Category / Just the Facts

what the center looks like
by karentwinem

New Mental Health Care Options

New ideas for helping people with mental health crises are becoming reality around the country. Federal, state and local governments support these programs and centers. They want to reduce the burden on emergency rooms and support rural residents who have little access to help.

These programs range from walk-in crisis care centers to intensive residential programs for children. One of the newest walk-in centers is in my home county: Franklin County, Ohio.

The Franklin County Crisis Care Center opened the first phase of its offerings on September 2, 2025. Open 24/7, the center is like a psychiatric emergency room. It provides immediate care in mental health or substance abuse crises. It is located at 465 Harmon Ave. on Columbus’ west side and accessible by bus lines. Families also can call 988 to get help from the center.

This month (November 2025) Franklin County voters passed a levy that continues funding for the new center and allows expansion of a non-police response to mental illness emergencies. More than 30,000 adults are treated for mental illness and substance issues in Franklin County annually.

Service Offerings

  • 24/7 Walk-In Services: Immediate access without an appointment
  • 23-Hour Observation: A safe and calming space for short-term stabilization and intensive observation for up to 23 hours
  • Community Services: On-site connections to mental health and substance use treatment providers, housing resources and other essential services within Franklin County
  • Substance Use Disorder Treatment Services: Comprehensive services from detox to the initiation of medication-assisted treatment
  • Pharmacy Services: On-site pharmacy with automated medication dispensing system

Improving the Gap Between Hospital and Home

Caregivers have long wanted more help as loved ones move from the psych ward to their homes. These options help people learn how to maintain sobriety and/or improved mental health.

Intensive residential programs give needed support to individuals, especially children, as they transition out of a hospital setting before going home.

Therapeutic boarding schools provide a highly structured environment with therapy for young people who don’t require intensive treatment but need support in a therapeutic setting. 

The availability of common-sense mental health care settings seems to be on the rise. That can only be a good thing for everyone.

justice scales and gavel on wooden surface
by karentwinem

At Last … Mental Health Courts

It took a long, long time. But mental health courts are here at last.

We can thank Florida for this. Judges there (finally) noticed that people with mental illnesses kept reappearing on the court docket. In 1997, Florida set up four mental health courts. By 2022, we have more than 300 of these courts in nearly every state, according to the Council of State Governments Justice Center.

The purpose of mental health courts is three-fold.

  • To help defendants improve their functioning and lives. (About 20% of people in prison have serious and persistent mental illness. And those prisoners have more repeat offenses than average.)
  • To provide structure for those who need it most. (Prisoners with mental illness spend more time in jail and get less time off for good behavior than other prisoners.)
  • To create an environment that encourages recovery and treatment. (Right now, only 11% of inmates who quality for mental health treatment get it.)

Mental health courts are among those with a specialized docket. These dockets aim to reduce stigma about conditions and break cycles of bad behavior. Other specialized dockets include child support enforcement, domestic violence, drugs, human trafficking, veterans and drunk driving. The council has found that, for every $1 invested in specialized dockets, $27 in taxpayer money is saved.

What Is a Mental Health Court?

A mental health court is a specialized docket for defendants with mental illnesses. It substitutes a problem-solving model for the traditional process of criminal courts. Those whose cases are on the docket have been screened and assessed for mental illness.

The participants also must volunteer to participate in a judicially supervised treatment plan. A team of court staff and mental health professionals develop this plan. It specifies tasks and criteria for success (or graduation) from the program. The plan also rewards adherence and sanctions nonadherence.

For example, Franklin County, Ohio, has two mental health courts: the RISE program and the LINC program.

  • Franklin County Court of Common Pleas started the RISE program in February 2022. Participants are moderate to high-risk felony offenders who have been diagnosed with a serious mental ilness that was a primary factor leading to their arrest.
  • Franklin County Municipal Court has the LINC program for those charged with misdemeanors.

Example: Mental Health Court for Felons

People eligible for the RISE program must have:

  • One or more felony charges.
  • Been competent to stand trial and not under a current finding of Not Guilty by Reason of Insanity
  • A diagnosis of mental illness
  • Entered a guilty plea

They are usually admitted to the RISE program at sentencing or during a probation violation hearing. Those who are not eligible for the program include:

  • Sex offenders
  • A defendant with a child victim or a history of child victim offenses
  • Those with a history of serious or repetitive violence, including domestic violence
  • Those who post a significant risk of harm to the staff or the community

The RISE program is a two-year program with four phases:

  1. Consistent adherence to the treatment plan
  2. Significant improvement in coping skills, healthy communication, boundary setting, emotional process and mood regulation
  3. At least 365 consecutive days of sobriety
  4. Completion of any restitution, fines or court costs associated with the case

The two-year time period is flexible as defendants can finish in shorter or longer time period. The program also includes rewards and sanctions to encourage positive behavior.

