Pennsylvania’s Involuntary-Commitment Laws Failed to Keep Governor Shapiro Safe

Cody Balmer was arrested in 2023 for allegedly striking his wife after a failed suicide. He then moved in with his mother, who reportedly contacted four police precincts in failed attempts to treat him involuntarily for schizophrenia and bipolar disorder. Earlier this month, less than three days after what his mother claims was her final bid to initiate a psychiatric evaluation, he allegedly scaled the gates of Pennsylvania governor Josh Shapiro’s estate and firebombed his house.

Balmer’s case follows an unfortunately familiar pattern. A person with a serious mental illness and a demonstrated history of violence becomes increasingly paranoid and delusional. His loved ones seek involuntary treatment through official channels—county crisis hotlines, police precincts, and psychiatric professionals. These requests get denied on the grounds that he is not an imminent danger to himself or others. He eventually snaps, harms himself or someone else, and only then is sequestered and treated.

States are understandably reluctant to detain a person because of what he might do rather than what he has done. That reluctance, along with a series of court decisions, inspired Pennsylvania and other states to make it harder to treat involuntarily people with mental illness. But the inevitable consequence of these policies is that people like Balmer remain on the street until they hurt themselves or others.

Before 1970, states committed people with mental illness to hospitals because they were incompetent, not because they were dangerous. They did so under the parens patriae (“parent of the country”) doctrine, a common-law principle that holds the state ultimately responsible for the welfare of dependent minors and incapacitated adults. Pennsylvania legislators crafted the state’s 1951 Mental Health Act on this basis, allowing hospitals to retain any patient whom two physicians had labeled “mentally ill and in need of observation, diagnosis, and treatment.”

These statutes prevented some number of people with serious mental illness from harming themselves or others. In the early days of asylum care, they provided dignified lives to people who otherwise would have lived in chaos and squalor. But countless families and physicians abused these statutes to sustain unnecessary and even harmful treatments and hospitalizations.

In response to abuse-inspired legal challenges, federal courts in the 1970s declared certain state commitment statutes unconstitutional. In 1972, the Supreme Court held in Humphrey v. Cady that states could not involuntarily treat a person “solely on the medical judgment that [he] is mentally ill and treatable.” Instead, states needed to demonstrate the person’s “potential for doing harm, to himself or others, is great enough to justify such a massive curtailment of liberty.”

Pennsylvania and other states then revised their statutes and raised the involuntary-commitment threshold. The Keystone State’s multiply amended but still-in-force 1976 Mental Health Procedures Act (MHPA) lets a person be treated involuntarily only if “he poses a clear and present danger of harm to others or to himself,” including the risk of suicide or of failing to “care for his own personal needs” (the so-called grave disability standard).

This sounds like a reasonable way to avoid unnecessary hospitalizations and protect individuals’ civil liberties. In practice, however, it prevents courts from hearing relevant information about a person’s condition and mental-health history. In assessing whether a patient is so gravely disabled as to require inpatient care, the MHPA allows courts to evaluate only whether the patient would be otherwise “unable satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety.” But what about a person who can meet his basic needs but has a history of mental-illness-induced violence and has lapsed into psychosis? In other words, what about people like Cody Balmer?

One option is to embrace a broader understanding of the parens patriae principle. That doesn’t mean a return to mass institutionalization and the abuses of the mid-twentieth century. It does mean that the state, like a parent, should intervene when people with mental illness have proved incapable of living dignified lives.

Balmer’s mother claimed that he was in the throes of psychosis and had tried to “eat batteries.” Modern commitment laws would see this as Balmer “satisfy[ing] his need for nourishment.” The parens patriae approach would see it, in conjunction with his mental-health history, as grounds, at least, for an evaluation.

States are right to be cautious. The central justification for involuntary hospitalization—that a patient has a serious mental illness—cannot be proved by a blood test, brain scan, or other objective criteria. The commitment procedure can be embarrassing, demoralizing, and even traumatic. Psychiatric hospitalization, as practiced today, sometimes fails meaningfully to improve patients’ condition.

But these challenges argue for prudence, not paralysis. The status quo is failing people like Balmer, who have a history of violence and a clear pattern of psychosis. For society at large, the cost of doing nothing is growing ever steeper.

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