By Jordyn Grzelewski
In the courtroom of Mahoning County Probate Judge Robert N. Rusu Jr., the atmosphere during a recent hearing was less like a formal court proceeding and more like a friendly conversation.
“You’re doing wonderful,” he said encouragingly to one client.
“I’m proud of you,” he told another.
He chatted with another woman about what books she was reading and told her he cared about her.
“Yes,” she agreed.
This is the approach in Judge Rusu’s Fresh Start Court, an Assisted Outpatient Treatment (AOT) track for people with serious mental illnesses that launched in May.
AOT is court-ordered outpatient treatment for individuals with severe mental illnesses who meet certain criteria such as a history of hospitalizations or arrests.
Research suggests AOT is effective in reducing the incidence and duration of hospitalizations, homelessness, arrests and incarcerations, victimization and violent episodes, according to the Treatment Advocacy Center, a national non-profit that promotes treatment for severe mental illnesses.
“It is about the best tool we have to help people who have trouble with engaging in treatment for severe mental illness, through no fault of their own,” said Brian Stettin, the group’s policy director, in a statement. “People are caught in this revolving door, where they are coming into hospitals again and again, stabilized, released and disengaging again and going through this tragic cycle repeatedly.”
Mahoning County officials believe Fresh Start Court will make AOT more effective by bridging a gap they had identified.
Previously, AOT patients would be discharged from the hospital and assigned a case manager, but wouldn’t see a judge until a hearing to determine whether they should remain committed to the mental health and recovery board.
“What I started seeing was, the same names were readmissions to the hospital. Something wasn’t working,” Judge Rusu said.
In Fresh Start Court, clients meet with the judge about every two weeks. He checks in with clients about taking their medications, their physical health, family support, housing and anything relevant to their case.
Clients are assigned a case manager from a local service provider. A team helps coordinate a treatment plan and assists with housing, transportation, employment and other needs.
The judge is there to check in on the individual’s progress and can order them to comply with the court if necessary, although he prefers to have their cooperation.
“The idea behind it is, it gives a sense of importance because a judge in a robe is telling them to do it,” he said.
Judge Rusu also sees the regular check-ins as a way to show clients that someone is invested in them and their health.
“If you show a little care to somebody, you get better results,” he said. “Our goal here is to show the program participant that there are people who care about them and want to help them stay healthy.”
Officials hope the program will benefit participants and taxpayers alike.
A new report from The Center for Community Solutions found that in 2015, more than 15,000 people with mental illness or substance-use disorders were in Ohio’s county jails, according to a recent Ohio News Service story. Nationally, jails serve an estimated 2 million people with serious mental illnesses each year, according to information provided by the Stepping Up Initiative, which aims to reduce the number of people with mental illnesses in jails. Jails spend two to three times more money on inmates with mental illnesses.
The mental health and recovery board also has a partnership with the Mahoning County Sheriff’s Office to provide additional services to inmates with mental illnesses, an effort that is aided by Stepping Up.
Mahoning County officials hope Fresh Start will help keep individuals with serious mental illnesses out of jail.
“The Fresh Start Court is a great tool in the court’s tool box,” said Duane Piccirilli, Mahoning County Mental Health & Recovery Board executive director. “These are individuals most at risk of negative outcomes if they do not continue to receive treatment. This project is reducing the need for inpatient treatment and possible incarceration by establishing a true team approach.
“This is a win-win for everyone involved, including the service provider, individuals on the AOT and the community, because it reduces the cost for treatment with better results.”
Judge Rusu believes the program is seeing some early success, such as one client who came to court with some physical health issues with which the Fresh Start team was able to help, in addition to working out some issues with his medication.
Another client had made enough progress with her mental health and medication compliance that the judge told her and her family she could come to court once a month instead of every two weeks.
A relative of the woman commended the Fresh Start team for always being available when the family had questions or concerns.