In response to the Aug. 4 mass shooting in Dayton, Ohio, Governor Mike DeWine announced a series of plans to address gun violence and mental health issues in the state. Among the proposals was one that could overhaul the treatment of people with mental illness who are accused of nonviolent misdemeanors.
News reports have suggested that the Ohio shooter, Connor Betts, may have struggled with untreated mental illness. “We must have increased access for the citizens of Ohio to our state psychiatric hospitals,” DeWine said at a press conference. The hospitals are often filled to capacity with people who do not need to be there, DeWine said, leaving little room for people who might pose a danger to their communities.
The week before the shooting, 79 percent of the roughly 1,200 adults in the hospitals were court-ordered to be there, many until their competency is restored for trial, DeWine said. According to the state’s Department of Mental Health and Addiction Services, almost a quarter of those people were facing nonviolent, misdemeanor charges.
“We have a problem in this state,” DeWine said during the press conference. “We have a problem with people who are not violent who have been sent there by a court who could be sent someplace else and these individuals are occupying space that we urgently need today.”
People ordered to competency restoration in a psychiatric hospital for misdemeanor charges in Ohio can spend up to 60 days in the institution, during which time they are supposed to learn how the court process works and get a basic level of treatment to allow them to return to court. But mental health experts told The Appeal that these individuals are often getting little to no effective treatment and that they could be better served in outpatient community programs.
Terry Russell, executive director of the National Alliance on Mental Illness (NAMI) Ohio, said his organization has been working with the Ohio Department of Mental Health for over two years to change the way the state handles people undergoing competency restoration. Under the current system, he said, the state is using hospitals to hold people for weeks or months while offering limited treatment. Many of these defendants are homeless or housing unstable and have been convicted of crimes of convenience, like theft and public urination, that are often later dismissed in court, Russell said, sometimes because the restoration process itself is considered “time served.”
“What we’re doing is using these very expensive—a thousand dollars a day—state hospitals for people to go and be restored, which does not allow or require treatment,” he said. “It is so bad.”
One solution is to simply arrest fewer people who commit low-level crimes, advocates say. Tristia Bauman, a senior attorney at the National Law Center on Homelessness and Poverty, said criminalizing homelessness is a “losing strategy” because it doesn’t help people get off the streets and it costs taxpayers money.
“We definitely think that cities and government at any level should not be criminalizing poor people for surviving in public space when they have nowhere other than public space in which to live,” she said. “It doesn’t help to reduce homelessness and it doesn’t meet any of the purported policy goals behind those laws.”
Because of the lack of space in psychiatric hospitals and limited resources for evaluations, people who are arrested also often languish in the court system before their 60 days can begin. Dustin McKee, policy director at NAMI Ohio, described one woman in her 20s who was arrested for disorderly conduct against a Franklin County police officer on the steps of a psychiatric facility, where her mother was trying to take her for help. A judge ordered her to be evaluated for competence to stand trial, but McKee said she had to spend weeks in the jail waiting until someone was available to evaluate her and then until there was a bed at the hospital. When she was eventually discharged from the hospital and returned to court, her charge was dismissed, he said.
John Tilley, a forensic psychologist who co-owns a company that contracts with a number of Ohio court systems to conduct competency evaluations, disputed the idea that people detained for competency restoration are getting absolutely no treatment. But he said the level of treatment they can be given in 60 days is inadequate and agreed that community-based alternatives would be much more effective.
“There are too many defendants in the hospital for competency restoration that don’t need to be there,” he said.
Evelyn Stratton, a former Ohio Supreme Court justice who now focuses on criminal justice and mental health issues, has worked with Russell and other experts, government officials, and attorneys on a task force charged with improving the state’s competency restoration process. “Our goal is to try to get [arrestees with mental illness] into the least restrictive environment,” she said.
The group has worked with DeWine and the Department of Mental Health and Addiction Services to consider outpatient treatment programs for people who don’t need constant attention and potentially creating new, long-term residential treatment centers for people who need more intensive treatment.
Russell said the goal should be setting people up to leave a program successfully. “I don’t want a new state hospital, but [we should] have some residential facilities where people could stay for 90 days and work on their illness and have an exit discharge plan in place where they have a place to go,” Russell said. “We need an array of residential treatment facilities and rehab facilities.”
For individuals who commit misdemeanors who are “very ill” and need to remain in a psychiatric hospital, Russell said they should be allowed more intensive treatment.
“They should be sent there for commitment as a danger to themselves and others and be treated for whatever length of time it takes to make them competent again,” he said.
Tilley said there also needs to be a shift in funding so that private companies like his are motivated to set up outpatient restoration programs. Currently, these companies are only paid to do competency evaluations.
Experts said they are encouraged by the consensus among key players that something needs to change. And although they would have preferred that changes were enacted before a man was able to obtain a gun and kill nine people, they are glad to see things shifting now.
“It’s just so unfortunate that it takes these types of terrible, terrible tragedies to make things move,” Russell said. “But they’re moving.”