The article discusses how systemic issues contribute to individuals with severe mental illness frequently entering the criminal justice system due to limited access to state psychiatric hospital care.
Overview of Systemic Challenges
Tyeesha Ferguson, mother of Quincy Jackson III, a 28-year-old with psychosis, describes her son's repeated encounters with homeless shelters, jails, clinics, emergency rooms, and Ohio's regional psychiatric hospitals. Interviews with patients, families, current and former state hospital employees, advocates, lawyers, judges, jail administrators, and behavioral health experts indicate that the current mental health system often leads to individuals being processed through the criminal justice system rather than receiving early intervention.
State psychiatric hospitals nationally face challenges in providing treatment for patients before they are charged with crimes. This is attributed to an increase in the proportion of patients with criminal cases, who typically require longer stays due to court orders.
Capacity and Patient Demographics
Psychiatric hospitals across the United States report staffing shortages, resulting in patient turnaways or extended wait times for treatment. Patients who receive beds are frequently admitted via court order following criminal offenses.
In Ohio, the percentage of state hospital patients with criminal charges increased from approximately 50% in 2002 to about 90% at present. This rise coincides with a 50% decrease in the total number of patients served by Ohio's state psychiatric hospitals over the past decade, from 6,809 to 3,421. Nationally, the number of patients served decreased by approximately 17% during the same period, from 139,434 to 116,320, with varied state-level responses including increased community services, bed expansion, and hospital closures.
Ohio Department of Behavioral Health officials declined interview requests for the article.
The reduction in state facility capacity occurred alongside the closure of psychiatric units in local hospitals across the country, which primarily served patients with Medicaid or who were uninsured. The financial stability of local hospital mental health services is anticipated to be further affected by projected federal Medicaid budget cuts over the next decade.
Retired Ohio Supreme Court Justice Evelyn Lundberg Stratton, co-chair of the state attorney general's Task Force on Criminal Justice and Mental Illness, characterized the constricted flow of new patients through state hospitals as a crisis impacting individuals needing hospital beds outside the criminal justice system.
Patient Experiences and Delays
Quincy Jackson III's history includes multiple arrests and hospitalizations. Body camera footage from one incident shows Jackson, while cuffed in a hospital bed, stating, "I'm sick; I take medication." His mother described this as an "episode" involving severe psychosis. Between December 2023 and the time of reporting (late 2024), Jackson was arrested or cited in police reports on at least 17 occasions, jailed at least five times, and treated over 10 times at various hospitals, including three state psychiatric facilities. A recent psychiatric evaluation notes his history of admissions to community and state facilities since 2015.
Jackson represents a demographic of individuals with severe mental illness who frequently interact with community hospitals, courtrooms, and jails, contributing to state hospital backlogs.
Several recent high-profile incidents involving individuals reportedly struggling with severe mental illness have been cited by families, law enforcement, and mental health advocates as examples of insufficient care. These include:
- In August, a North Carolina man reportedly diagnosed with schizophrenia fatally stabbed a woman on a train.
- Also in August, a Texas gunman with a reported history of mental health issues killed three people at a Target store.
- In July, a Michigan man, whose family reported decades of needing treatment, attacked 11 people at a Walmart store with a knife.
- In June, police shot and killed a Florida man reportedly diagnosed with schizophrenia after authorities stated he attacked law enforcement.
Mark Mihok, a municipal judge near Cleveland, noted an increase in individuals with serious mental illnesses in the criminal justice system.
Hospital Bed Shortages and Wait Times
Ohio has approximately 1,100 beds across its six regional psychiatric hospitals. In May, the median wait time for a state bed was 37 days. Shanti Silver, a senior research adviser at the Treatment Advocacy Center, noted that this represents a significant period to await treatment in jail.
Extended wait times, often leading to individuals remaining in jails, have led to lawsuits in states such as Kansas, Pennsylvania, and Washington. A 2014 class action case in Washington resulted in systemic changes, including expanded crisis intervention training and residential treatment beds.
Ohio officials identified bed shortages as early as 2018. Subsequent actions included establishing task forces, expanding jail-based treatment, launching community programs and crisis units, and implementing a statewide emergency hotline. Despite these efforts, hospital backlogs have continued to increase.
