Mental illness — or more specifically, the lack of proper mental health treatment — can disrupt more than just the life of the person struggling with an illness.
A nationwide initiative to keep the mentally ill out of jails not designed to house or treat such a serious illness has come to Lorain County as a coalition of local law enforcement, court officials and community agencies are working together to address the issue.
Called “Stepping Up,” Ohio held its first statewide conference in 2016. Since then, 33 counties — including Lorain — have signed on, devising a strategic plan that brings together a range of people, including police and probation officers, local mental health officials, judges and alcohol and drug-abuse specialists, who work with the mentally ill.
Experts say the problem is at “crisis levels,” and the statistics back it up:
- An estimated 2 million mentally ill people are jailed each year, often with co-existing substance abuse issues.
- As much as 80 percent of the seriously mentally ill also have substance abuse problems.
- While only 5 percent of the general population has serious mental illness, an estimated 7 to 10 percent of all police interactions involve someone who has it.
- About half of all military veterans in the criminal court system have mental illness or substance use disorders.
- In Lorain County between 2016 and 2017, 4,243 mental health assessments were completed at the Lorain County Jail. During that time, 200 incidents at the facility were mental health-related.
- Nearly 4 percent of all Lorain County Jail inmates were identified as having a serious mental illness and 47 percent of those with mental issues have no health coverage.
- Daily, two to 32 Lorain County Jail inmates receive suicide prevention measures at the facility.
“We’re not talking about anxiety or depression here, these are people that really cannot function because of mental illness,” said Lorain County Adult Probation Officer Bridget Novak. “It costs $70 a day for a typical person in the Lorain County Jail and a heck of a lot more for medical staff and psychotropic meds. Think of the potential tax dollars that can be saved.”
Locally, agencies like Adult Probation, the county Board of Mental Health, municipal and county police agencies, hospitals, county commissioners and judges meet regularly to develop plans to change what is too often a never-ending cycle that carries a risk of ending tragically.
“Jail is not an appropriate placement, and we know it. They might be doing something petty in the community — and the only answer is to take them to jail. Jail is housing that person instead of them being better off in a mental health facility,” said Melissa Fischer, project specialist for the Lorain County Sheriff’s Office.
Fischer said she is tracking basic statistics for the county jail: What are the basic challenges? What is the average length of stay? She said the state recently adopted a definition for “severe mental illness,” meaning “you’ll have an apple-to-apple comparison across the state.”
Some long-term goals already have been made clear: There is a need for more housing for the mentally ill. Throughout the country, jails have become the de facto providers of mental health services. Each county is trying to track local trends — are jail stints longer here than the U.S. average? Is there a barrier to services offered locally, or are there enough services locally?
Some agencies have banded together to create targeted intervention strategies. For instance, Adult Probation has collaborated with Elyria and Lorain police to do crisis intervention outreach. Each agency has specially trained officers; a small team of trained probation officers conduct home visits with people on probation who are flagged with mental illness to check up: Are they taking their medicines? Do they need help acquiring refills or scheduling doctor appointments? Do they need transportation to appointments?
“When they come in to (our agency), they’ve already been in some kind of trouble. They’ve got a felony or pending felony,” Novak said. “These are the ones that are constantly in and out. Some are in Lorain County Jail every month, at a huge cost to taxpayers.”
Once identified through screening, the agency’s outreach officers meet with the mentally ill person on their home turf on scheduled visits to check to see if they’re taking their medicine and attending to their condition. Sometimes they hand out small incentives as rewards for staying medically compliant, like a $10 gas card.
“If I give that out every other month, I’ve spent $60, compared to what it would cost to go to jail,” Novak said. “It’s a huge cost to taxpayers. We’ve found that if you just work with them prior to that, there’s much less recidivism by staying medicated, linked up to providers.”
Substance abuse can lead many to end up behind bars, and often mentally ill people without the proper care or medications will self-medicate by drinking or using street drugs. Sometimes it is easier to get drugs on the street than obtain medical appointments or expensive medications. Then, a mentally ill person can end up with a drug charge, or charges of menacing, disorderly conduct and resisting arrest if their mental illness makes them unable to understand what is being asked of them by an arresting officer.
“Sometimes they can’t be the best advocate for themselves because their thoughts are so disorganized, they might be paranoid, might be depressed, bipolar or schizoaffective — and that could spiral into a confrontation with police,” Novak said.
If an officer trained in crisis intervention is called to the scene, the outcome can be much better — for the mentally ill person who needs treatment and for the safety of all involved.
One of Novak’s clients is a woman who has struggled for years with low-level offenses and severe mental illness. The Chronicle-Telegram is not revealing her identity to protect her privacy. She goes by “Birdie.” She is 45, and has been diagnosed as bipolar and mildly mentally ill with post-traumatic stress disorder.
“I’ve had plenty of arrests that I feel I shouldn’t have been taken to jail; I should have gone to a hospital,” Birdie said. “I wasn’t taking my medications and things got out of hand. A few times police did call an ambulance for me, and I appreciate them times. I really, really needed to be there. I was probably trying to make my way there when I (ran across the police).”
“Mental illness can be embarrassing. You’re stigmatized already, “Oh you’re crazy,’” she said. “I don’t make decisions well. I spiral out of control. It’s an unbalanced situation, to tell you the truth. My thoughts are not in order.”
She does not mention the specific circumstances that have landed her in jail before, but she said sometimes she has been manic, “lashing out at everybody,” or she has misperceived a threat and, in a self-defense response, ended up arrested.
“I’m not a violent person. I do know that I have manic episodes where I can think people are out to get me and I think I have to defend myself. It’s a hard thing to explain,” she said.
“(Novak) makes sure I’m up to date on going to my doctors, she checks my schedules and my medicines,” Birdie said “What impressed me is the time she took to talk to me. She asked how I’m doing. I could talk to her.
“It’s a very, very fine line between people that just do things because they do and people that don’t really realize this is happening … to not mentally be able to make that right choice, especially if they’re caught up in a depressive or manic episode. The thoughts that I have, that people are trying to do this or that to me, that people are laughing at you — and to have (Novak) come to me as nice as she did almost felt like welcoming arms. I took it as her putting her hand out to me to help me through it,” Birdie said.
The Lorain County Board of Mental Health has done crisis intervention training for 16 years, preparing 235 officers. From 2013 through last year, 80 of those officers were given advanced crisis intervention training. The agency also has provided training as part officers’ state training requirements, said Clare Rosser, director of communications and community relations for the agency.
Elyria police are far above the national recommendation of having 25 percent of the force trained in crisis intervention. Forty percent of Elyria police have the training, said Lt. Deena Baker. This greatly increases the disbursement of crisis intervention officers for all shifts, providing the service around the clock.
While Baker cannot yet provide statistics to show how crisis intervention has helped, “I can definitely say and research supports that (crisis intervention) training is effective at improving officer attitudes, skills and level of preparedness in responding to individuals experiencing a mental health crisis,” she said.
However, even specially trained officers need alternatives to offer the mentally ill, and part of the Stepping Up initiative locally will try to identify what is needed and start fulfilling those needs.
“People are not going to jail as frequently, they’re linked up with services, they stay medically compliant, and you don’t have these guys going through the jail,” Novak said. “The local police are always going to protect the public. They’re not in the business of having dangerously mentally ill people out in public. But some of these people, we feel a lot of these can stay medically compliant and even-keeled and get better in society.”
Contact Rini Jeffers at firstname.lastname@example.org.