Mahoning County Sheriff Jerry Greene says the Mahoning County jail is the largest mental health facility in the county.

“When we have 500 inmates, we know that one third of those inmates are on some type of psychotropic meds,” he said.

“We started realizing: Where are these people going to go when they get released? Where is their next meal going to come from? Who is going to give them their meds? These are all things that weren’t thought about before.”

Interventions through community partnerships can stop the endless cycle, and find more appropriate places to treat and house them than jail, Greene said.

He and Mahoning County Common Pleas Court Judge Maureen Sweeney participated in a recent meeting with local mental health partners.

Sweeney oversees the county’s mental health court, one of the first in the state. In the years she has presided over the court, only one person has reoffended.

“People who actually make it through the program are successful,” Sweeney said. “When they are done with the program, if they make it through, they don’t have a criminal record. The prosecutor’s office has cooperated with us to expunge whatever charges they were facing.”

The program also helps people connect to jobs, Sweeney said.

But the biggest challenge is finding housing for people with mental health issues, she said. Though there are housing options for people in recovery from substance use disorders, “John Q public” is “scared” of people with mental illness, Sweeney said.

“They don’t know how to react to them. We have very limited resources for housing, and that is actually limiting the amount of people we can take into the court, more so than ever,” Sweeney said. “So, we’re looking for other housing sources, which is really important to us.”

Over the past 20 years, housing has been the major issue for this area, retired Ohio Supreme Court Justice Evelyn Lundberg Stratton said.

“It is something we are really focusing on,” Stratton said. “If you don’t have housing, you really don’t make much progress.”

SPECIAL DOCKETS

The advent of special dockets for those with mental illness is one of several recent developments that can help to increase the availability of mental health services.

In Mahoning County, probate Judge Robert Rusu said some of the most difficult cases appear before his Fresh Start Court.

“We take the frequent fliers who are constantly cycling in and out of the system. They come in front of me with a treatment team, and we try to persuade them or order them to comply with treatments and to see the benefits of treatment,” Rusu said.

The programs can connect people to medications, counseling, jobs and housing, and has seen some success, Rusu said. But the programs usually are implemented after criminal cases are finished.

In Trumbull County, on low-level charges, interventions can be filed for treatment-in-lieu-of-conviction for mental health issues, said David Rouzzo, a defense attorney who often represents people who can’t afford to pay for their own representation.

Under the supervision of the probation department, a treatment plan is developed with a certified provider. However, the program is not available for third-degree felonies and above, he said.

“When you have a serious case, the only time mental health is relevant is at sentencing, and many times that doesn’t matter because of mandatory prison terms,” Rouzzo said.

JAIL COUNSELING

Both Trumbull and Mahoning county jails have fairly new jail counseling programs.

Duane Piccirilli, executive director of the Mahoning County Mental Health and Recovery Board, said a national provider of mental health services, Well Path, now is working closely with other agencies in the jail.

“We acknowledge the justice system is one of the major providers of mental health and addiction services, and we must partner with them,” Piccirilli said.

Wendy Laurenzi is the jail liaison and counselor for Coleman Professional Services in the Trumbull County jail, paid for by the Trumbull County Mental Health and Recovery Board. The program began about a year-and-a-half ago and is expanding with a second counselor. Those who stay in the mental health pod are seen more frequently.

Part of her job is to track incoming inmates to see if they are clients so she can connect them to medications, although she works with inmates who aren’t clients of Coleman. The medications are paid for with grant money obtained from the MHRB.

She also conducts suicide watch assessments and makes recommendations to the jail doctor, and completes mental health assessments. She works to schedule appointments for people on the outside that correlate with release dates in an effort to continue services. Coleman provides a sliding scale for paid services outside of the jail, so there’s a chance to continue treatment, she said.

“A lot of the people in and out the door over and over again have struggles with mental health. We hope to link them to services, but some do not have the ability to follow up with those repeat issues,” Laurenzi said. “I try to give them hope, to just be someone to listen to them, and they appreciate someone sitting down with them and hearing their feelings. No one else is listening to them.”

However, the environment is not the place to work through the trauma and serious issues many bring with them to the jail, she said. “We work on getting through the time here and connecting with services.”

CRISIS INTERVENTION

People with mental health issues are more likely to connect to services and avoid jail if the police officers called to assist during an episode are properly trained in crisis intervention.

Both Trumbull and Mahoning counties offer special training to officers.

Liberty police Chief Toby Meloro said crisis intervention training is more than just training.

“Our goal at the Liberty Police Department is to get these individuals the proper help they need instead of placing them in the criminal justice system due to illness related behavior. Arresting someone is easy; getting the person the proper help they need is the challenge,” Meloro said.

All of the Liberty officers have the training “because the training improves the officer’s and public’s safety,” he said.

In Mahoning County, all deputies attend the mental health first aid training sponsored by the MHRB. Sometimes a disturbance with someone in crisis doesn’t reach the level of criminal behavior until police intervene, so proper de-escalation can help resolve more problems before they arise.

Retired Ohio Supreme Court Justice Evelyn Lundberg Stratton said 30 years ago, only 100 officers in Ohio had the training. But after a push to promote the training, more than 7,000 Ohio officers are CIT trained. There are more than 25,000 police officers in the state. The problem is, after a trained officer successfully manages the situation, not enough places for treatment are available. Crisis centers and more focus on a continuum of care for follow up treatments would help, Stratton said.

Without more services, jails and prisons will continue to serve as the “biggest mental health facilities in the state,” Stratton said.

STEPPING UP

Allowing jails and prisons to continue serving as the state’s mental health treatment facilities is more expensive in the long run, Stratton said.

A person cycling in and out of prisons and state facilities can rack up costs in the hundreds of thousands, while supportive housing costs a fraction of the amount, Stratton said.

But the Stepping Up Initiative, a nationwide program that began in 2015, is seeking to help counties save money by implementing smarter practices, and to keep more people with mental illness out of jails and prisons.

“There are simple things to do, and it saves money,” Stratton said.

Mahoning, Ashtabula, Columbiana, Portage, Stark and Summit counties are some of the 48 counties in Ohio and 524 in the country joining the program. Mahoning just recently joined, while Trumbull has not done so yet.

rfox@tribtoday.com