Patrick Peralta last saw his sister Pamela Cisneros at their stepfather’s birthday party in early August. She had helped organize it. Three weeks later, he saw her again on the evening news and spent several minutes hoping the woman in the footage wasn’t her.
It was. Cisneros, 49, a Queens native with a master’s degree in psychology and three daughters, was shot and killed by NYPD officers on August 31 after police say she stabbed two strangers in Times Square. One of them, 32-year-old Erin Piacenti, died at Bellevue Hospital. A 68-year-old man survived.
For Cisneros’s family, what happened was difficult to reconcile with the woman they had known in the years leading up to the attack. Her brother said she had struggled with serious mental health difficulties for decades, but had appeared stable for the previous four or five years. She worked, joined family dinners, and regularly visited their mother.
Then, during the week before the attack, she stopped showing up.
Her family called. Cisneros answered and said she was fine. Days later, everything changed. “It was like a switch,” Peralta told reporters.
What happened during those final days remains unknown. Her family’s experience raises a difficult question with no simple answer: when someone who appears stable begins to change, how much warning is there before a serious mental health crisis, and how reliably can even the people closest to them recognize it?
What the Family Describes
Mental health difficulties had been part of Cisneros’s life for decades, beginning more than 20 years ago after the birth of her second daughter, Peralta said. Cisneros attempted suicide in 2019, a year he describes as a turning point after which her condition appeared to improve with medication. “She was doing well, like for the last four years, five years. She was getting injections. She was never aggressive,” he said.
Cisneros lived in an apartment in Woodside, Queens, and worked on and off with an attorney who specialized in immigration cases. She visited her mother and stepfather regularly, helped plan family gatherings, and by her brother’s account gave no indication of the acute deterioration that apparently preceded August 31.
The family became concerned in the days before the attack when Cisneros did not make her usual visits. Her brother said they called her. Their mother spoke with her the Saturday before the attack. Cisneros said she was fine. That was the last contact the family had before seeing her on television. “It was like a switch, and I don’t know what happened in her mind,” Peralta said.
What Happened on August 31
On August 31, 2026, police say Cisneros carried out a random stabbing attack in Times Square, killing 32-year-old Erin Piacenti and seriously wounding a 68-year-old man. According to NBC New York, NYPD Commissioner Jessica Tisch said a witness told police Cisneros removed two knives from a red shopping bag before approaching her first victim, and that the two stabbings occurred about 20 seconds apart.
According to a press release from the New York Attorney General’s Office of Special Investigation, at approximately 4:26 p.m., NYPD officers encountered Cisneros holding a knife in each hand on the sidewalk on Seventh Avenue between West 42nd and West 43rd Streets. Officers ordered her to drop the knives. She did not comply. She allegedly told officers, “I would rather kill both of you.” Three officers discharged Tasers with no apparent effect. Two officers then discharged their service weapons. She was transported to a local hospital, where she was pronounced dead.
The New York Attorney General’s Office of Special Investigation opened a formal investigation into Cisneros’s death. Under New York State law, that office reviews every incident in which police may have caused the death of a civilian, whether the person was armed or unarmed.
According to ABC7, NYPD Commissioner Jessica Tisch confirmed that Cisneros had a documented mental health history with the department. Authorities have not publicly provided details about those specific incidents.
Mental Illness and Violence: What the Evidence Shows
Mental health advocates and clinicians distinguish between someone who has a documented psychiatric history and someone who poses an imminent risk of violence. According to data from the Council of State Governments Justice Center, people with mental illnesses account for only about 4% of violent crime in the United States. The vast majority of people living with serious psychiatric conditions pose no elevated risk to others.
People with schizophrenia or other psychotic spectrum disorders are substantially more likely to be victims of violence than perpetrators. Media narratives that sensationalize rare extreme cases contribute to stigma that makes it harder for people to seek help and receive adequate care. A psychiatric diagnosis alone does not predict individual behavior, and characterizing people with mental illness as broadly dangerous is not supported by the population-level evidence.
Treatment access, continuity, and support all factor into outcomes in ways that a diagnosis alone cannot predict. Research consistently shows that sustained, supported care shifts outcomes at a population level – but nothing in the existing evidence allows clinicians or families to reliably predict what a specific individual will do on any given day.
Why Predicting an Individual Crisis Remains So Difficult
Peralta’s account raises a question that clinicians and researchers have studied for decades without a clean answer: why do some people who appear stable experience an abrupt and severe change, and is there any reliable way to detect the warning signs that might precede it?
Structured violence risk assessment tools are more accurate than clinical intuition alone, though they are designed for population-level risk stratification – not for predicting what any single person will do on a specific afternoon. Even the most rigorous clinical tools carry meaningful uncertainty at the individual level.
Long-acting injectable antipsychotics, sometimes called LAIs, are one format designed to support treatment continuity – injections that release medication into the body over time, reducing the need for daily oral dosing. They are commonly used in the treatment of schizophrenia, bipolar disorder, and related conditions. Peralta mentioned that his sister had been receiving injections during the years when she appeared stable. He did not suggest – and this article does not speculate – that any change in her treatment caused what happened.
The Signs Families Sometimes Miss
Peralta’s account captures something that families dealing with a loved one’s mental health struggles often describe: a period of relative stability, followed by a withdrawal from contact, followed by a crisis that seemed to come without warning. Changes in routine, declining engagement with family or caregivers, and withdrawal from regular contact can sometimes signal a shift in someone’s mental state.
That Cisneros’s family noticed her absence before the attack, and that they tried to reach her, reflects the kind of attentiveness that mental health advocates recommend. Cisneros told her mother she was fine the Saturday before the attack. During an acute episode, a person may genuinely believe that self-report. Mental health crisis signs are not always easy to interpret without clinical training.
If you’re concerned about someone’s mental health, the 988 Suicide and Crisis Lifeline (call or text 988) connects callers to trained crisis counselors around the clock.
Two Families in Grief
Peralta told reporters that his family does not know how to explain what happened, and that no explanation would bring anyone back. “We feel their pain, too,” he said.
Erin Piacenti was killed on the same day she returned to work after maternity leave, according to NBC New York. The 68-year-old man who was also stabbed survived his injuries.
Questions Without Easy Answers
The attack on August 31 left two families grieving and questions that may never be fully answered. Peralta does not know what changed in his sister during her final days, and the available evidence does not establish what caused her behavior.
Her history of mental illness is part of the story, but it cannot explain the story by itself. A psychiatric diagnosis does not allow families, doctors, or the public to predict that someone will become violent, and cases like this should not be used to characterize the millions of people living with mental health conditions who will never commit acts of serious violence.
What Cisneros’s family did notice was a change in a familiar pattern. She stopped making her usual visits. They reached out. She told them she was fine. In hindsight, those details carry enormous weight, but at the time they did not tell the family what was about to happen.
That may be one of the hardest realities surrounding a mental health crisis: changes in behavior can sometimes be warning signs, but they do not come with a clear explanation of what they mean or what will happen next. Families can pay attention, stay connected, encourage treatment, and seek professional or crisis support when something feels seriously wrong. They cannot be expected to predict the unpredictable.
For Peralta and his family, the question remains the one he has been asking since August 31: what changed?
Disclaimer: The information provided here is for educational and informational purposes only and is not a substitute for professional psychological, psychiatric, or mental health advice, diagnosis, or treatment. Always seek the guidance of a licensed mental health professional, therapist, psychologist, or psychiatrist with any questions or concerns about your emotional well-being or mental health conditions. Never ignore professional advice or delay seeking support because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.