YOUNGSTOWN — Mahoning County officials say the community needs to have a better way for helping people in the legal system with mental health issues.

For now, most of those people are being served by the Mahoning County jail.

Duane Piccirilli, executive director of the Mahoning County Mental Health and Recovery Board, and Mahoning County Prosecutor Lynn Maro say the county needs a lockdown facility for those who require immediate mental health assessments and intervention before they begin to navigate the legal process. But those plans are still in the works and such a facility may not be available for at least a couple of years.

Piccirilli said the county is in the midst of reevaluating how it addresses mental health problems at every level, but certainly within the justice system.

“We’re working with an outside consultant to review our adult mental health system,” he said. “Starting the first of the year, judges, the prosecutor, the sheriff and providers and family members — and we’re working with the National Institute of Mental Health — we’ll all be meeting, and we’re going to work to find out where the gaps are in our mental health and addiction system and make improvements.”

Maro spoke about it at a Mahoning County commissioners meeting earlier this month, when the board recognized Piccirilli’s agency for its suicide prevention efforts. September is National Suicide Awareness and Prevention Month.

“We’re trying to do things from our end, but we see it every day in our courtrooms; we see it every day in our jails,” she said. “We need to have a facility where they can get treatment and assistance.”

Piccirilli said the process is underway to find a facility and work with the state of Ohio to find out what is required to open a lockdown facility, which he said is not something commonly found in other counties.

But right now, the Mahoning County jail is the largest provider of mental health services for those charged with crimes. The Vindicator reached out to the Mahoning County Sheriff’s Office to get a better understanding of what that looks like.

Chief Deputy William Cappabianca, who oversees the jail, said that while the jail has always provided counseling services, Sheriff Jerry Greene began to provide increased services in 2021 because he saw an increase in the number of inmates experiencing mental health conditions.

As of this week, Cappabianca said about 110 inmates are on the mental health case load and the jail’s projections suggest it serves just under 6,300 inmates per year with mental health needs.

Mahoning County employs three full-time master’s-prepared licensed counselors, one psychiatrist and one psychiatric nurse practitioner, as well as 19 nurses that work around the clock daily, all trained to recognize and screen for behavioral health problems.

The annual cost to the jail for providing services is about $642,600, he said.

Cappabianca said some of that is offset through its contracts with providers. For example, VitalCore, Mahoning County’s jail medical provider, participates in the medically assisted treatment (suboxone) and psychotropic drug reimbursement program through the Ohio Department of Rehabilitation and Corrections, in partnership with the county Mental Health and Recovery Board.

“Through this program, we may receive up to 60% reimbursement of our MAT and psych medication expenses,” he said.

Cappabianca said the jail provides many programs and resources for those dealing with mental health and addiction problems. The programs are intended not only to meet inmates’ needs while they are in jail, but to help them transition to life outside.

Piccirilli noted that all the medications provided to inmates are the same medicines available at regular pharmacies, so the inmates will not have trouble continuing their pharmaceutical treatments upon release.

Like many county and state facilities, the jail offers Alcoholics Anonymous groups and Mahoning County has an Incarceration-to-Release Offender Coordinated Services program through Catholic Charities. Cappabianca said the IROCS team meets with inmates before their release to assess housing and nutrition needs, benefits enrollment (including Supplemental Security Income and Medicaid), and connects them with community mental health services.

“Our counselors also provide names of community organizations for individuals who wish to engage with support services after release, based on their needs,” he said. “The Forensic Center handles all court-ordered psychological evaluations, and Heartland Behavioral is the only psychiatric facility we utilize for higher levels of care.”

When inmates leave the jail, the facility ensures that their care is continued.

Cappabianca said if they are transferred to another detention facility, their medical records can be shared with the new facility’s medical personnel. For those who have completed their sentences, the jail’s counselors will work with community case managers to assist with discharge planning for inmates with serious mental illness or intellectual delays.

But the jail’s capabilities are limited.

“Without having a dedicated discharge planner on the behavioral health team, our counselors do not have capacity to coordinate community care with every inmate on the behavioral health caseload,” he said.

This is one of the fundamental flaws in the system and is not unique to Mahoning County.

“A jail was never designed to be a mental health facility, but with no mental health hospitals to service this population, county jails across America are finding themselves being a mental health provider,” Cappabianca said. “There is not enough funding and proper training that can be given to deputies to be able to handle this population as efficiently as a facility which is specifically designed to do just that.”

And deputies do face challenges as the mental health and addiction problems increase, in addition to the regularly expected troubles inmates can create.

“We deal with it daily, and the best that we can, with the limited resources that we have, compared to a mental health hospital,” he said.

Severely problematic inmates are rarely removed, because of a lack of alternative housing for them.

“The inmates in this type of situation remain incarcerated until the final disposition of their case. It is a severe hindrance on our detention staff, attempting to handle inmates like this,” Cappabianca said.

He said that sometimes the court intervenes and orders the inmate to Heartland Mental Health – a specialized hospital in Massillon, or another state facility for special assessment and treatment “However, the inmate always returns back to our facility for the criminal charges they still have to answer to,” he said. “Which, once inside of our jail walls, causes a relapse of any positivity gained while at the mental health facility. Beds at these facilities are few and usually there is a three- to four-month waiting list to get the bed.”

Cappabianca said the jail will continue to provide the services as best it can and he believes the facility and staff provides the best care they can, given the circumstances.

“With the effort that is put forward through counseling, medical care, and medication by our mental health staff, the daily operations of the jail become more manageable for our detention staff, and property damage to the jail with inmates experiencing mental health issues is becoming more stable,” he said. “However, the level of stability in each individual is different, causing a new stress in corrections that staff members did not experience a decade ago.”

Cappabianca said the solution is not about providing more resources to the jail but recognizing that the jail is not the answer to the problem.

“Our deputies’ and correctional guards’ training is not enough to be effective to solve this problem,” he said. “The Sheriff’s staff is doing a fantastic job with the training that they have received. The answer is that the state of Ohio needs to invest in building more mental health facilities that specialize in service of criminal justice and incarcerated mental health patients.”