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By Ed Runyan
As day-shift commanding officer for the Warren Police Department, Lt. Cathy O’Grady deals directly and often with calls about someone with mental-health problems. “It’s very rare we go a day without dealing with a person with mental- health issues,” she said.
But Warren has a sizeable number of agencies that treat mental-health and substance-abuse issues and has low-cost housing and homeless shelters, so the city attracts many people with these problems, O’Grady said.
At the same time, Warren has many restaurants and stores whose managers and employees don’t like people loitering near the business, especially if they make other customers uncomfortable.
In recent years, O’Grady said she and other officers have dealt with a growing number of people with mental-health issues.
They frequently get into trouble with business managers for harassing customers, prompting a call to police, who will respond, asking the person — usually known to the officers — to leave. After several such calls or if there is a confrontation, the person is arrested.
The person frequently ends up at one of the hospitals, “pink slipped,” meaning an evaluation is done to determine whether the person poses a danger to himself or others. In a few hours or days, after medication is given, he or she typically is released.
“What’s to make the person take their medication?” O’Grady said. Frequently the same person is right back at it soon after, she noted.
“Twenty-nine years ago, when I started, we had a handful that had diagnosed mental-health issues. Now there are so many more,” she said.
“We see the same people over and over again, and my question is, ‘What do we do with them?’”
O’Grady said people on mental-health medication who don’t have someone watching over them frequently don’t take it correctly, don’t take it at all or abuse alcohol and drugs.
“It’s like giving a 4-year-old its medication and expecting them to take it right,” she said. “A lot of times they say they don’t like the way the medication makes them feel, so they quit taking it.”
Back to Columbus
Warren Municipal Court Judge Thomas Gysegem says he traces the problem to Columbus, noting that Ohio has gone through phases, such as when Richard Celeste was governor from 1983 to 1991, and Ohio was among the top states in the nation in providing mental-health care.
“Since then, we’ve seen a decimation,” Judge Gysegem said of funding for mental health.
“When the economy isn’t steaming along, these [mental-health programs] are the first things to be cut,” he said.
Traci Mendenhall, a Warren prosecutor, said her job feels more like social worker most days than prosecutor because she spends so much time trying to find solutions for defendants rather than prosecuting them.
“Generally, we punish bad behavior” as a deterrent, but “you can’t deter a mentally ill person,” she said.
Susan Lightbody, magistrate for Probate Judge Thomas A. Swift, who refers Trumbull County residents about 175 times per year to a Massillon state psychiatric hospital called Heartland Behavioral Healthcare, says many standard forms of treatment don’t adequately address the mental-health needs of many people.
For one thing, it can take months for a psychiatric medication to work. For another, many people won’t accept the side effects they cause. And for another, some patients don’t think anything is wrong with them, Lightbody said.
“There are people who are noncompliant [with treatment programs] because of a lack of insight and judgment that they have mental illness,” she said.
Judge Swift says he thinks mental-health courts work best at the municipal-court level “but the issue is funding.” Judge Swift said he tried four years to get the state to create an outpatient mental-health facility in Youngstown for people who don’t comply with their treatment regimen, but he got nowhere.
Judge Gysegem says he’s been trying to make the best use of the tools available, such as the Valley Counseling agency, which provides medication and case management for most people with mental health issues who are getting arrested.
“It’s slow, but we’re getting reports,” Judge Gysegem said of information the agency provides to indicate whether individuals are receiving their medications and treatment.
The Ohio Supreme Court has encouraged Ohio courts to create “special dockets” to address specific problem areas.
In 2009, Judge Gysegem started a domestic-violence court, he said, because domestic violence is the largest cause of homicides, he said.
Trumbull County Common Pleas Court has operated a drug court since 1999 to combat drug and alcohol abuse, and officials say most graduates have succeeded in staying out of trouble. Participants meet with Judge Andrew Logan and substance-abuse counselors and probation officers for between 18 months and three years.
The Mahoning County Common Pleas Court started a mental-health court in 2005. Judge Maureen Sweeney, who runs it, says all but one of its graduates have stayed out of trouble.
Asked about a mental- health court for Trumbull County, Judge Gysegem said he would like to see the current system work better — perhaps through “regionalization” among agencies that work in the field now, such as Valley Counseling and the Forensic Psychiatric Center of Northeast Ohio in Austintown.
Judge Gysegem said those types of agencies could better monitor mentally ill individuals if they worked together. He also thinks electronic ankle bracelets could be used to monitor people with mental health issues, but the Ohio Legislature would have to act to make the ankle bracelets legal.
