Overview: State Mental Hospitals and Criminal Justice Interaction
State psychiatric hospitals across the United States are increasingly admitting patients with criminal justice system involvement. This trend has been observed alongside a reduction in overall patients served by these facilities and a rise in treatment delays, contributing to a complex interplay between mental health care and the criminal justice system.
Demographic Shift and Capacity Issues
Data indicates a significant increase in the proportion of state hospital patients who have criminal charges. In Ohio, for example, the percentage of state hospital patients with criminal charges rose from approximately 50% in 2002 to about 90% currently. This surge has coincided with a 50% decline in total state psychiatric hospital patients served in Ohio over the past decade (from 6,809 to 3,421). Nationally, the total number of patients served decreased by approximately 17% during the same period, from 139,434 to 116,320.
The reduction in state facility capacity has occurred concurrently with the closure of psychiatric units in various local hospitals, which often serve patients covered by Medicaid or who are uninsured. The financial stability of local hospital mental health services is also anticipated to be affected by federal legislation that reduced the federal Medicaid budget.
Retired Ohio Supreme Court Justice Evelyn Lundberg Stratton has described the constricted flow of new patients through state hospitals as a significant issue, affecting individuals who require hospital beds but are not involved in the criminal justice system.
Patient Interactions with the System
Individuals with severe mental illness frequently navigate a cycle involving community hospitals, courtrooms, and jails, often leading to backlogs at state psychiatric hospitals.
Quincy Jackson III, 28, has experienced this cycle, with his mother, Tyeesha Ferguson, expressing concern for his well-being. Jackson, who has a history of severe psychosis, has been arrested or cited on at least 17 occasions, jailed at least five times, and treated at hospitals, including three state-run psychiatric facilities, between December 2023 and July 2025. A psychiatric evaluation noted his intermittent presence in community and state facilities since 2015. Law enforcement body camera footage captured Jackson in a hospital setting, handcuffed, asserting his illness before being returned to jail due to behavioral concerns. Ohio’s state hospitals, with approximately 1,100 beds across six regional facilities, had a median wait time of 37 days for a bed in May. Delays in receiving mental health treatment in jail have led to lawsuits in multiple states, including Kansas, Pennsylvania, and Washington.
Another case involves Patrick Heltzel, 32, who has resided at Heartland Behavioral Healthcare for over a decade after being found not guilty by reason of insanity of aggravated murder. Heltzel emphasized the importance of long-term inpatient care for medication stabilization and developing insight into chronic conditions. Prior to the crime, Heltzel had a short stay at Heartland and was released, despite his mother's request for extended care and his own perception of still being unwell. He subsequently stopped taking medication and killed 71-year-old Milton A. Grumbling III. Judges cited Heltzel's failure to take medication as a factor in denying his conditional release request.
Operational Impacts and Safety Concerns
The shift towards a higher proportion of criminally charged patients in Ohio's psychiatric hospitals has been associated with increased restrictiveness, understaffing, and safety concerns for both patients and staff.
In the first 10 months of 2024, at least nine patients escaped from Ohio's regional psychiatric hospitals, compared to three in the preceding four years. Following one incident where a patient left during an off-site dental trip, state officials implemented a policy stopping all patients from leaving any of the six regional hospitals. This measure impacted patients like Patrick Heltzel, who previously had off-site privileges.
Federal records indicate that larger state-run psychiatric hospitals in Ohio, such as Summit and Northcoast, have experienced imminent danger to patients and staff. Investigations in 2019 and 2020 noted patient deaths, including two suicides at Northcoast within six months. One hospital employee reported understaffing and dangerous conditions to federal inspectors. Disability Rights Ohio filed a lawsuit in October against the department, alleging abuse and neglect, which was later settled. A former police officer at Northcoast, Louella Reynolds, cited increased dangers and insufficient staffing due to the change in patient demographics.
State Efforts and Ongoing Challenges
Ohio officials identified bed shortages as early as 2018, leading to the formation of task forces and the expansion of jail-based treatment. They also launched community programs, crisis units, and a statewide emergency hotline. However, hospital backlogs have continued to grow.
LeeAnne Cornyn, former Director of the Ohio Department of Behavioral Health, stated in May that the agency prioritizes a therapeutic environment and safety. The state has added 30 psychiatric beds by replacing a hospital in Columbus and plans a new 200-bed hospital in southwestern Ohio. However, Lisa Gordish, Ohio Director of Forensic Services, noted that merely adding capacity may not resolve the issue, as new beds tend to fill rapidly without addressing underlying systemic challenges.
Quincy Jackson III waited 100 days in the Montgomery County jail for a state hospital bed in 2024. His mother expressed that there is no safe place for him to experience symptoms in Ohio. After a 45-day stay at Summit Behavioral Healthcare—his longest at a state facility—Jackson returned to jail in early September facing misdemeanor charges. His mother observed signs of his deteriorating condition during a video call from jail.