LeeAnne Cornyn, former Director of the Ohio Department of Behavioral Health, stated in May that the agency "works diligently to ensure a therapeutic environment for our patients, while also protecting patient, staff, and public safety." Eric Wandersleben, director of media relations and outreach for the department, declined specific questions, referring to a governor's working group report released in late 2024 for public responses.
Elizabeth Tady, a hospital liaison, reported 45 patients awaiting beds at Northcoast Behavioral Healthcare, which serves the Cleveland region.
Ohio officials have added 30 state psychiatric beds by replacing a hospital in Columbus and plan for a new 200-bed hospital in southwestern Ohio. However, Lisa Gordish, Ohio Director of Forensic Services, cautioned that adding capacity alone may not resolve the issue, citing experiences in other states where new beds quickly fill, and waitlists persist.
Jackson waited 100 days in the Montgomery County jail for a state hospital bed during the current year. His mother stated she could not bail him out, explaining her son's inability to live independently.
Long-Term Care and Hospital Conditions
Patrick Heltzel, a 32-year-old patient at Heartland Behavioral Healthcare, has resided there for over a decade after being found not guilty by reason of insanity for aggravated murder. Heltzel emphasized the necessity of long-term care for medication stabilization and developing "insight" into chronic conditions.
Over the past decade, as the proportion of criminally charged patients in Ohio's hospitals has increased, reports from Heltzel, other patients, and former staff, alongside public records, indicate impacts on patient care, including concerns about safety, increased restrictiveness, and understaffing.
Katie Jenkins of NAMI Greater Cleveland noted that the shift toward criminally charged patients has altered the hospital environment, suggesting that the culture of jails can transfer to these facilities.
In the first 10 months of 2024, at least nine patient escapes occurred from Ohio's regional psychiatric hospitals, compared to three in the preceding four years. Escapes involved instances such as patients lunging at staff or breaking windows. Following an incident where a patient absconded during an off-site dental trip, state officials implemented a policy prohibiting patients from leaving any of the six regional hospitals. This change impacted Heltzel, who previously had regular off-site privileges, including weekend home visits.
Federal records indicate safety concerns at larger state-run psychiatric hospitals in Ohio, including Summit and Northcoast. Federal investigations in 2019 and 2020 addressed patient deaths, including two suicides within six months at Northcoast. An employee reportedly told federal inspectors that understaffing was a persistent and worsening issue creating a "very dangerous" environment. Disability Rights Ohio filed a lawsuit in October against the department, alleging abuse and neglect related to a patient death, which was later settled.
Retired sheriff's deputy Louella Reynolds, who worked at Northcoast for five years, stated that the increase in criminally charged patients made hospitals "less safe," recalling a physical assault. She advocated for armed officers and increased staffing to manage patients, noting frequent mandatory overtime.
Challenges in Treatment and Release
Heltzel's request for conditional release was denied by a judge. Heltzel had previously been hospitalized for approximately 10 days in early 2013 after an incident with his father. His mother reportedly advocated for him to remain hospitalized, but he was discharged. Heltzel reported feeling "still sick" and "delusional" upon discharge and subsequently stopped taking his medication. Within weeks, he killed Milton A. Grumbling III, believing Grumbling had abused him in another life, a delusion stemming from schizophrenia. A family member of the victim advocated for Heltzel to remain confined. Judges cited Heltzel's failure to adhere to medication before the killing as a reason for denying conditional release.
Katie Jenkins noted that psychiatric medications can take up to six weeks to become fully effective, suggesting patients may not achieve stabilization during typical hospital stays.
Jackson reported that inconsistent care or unmedicated periods in jail "worsens my symptoms." During a July interview from a state psychiatric hospital, he described head pain without medication. In early September, after a 45-day stay at Summit — his longest at a state psychiatric hospital — Jackson returned to the Montgomery County jail on misdemeanor charges related to an April altercation at a behavioral health hospital. His mother observed signs of distress during a jail video call.
Ferguson stated that before his diagnosis over a decade ago, Jackson had goals and dreams and is "loved and liked by a lot of people." She expressed concern about the lack of safe environments for her son to experience symptoms in Ohio.