Example: Tennessee Mental Health Courts

Tennessee grew from three mental health courts in 2022 to 17 in 2023. The state’s legislature adopted the Mental Health Treatment Act of 2022 to give $5.7 million to run the mental health courts.

The Tennessee Department of Mental Health and Substance Abuse Services reports that, so far, 60% who participate in the recovery court programs improve or maintain employment. Seventy percent improve or maintain housing.

However, the department found that the biggest benefit of the program was an increase in public safety.

Mental Health Court Locator

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services can help determine if a mental health court is in your county.

You can visit the Mental Health Court Locator to find courts for adults and juveniles. You also can call the SAMHSA helpline at 1-800-662-4357.

In Case of Arrest

If your loved one is arrested, talk to your defense attorney about moving the case to the mental health court docket. You also can call the prosecutor and ask to get your loved one’s case into mental health court. Remember: In most cases, your loved one will be required to plead guilty to the charge and will be put in the program after assessment at sentencing.

Mental health courts offer an essential service to keep our loved ones with mental illness out of the revolving door of multiple arrests and prison terms. I’m so thankful this idea is taking hold nationally.

1 in 5 kids has mental illness
by karentwinem

How Children’s Mental Illness Hurts Workplaces

Earlier this year, Nationwide Children’s Hospital released a first-of-its-kind study on how pediatric and adolescent mental health crises impact the workforce. The answer is: Hard. Very hard.

The study is titled “The Great Collide: The Impact of Children’s Mental Health on the Workforce.” Funded by the Nationwide Foundation, it is part of Nationwide Children’s Hospital’s On Our Sleeves movement.

It found that among working parents:

  • 53 percent have missed work at least once a month to deal with a child’s mental health issues.
  • 54 percent have interrupted their work to answer communication about their child’s mental health situation during work hours.
  • 85 percent think it’s a good idea to talk about their children’s mental health issues, but few have done it.
  • Up to 50 percent are thinking about their children’s mental health while at work.

The study also found that working parents under age 40 are more concerned about their children’s mental health and more likely to select jobs offering benefits that give them access to mental health services.

If these numbers seem high to you, it’s because of the secrecy involved in dealing with a child’s mental illness. You don’t call in because your child is sick; instead you claim to be sick yourself. I know this from experience.

During the 1990s, I had a young child with mental health issues. My boss once denied me a raise specifically because of the number of phone calls that I received from my child’s school. I frequently had to go get my child at school due to behavioral problems. (My co-workers joked that I should put a courier slip in her hair on a barrette, so the courier could bring her to the office when needed. That way I wouldn’t have to leave.) I held my breath until 2:30 p.m. when school was out every work day. And that was before we had to start homeschooling for the child’s safety from bullying.

Nationwide is adding resources for parents on OnOurSleeves.org as well as rolling out a program for employers soon. Parents need this help. Therapists rarely have time to help parents with all the caregiving issues around having a child with a mental illness. Yet it’s so, so common.

a therapy session for mental health treatment
by karentwinem

Treatments for Mental Illness

Navigating the mental health system can be quite difficult. But once you have your loved one there, what happens?

For severe and persistent mental illness, the best practice is to use traditional psychotherapy or “talk therapy” with medication. If the brain is not functioning correctly, all the therapy in the world can do little good. So stabilizing the brain is the first priority.

What types of medication are used?

  • Antipsychotics reduce or eliminate delusions and hallucinations by impacting the brain chemical dopamine.
  • Antidepressants improve depression by impacting the brain chemicals associated with emotion: serotonin, norepinephrine and dopamine.
  • Antianxiety medication reduces the emotional and physical symptoms of anxiety. This includes meds like Xanax and beta-blockers.
  • Mood stabilizers are medicines that treat and prevent mania and depression. They are most commonly used for bipolar disorder. Examples include carbamazepine (Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal) and lithium.

What types of treatment are used?