“On the one hand, I’m impressed with the agencies we have here, but the use of technology and specialization for some defendants such as monitoring is the key because we have to reduce the prison size,” he said.
Terry Ivanchak, the other Warren Municipal Court judge, said he sees about 10 people in his court on a regular basis with persistent mental-health issues but added he and Judge Gysegem “are pretty aggressive in following up” to see that they get treatment.
Vince Arduin, forensic monitor for Trumbull County for the Forensic Psychiatric Center of Northeast Ohio in Austintown, says a small percentage of people with mental illness get into trouble with the law.
It’s more common in the larger cities, and it is there that a mental health court seems to provide the most benefit.
Judge Sweeney says her mental-health court seems to be working.
“They’re on their meds, and they’re liking themselves again,” she said. “We take nonviolent offenders, get them back on their meds, get them in school to get their GED or whatever,” she said.
“They become employed, taxpayers again,” she said. Keeping mentally ill defendants out of the Mahoning County jail saves taxpayers money because the cost of housing a mentally ill defendant is double that of other defendants because of the cost of their medication.
The court typically handles a caseload of 20 people at a time, with each person usually taking part in the program for about two years.
Since the program’s first graduation in 2008, only one person has gotten back into trouble after completing the program — a woman who stopped taking her medication, Judge Sweeney said.
Toni Notaro, administrative director of the Mahoning County Mental Health Board, said she believes the Mahoning County Mental Health Court is making a difference, saying the court is reducing the number of repeat criminal offenders among the mentally ill.
She believes the mental- health court “reduces the strain on the [county] jail, but the most important part ... is people are getting needed services.” Untreated mentally ill people put a strain on “all of our resources,” Notaro said, including law enforcement, the jail and crisis services, she said.
The county health board spends about $100,000 per year to operate the mental health board through a contract with Turning Point Counseling Services. The money paid to Turning Point comes from the mental health board’s levy, she said.
April Caraway, executive director of the Trumbull County Board of Mental Health and Recovery, says the $100,000 that Mahoning County provides per year to operate the mental-health court is “not available” in her budget.
The Trumbull Mental Health and Recovery Board provides $19,000 per year for a man to work 20 hours per week in the jail to assess the mental health of inmates and pays some of the costs of commitments to the state hospital in Massillon done by Judge Swift.
CASE AGAINST COURT
She questioned the number of mentally ill people who would be served by a mental health court, saying the numbers are small, “but people see them out in the community.”
“I think somebody would have brought it to our attention if it was a good idea,” Caraway said of a mental health court. “We do basically the same through the probate court.”
Judge Logan, administrative judge of Trumbull County Common Pleas Court, said the drug court he runs out of his courtroom has a cross-diagnosis component.
“A lot of the people in drug court have mental-health issues,” the judge said, so the drug counselors in Trumbull County Drug Court sometimes refers people from drug court to Coleman Behavioral Services of Warren for mental health services.
In some cases, the drug court can’t take defendants because of their mental- health problems, he said.
“We can’t get them through [substance-abuse recovery] if their mental health problems are too severe. We can’t deal with the drug and alcohol abuse problems. Those are the people who would be ideal for a mental health court,” Judge Logan said.
The judges of Trumbull County Common Pleas talked about creating a mental health court several years ago with Judge Swift, but the judges “never figured out how to work it out in our community with our population,” Judge Logan said. “We know mental health court can be a good thing, but we have not seen it as a serious problem at this time. If the demand shows itself as a little greater, then we’ll be willing to look at a Trumbull County Mental Health Court.”
Mahoning County is the state’s 10th most populated county in Ohio with 238,823 people in July 2010, according to estimates. Trumbull County is the state’s 13th with 210,312 people.
Dr. Philip Malvasi, who has the contract to provide medical services at the Trumbull County jail, said he believes 10 percent to 12 percent of jail inmates have mental-health issues. Once they leave the jail, “there’s no follow-up care,” he said, so they “fall through the cracks again.”
Malvasi said a mental-health court in Trumbull County “would definitely work. We do that with people who are not incarcerated.”
Paul Bolino, executive director of Valley Counseling, said mental-health courts are “as a general concept a good idea” but he said he cannot quantify the number of people here with mental-health issues who run afoul of the law.
Evelyn Lundberg Stratton, recently retired Ohio Supreme Court justice, wrote earlier this month that Ohio never put community health centers in place after closing most of its mental-health hospitals.
“Many families [of the mentally ill] often turn to the courts and police for help because there are no other resources for them to assist their loved ones. Jails and prisons become the de facto mental-health system.
“Mental-health courts, where a team led by a judge works to stop the revolving door of jail and prisons, was one response to this crisis of lack of care,” she said.