State Psychiatric Hospitals Shift to Criminal Caseloads
State psychiatric hospitals across the United States are increasingly admitting patients with criminal charges, leading to significant shifts in their function and capacity. This trend has resulted in extended stays for court-ordered patients and reduced ability for hospitals to treat individuals before their mental health conditions escalate to criminal offenses.
Ohio's Changing Patient Demographics
In Ohio, the proportion of state hospital patients with criminal charges has risen from approximately 50% in 2002 to around 90% currently. Concurrently, the total number of patients served in Ohio's state psychiatric hospitals has decreased by 50% over the past decade, from 6,809 to 3,421. Nationally, the total number of patients served has declined by about 17%, from 139,434 to 116,320, with varying state approaches to addressing mental health services.
Contributing factors to this capacity reduction include the closure of psychiatric units in local hospitals, which disproportionately serve patients covered by Medicaid or who are uninsured. Proposed federal budget reductions to Medicaid could further impact the financial stability of these services.
Challenges in Access and Treatment
Psychiatric hospitals frequently face staffing shortages, resulting in patients being turned away or experiencing prolonged waits for treatment. Individuals often arrive at these facilities via court orders following criminal offenses.
Quincy Jackson III, 28, has navigated a cycle of family homes, homeless shelters, jails, clinics, emergency rooms, and Ohio's regional psychiatric hospitals due to severe psychosis. His mother, Tyeesha Ferguson, has indicated that the mental health system often leads to criminalization rather than treatment. Jackson has been arrested or cited at least 17 times and jailed at least five times within a recent period, often returning to jail from hospitals.
This lack of care is often cited in discussions following incidents where individuals with severe mental illness have been involved in harm to others. Recent high-profile cases include incidents in North Carolina, Texas, Michigan, and Florida where individuals reportedly diagnosed with mental health conditions were involved in violent acts.
Wait Times and Systemic Responses
Ohio's state psychiatric hospitals, which collectively have about 1,100 beds, reported a median wait time of 37 days for a bed in May. Some individuals, like Jackson, have waited significantly longer, with one instance reaching 100 days in jail for a state hospital bed. This duration in jail without mental health treatment has prompted lawsuits in several states, including Kansas, Pennsylvania, and Washington.
Ohio officials identified bed shortages in 2018 and subsequently implemented various measures:
- Formation of task forces.
- Expansion of treatment options within jails.
- Launch of community programs and crisis units.
- Establishment of a statewide emergency hotline.
Despite these efforts, backlogs persist. The state has added 30 psychiatric beds by replacing a hospital in Columbus and plans for a new 200-bed hospital in southwestern Ohio. However, officials like Ohio Director of Forensic Services Lisa Gordish suggest that increasing capacity alone may not resolve the issue, as new beds tend to fill rapidly.
Impact on Hospital Environment and Patient Care
The increased presence of criminally charged patients has reportedly altered the environment of Ohio's state hospitals, making them more restrictive and leading to concerns about patient safety and staffing. In the first 10 months of 2024, there were at least nine patient escapes from Ohio's regional psychiatric hospitals, compared to three in the preceding four years. This led to a statewide policy preventing patients from leaving facilities for off-site outings.
Federal investigations in 2019 and 2020 at larger state-run psychiatric hospitals in Ohio, including Summit and Northcoast, documented patient deaths, including two suicides over six months at Northcoast. An employee reportedly stated that the facility was understaffed and dangerous. Disability Rights Ohio filed a lawsuit alleging abuse and neglect, which was later settled.
Patrick Heltzel, a patient at Heartland Behavioral Healthcare, found not guilty by reason of insanity of aggravated murder, has been receiving long-term inpatient care for over a decade. He emphasized the importance of such care for medication management and developing insight into a chronic condition. Heltzel noted the impact of the lockdown on his treatment and freedom, as he previously had regular outings.
Consequences of Inconsistent Treatment
Heltzel's case illustrates the severe consequences of interrupted treatment. After a short hospital stay in 2013, he was discharged despite feeling unwell and subsequently stopped his medication. Within weeks, he committed a murder, believing he was acting on delusions related to schizophrenia. His request for conditional release was later denied, citing his past failure to adhere to medication.
Similarly, Jackson has stated that inconsistent care or unmedicated periods in jail worsen his symptoms. After a 45-day stay at Summit, his longest in a state psychiatric hospital, he returned to jail facing misdemeanor charges. His mother expressed concern about his inability to survive independently and the lack of safe environments for him to manage his symptoms in Ohio.