This article was published in partnership with The Marshall Project - Cleveland, a nonprofit news team covering Ohio’s criminal justice systems. Sign up for their Cleveland newsletter and Facebook Group, and follow The Marshall Project on Instagram, Reddit and YouTube.
Ohio’s state-run psychiatric hospital system serves more than 1,000 patients daily.
It’s a system of last resort for people with no money, no insurance, severe mental illness and nowhere else to go. Often flagged by loved ones or judges as a danger to themselves or others, patients are placed by court order into the system’s six regional hospitals for stabilization and treatment.
But now, in a trend that predates the pandemic, the path to care almost exclusively runs through the criminal justice system. Patients awaiting trial for criminal charges or found not guilty by reason of insanity are overwhelming Ohio’s understaffed state psychiatric hospitals. This exacerbates wait times for beds and deprives thousands of other patients of access to treatment each year, even those who don’t have criminal cases.
So, why are so many patients funneled through criminal courts? Who’s in the psychiatric hospitals? And when can they get out?
How do people get into Ohio’s psychiatric hospitals?
Criminal defense lawyers or judges can raise concerns about a defendant’s competency — legally defined as the ability to assist their attorneys and understand the court process. Defendants are presumed competent until examined by a medical doctor or psychiatrist.
A court-ordered competency evaluation typically takes less than a month.
If deemed incompetent, the defendant is ordered to be restored at a state hospital. State law allows 30 days to a year for restoration, depending on the seriousness of the criminal charges.
Restoration is not treatment, state officials and experts say, but rather an effort to use medication to stabilize patients and legal education to prepare them for trial.
If health officials cannot restore the defendant, the trial judge may dismiss the case and ask a civil court to involuntarily commit the patient to a state psychiatric hospital. It’s a move similar to how family members or police request that a person they fear may harm themselves or others be forced into hospitalization by a probate judge — a process sometimes called pink-slipping.
About 10% of state psychiatric beds were filled by civil patients last year, down from 33% in 2016. While uncharged patients can be involuntarily hospitalized for up to 90 days, the average stay is 12 days compared to 111 days for criminally charged patients.
If a judge, after reviewing the doctor’s evaluation, agrees that a criminal defendant is competent or restored to competency, the criminal case moves forward.
A defense attorney can argue that an altered mental state at the time of the crime prevented a client from understanding right or wrong. If found not guilty by reason of insanity, the judge may place the defendant in a state psychiatric hospital for as long as they could have been imprisoned if found guilty, based on the most serious charge, or until their mental disorder can be safely managed outside the hospital.
About a quarter of Ohio’s state psychiatric patients have been found not guilty by reason of insanity.
Why are there so many criminally charged patients?
National experts in mental health and criminal justice attribute the rise in criminally charged patients to:
- A greater awareness of how mental illness can drive crime.
- Courts adopting specialized dockets for defendants with mental health or substance abuse disorders.
- The disruption of mental health services during the pandemic.
The share of criminally charged patients in state hospitals grew three times faster in Ohio from 2016 through 2023 than elsewhere in the country, according to surveys conducted by the Treatment Advocacy Center, a nonprofit research and policy group.
By December 2024, criminally charged patients filled nearly every bed at some state-run regional hospitals in Ohio, including Northcoast Behavioral Health, located between Cleveland and Akron.
“In all the years I’ve been involved, almost 40 years now, I’ve never seen so many seriously mentally ill people — kind of on the streets and now punted into the criminal justice system — that we have to deal with,” retiring Lorain Municipal Court Judge Mark J. Mihok said at a gathering of lawyers, judges and mental health professionals in May 2025.
State officials say local courts are also responsible for the increase in criminally charged patients. Municipal and county judges put defendants in state psychiatric hospitals “as a pathway to access mental health care rather than for its intended purpose,” state mental health officials said at the same gathering held in Cleveland.
Lisa Gordish, Ohio’s director of forensic services, added that 63% of court-ordered evaluations find defendants competent.
How long and why are people waiting in jail for Ohio’s psychiatric beds?
Wait times for state psychiatric beds are measured from the time of a court referral, not the time the person is arrested or jailed.
“We have had wait times that go up to a year for an individual awaiting mental health housing,” Bryan D. Morgenstern, the administrator of the Portage County jail, said in response to a statewide survey by The Marshall Project – Cleveland.
Referred to as the new asylums by patient advocates and mental health experts, jails are not conducive or equipped to treat mentally ill people, according to county officials who run them. Defendants on suicide watch or who require extra care drain resources and strain staffing.
Wait times vary by region, and from month to month. At one end, the regional state psychiatric hospital in Columbus has consistently reported about a 30-day wait to admit new patients. But across southern Ohio, from Cincinnati through Appalachia, patients have waited up to nearly 90 days, on average, in the past year.
Ohio has fewer state psychiatric beds per 100,000 people than the national average, which is already less than a third of what is needed, according to a 2023 survey by the Treatment Advocacy Center.
But, at about a month-long wait statewide, Ohio is not the worst.
Criminally charged patients in Louisiana, Wyoming and Mississippi waited an average of six months or more in jail. Texans waited a whopping 444 days.
At the time of the survey, Ohio officials reported 78 criminally charged patients were waiting for a psychiatric bed. Including patients without criminal charges, state records showed 160 people had been waiting even longer — 37 days on average — by the end of May 2025.