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Crisis behavior not necessarily criminal acts

Justice system often substitute for needed mental health care

People in the throes of a mental health crisis often intersect with the criminal justice system, and while efforts are being made to increase the availability of mental health services, observers say existing systems are still lacking.

When people with mental health issues become involved with the justice system, it often can be during an episode involving crisis behavior. Or, the person has a repetitive history of similar behavior.

Sometimes the behavior itself is not criminal, but causes alarm in family members or bystanders who have few options but to call for police or an ambulance; other times, the behavior leads to criminal acts.

When police and people with mental illness interact, tactful de-escalation tactics can be a lifesaver, but sometimes the experiences unravel into chaos.

The exchanges can lead to a revolving door of being “pink slipped” for emergency hospitalization, homelessness, repeated police encounters, committing crimes just for a place to stay in jail, a whirlwind of judges and courtrooms, lapses in treatment — all with mental anguish for the individuals and their family members.

Police officers and mental health officials alike do not believe county jails are the appropriate place for people with mental illness to get treatment, but often no other option exists.

“By dismantling the mental illness treatment system, we have turned mental health crisis from a medical issue into a police matter,” said John Snook, the former executive director of the advocacy center. “This is patently unfair, illogical and is proving harmful both to the individual in desperate need of care and the officer who is forced to respond.”

LOCAL SYSTEMS

Trumbull County Sheriff’s Office Maj. Dan Mason said the local systems, while staffed by those with good intentions and programs attempting to cover the gap, fall short. He’s watched treatment options dwindle during his career.

“From the time I was hired as a patrolman in Warren in 1992 until 1996, the Mahoning Valley was served by Woodside Receiving Hospital. This was a state-run psychiatric hospital that had a capacity of about 600 patients. Courts were able to send individuals exhibiting signs of mental illness to be evaluated for treatment. In the event that an individual was evaluated and determined by a physician to be mentally ill, Woodside Hospital was capable of long-term treatment,” Mason said.

“Since 1996, the majority of mental health evaluations being conducted are at local hospitals.”

In the Mahoning Valley, there are 19 beds for adult psychiatric care, ages 18-54, and 16 beds for geriatric psychiatric care, 55 years and older, at Trumbull Regional Medical Center; and St. Elizabeth Youngstown Hospital has 34 psychiatric beds, said April Caraway, Trumbull County Mental Health and Recovery Board executive director. St. Joseph Warren Hospital serves people experiencing a mental health crisis, Caraway said. If after a mental health assessment they believe the person could benefit by hospitalization they transfer them to St. Elizabeth.

It’s only been in the last 15 years or so that attempts were made to integrate treatment for mental health or substance use disorders into the criminal justice system.

Even though officers are getting more training in de-escalation tactics than they were 10 years ago, “there are (fewer) agencies to provide services causing the facilities to become overwhelmed with the increasing number of patients,” Mason said. “And, since there is decreased long-term bed space, most patients are released for outpatient services. Without daily monitoring, many individuals become noncompliant with treatment and end up in a mental health crisis causing law enforcement interaction, which becomes an endless cycle.”

Caraway said the system works this way by design.

“The goal of inpatient treatment is to stabilize the individual, connect them to services / resources and return them to their homes and / or another facility in the community. It is not our goal to remove these individuals from the community for months at a time. That would result in job losses, loss of housing, child care and other family issues,” she said.

AN EXAMPLE

For example, Warren police reports show a steady escalation of one Youngstown man who kept refusing to leave a local hospital.

In October 2019, police were called to Trumbull Regional because he wouldn’t leave after being discharged. He was arrested on charges of criminal trespassing and menacing. In June, police were called to the emergency room there when the same man refused to leave after being discharged. He was arrested on another criminal trespassing charge.

On Dec. 6, an ambulance took him to St. Joseph Warren Hospital because he was suicidal. Just an hour later, he was discharged and arrested on the warrants for not appearing in court on the charges he accrued after the first two incidents.

Then, on Jan. 14, police again were called to Trumbull Regional. Earlier in the evening, the man encountered police and told them “he wanted to go to the hospital for suicidal thoughts because it was cold outside and he is homeless.” But at the hospital, he was discharged again, hours later, and refused to leave. He became “angry and argumentative,” threatened staff and slammed a hospital computer, causing about $1,500 in property damage, the report states. He remains jailed, waiting to see if a grand jury will indict him on felony charges.

“Many times it is the same people over and over again. In my experience, the system is ill-equipped to handle the challenges of mental illness. And I think that goes from the jail, to prison, throughout the whole system,” said David Rouzzo, a defense attorney who often represents people who can’t afford to pay for their own representation.

“I’ve had clients that commit crimes in the winter so they won’t be homeless, a property crime, like throwing a brick through a window and sitting down on the sidewalk to wait to get picked up. It’s better than freezing to death. And many times they avoid the shelters because of the rules and the religious aspects,” Rouzzo said.

Caraway said it isn’t always appropriate to admit people when they come to the emergency room.

“Depending on one’s mental health diagnosis and history, a community crisis plan may be utilized to ensure they are receiving the appropriate level of care … There are many factors that are involved when developing a community crisis plan: history, baseline presentation, mental health diagnosis, treatment compliance, etc.,” she said. “Part of assisting this person to recover is limiting in-patient admissions.”

NO IN-BETWEEN

Robert Gaskins said the system is “frustrating” as the family member of someone with paranoid schizophrenia.

“The first time he had an episode, they gave him a shot to sedate him. He had to be put on a ventilator because of it. Others have been killed by the drug, given to people during manic episodes to subdue them,” Gaskins said.

Newton Falls police and Trumbull County Sheriff’s Office deputies were called in December when his family member was going door-to-door asking “to enter homes to warm” up. Gaskins wanted to take the family member to the hospital because he knew he was off his medications. The family member struck one of the officers, there was a struggle as he told the officers of an “implant in his ear” and other delusions.

Gaskins said police handled it well: “They just tried to keep calm. They did the best they can.”

When the family member stayed at the state hospital for a couple of weeks, Gaskins saw a pointed change, but it didn’t last long.

“What he needed at that point was some sort of maintenance treatment. He needed something more intense than a counselor, less intensive than a mental hospital, but there was no in-between,” he said.

Retired Ohio Supreme Court Justice Evelyn Lundberg Stratton said one of the biggest obstacles is that people with mental illness can’t make rational decisions on their own, but still aren’t sick enough to be placed in a guardianship. The state failed to create a plan for services when state hospitals were closed, instead using the funds on other things, Stratton said.

The process of guardianship is a huge responsibility for those who undertake it.

“It’s like having another kid,” Gaskins said. And family members have to decide what types of boundaries to set in their lives for other loved ones, he said.

Caraway said guardianship is rarely an option for clients with mental illness unless there is a cognitive issue such as dementia. “Even with guardianship, the client cannot be forced to take medication in the community,” she said.

rfox@tribtoday.com

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