adequate treatment in the community, guess where they go?” Cochrane said. “They get arrested and they go to jail and they go to the state hospital. We need to divert on the front end and get people that primary care, so we’re not having to deal with tertiary care.”
Alexander, director of UNC Charlotte’s Violence Prevention Center, agrees.
“I think part of the competency crisis is that we just don’t have adequate mental health treatment — period — in communities,” Alexander said.
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.