The Times Square Tragedy and America's Broken Mental Health Safety Net
Publish Date: September 4, 2026
Author: Dr. Jeffrey Lieberman
Source: Shrink Speak substack
How a preventable mental health crisis and a lapsed treatment program reveal the deep failures in how we care for the severely mentally ill and the public around them.
An examination of the tragic Times Square stabbing unpacks a crisis playing out across the country: What happens when people with severe, untreated mental illness fall through the cracks of a system meant to protect them?
Drawing on the details of this case – including the apparent breakdown of a court-mandated treatment program – Dr. Lieberman explores why psychosis – driven violence keeps recurring, why law enforcement is so often left to respond to what is fundamentally a medical emergency, and why New York's mental health infrastructure failed at multiple points before this outcome became almost inevitable. It's a sobering look at a system that allows vulnerable people to "die with their rights on" and a call for the structural changes needed to prevent the next tragedy.
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On September 1st, a terrible thing happened in the middle of Manhattan in broad daylight. Two people were walking home through Times Square after work, and they were attacked by a woman who stabbed them with two butcher knives. One of the victims died. The other one was hospitalized for treatment. The perpetrator was Pamela Cisneros, a 49-year-old woman who, according to her father, had a long history of mental illness for which she was receiving treatment. Her brother said he believed the diagnosis of her illness was a bipolar disorder with psychotic symptoms.
Now, this terrible occurrence is not uncommon. Why? Because people who have severe mental illness, if they go without treatment, can be influenced by their symptoms: Delusions, which are false beliefs and hallucinations, often take the form of voices directing them to do certain things and act on their delusions. And so it's very likely that Ms. Cisneros, in a state of psychotic symptoms, was impelled by these to feel that these two people warranted being attacked in that way.
Now, the second part of this tragedy, this senseless death and injury, was that she was apprehended shortly after by police, who, when they couldn't subdue her manually and she attacked them with the knives, were required to resort to force, meaning using their firearms, and Ms. Cisneros died. So this was death by cop, which often happens when people who are mentally ill run amok and do things that require intervention by law enforcement – who are not necessarily trained to be mental health providers.
Now, a couple of things are notable. We have many such instances around the country – and it's sort of like a ticking time bomb before one of these things goes off and someone commits some type of injurious or lethal action because they're under the influence of their symptoms. And our society allows this to happen because one, our mental health care system is woefully inadequate, and so there's not access or availability for good quality mental health care (and even if there was, it's not always affordable because insurance doesn't cover it in a very substantial way). We allow people to reject the need for treatment who are manifestly not in their right mind. And we cynically refer to this ironic situation as allowing people to "die with their rights on." Because what happens is they get apprehended by police and they're at risk for being maimed or in this case, like Mrs. Cisneros, killed, because the police have to use some means to protect themselves and subdue the person.
This incident also reflects the fact that New York State did not deal with this situation sufficiently. According to her father, Ms. Cisneros was receiving a long-acting injectable medication, which likely means she was in a program called A.O.T., Assisted Outpatient Treatment, or Assertive Community Treatment. That means that she was required to take medication, and if she didn’t comply, then the clinic that she was being treated by had the right to go and find her and then administer treatment. In this case, the New York State Office of Mental Health didn't do a very good job because in her case, the agency that they contract with to implement this program allowed treatment to lapse, which enabled her to go without treatment, therefore relapsing. And in the throes of the relapse, her symptoms were exacerbated, which then resulted in these senseless deaths.
And this happens time and time again, even though it's totally unnecessary. It's yet another incident about which everybody would say, "This is crazy. We can't allow this to happen. There's got to be something done." And it's a wake-up call to force the health care system – and in this case, the government of New York and the Office of Mental Health – to do a better job of ensuring that the people who need treatment because of severe mental illness get it, thus protecting the rest of society.