Once the medications are working, doctors and social workers have a variety of options for psychotherapy. In each case, the person works with a therapist in a safe, confidential environment to understand their feelings and behavior, while learning new ways to cope. These types of treatment may include:

  • Cognitive Behavioral Therapy (CBT) is based on the relationship between thoughts, emotions and behaviors. The therapist works to uncover unhealthy patterns of thought that cause self-destructive behavior and beliefs. Once those patterns are identified, the patient can identify them and learn to find more constructive ways of thinking and responding. Used for depression, anxiety, bipolar disorder, eating disorders and schizophrenia.
  • Dialectical Behavior Therapy (DBT) combines CBT with teaching skills in mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. It emphasizes validation, or accepting uncomfortable thoughts, feelings and behaviors. The therapist helps the person find a balance between accepting themselves and changing by learning new skills and coping methods. Originally developed for people with borderline personality disorder, it is now used for other illnesses as well.
  • Eye Movement Desensitization and Reprocessing Therapy has the patient focusing on two things at once: emotionally disturbing thoughts and an external stimulation, like eye movements. For PTSD.
  • Exposure Therapy involves gradually exposing the patients to their phobia or the cause of their anxiety without causing them any danger. For obsessive-compulsive disorder, PTSD and phobias.
  • Interpersonal Therapy focuses on relationships by improving the patient’s interpersonal functioning. For depression.
  • Psychodynamic Therapy includes free association and open-ended questions. For depression, anxiety, borderline personality disorder and other illness.
  • Mentalization-Based Therapy combines psychodynamic, CBT, systemic and ecological therapies. It’s used for borderline personality disorder because the illness often causes feelings of emptiness or unstable self-image. Mentalizing allows the patient to consciously perceive and understand their own feelings and thoughts. It also allows them to understand more about the feelings and thoughts of others.
  • Therapy Pets help reduce symptoms of anxiety, depression, fatigue and pain.

Next time we’ll cover the best ways to work with mental health professionals and how to keep a treatment record.

988 is new suicide prevention hotline number
by karentwinem

Now Open: 988 Suicide Hotline

A new national suicide hotline number is now open. Call 988 when you want to prevent suicide.

In Ohio, the 988 number connects to one of 15 designated lifeline call answering points. Trained mental health specialists answer the calls, providing both counseling and direction to resources for mental health care.

The new number is based on the success of 911, which has been used as an emergency number for all types of crises since 1968. Officials hope that sending suicide calls to 988 will take pressure off the 911 system, which sends police and/or paramedics to a scene.

The 988 calls connect people immediately to mental health crisis services. It also improves the information provided. Until the hotline opened this month, more than 40 percent of Ohio’s suicide prevention calls were answered by people from other states who didn’t know the Ohio system and could not give advice about accessing its resources.

The Department of Mental Health and Addiction Services is implementing the new line with federal startup funds of $400 million.

In addition to the designated call line, NAMI Ohio is also asking for the development of a better, more thorough crisis response system, allowing the specialist to help direct people to housing, rehabilitation services and employment services. I agree with this, although I know it will be difficult to get the funding. After all, it doesn’t help much to answer the phone if you can’t direct people to the help they need.

nurse and doctor comfort patient
by karentwinem

Who’s Who on a Mental Illness Team

The United States does not have a well-organized system to treat substance abuse and mental illness. Sometimes it’s hard to know who to turn to for your needs. This overview answers the question: Who does what?

Primary care physicians can prescribe and monitor medication, but often prefer that you work first with a psychiatrist.

Psychiatrists are licensed medical doctors with medical and psychiatric training. They can diagnose and prescribe medication.  Some provide therapy.

Psychiatric nurse practitioners have a master’s or PhD and specialized training. They can assess, diagnose, prescribe medication and do therapy. You can usually get an appointment with a psychiatric nurse practitioner more quickly than with a psychiatrist.

Clinical psychologists with doctoral degree make diagnoses and provide individual and group therapy.

Psychiatric or mental health nurses, depending on education and licensing, can assess and treat illness, do case management and provide therapy.

School psychologists can make a diagnosis, provide therapy, and work to provide healthy school environment. My personal experience is that school psychologists do not have enough bandwidth to do an effective job with children who are struggling.

Counselors can help find better ways of thinking and living, as well as help people develop life skills. Some can diagnose and treat.

Clinical social workers has a master’s degree in social work. They make diagnoses and provide counseling, case management and advocacy.

Peer specialists are individuals who have experience with a mental illness and can help others with recovery.

Social workers with a B.A. or B.S. can provide case management, inpatient discharge planning and placement services.

Psychiatric pharmacists have doctoral training and residence training to provide comprehensive medication management. They usually work in a health care system like Veterans Affairs, hospitals, clinics., etc.

abandoned mental hospital interior
by karentwinem

Our Mental Health “System”: A Shameful History

When you are navigating the mental health system, have you felt:

  • Confused?
  • Frustrated?
  • Angry?
  • Insulted?

To say that the United States does not have a well-thought-out mental health system is a great understatement. Here’s a brief review of how we got here:

In the 1700s, mental health treatment began to move from the horrific asylums to hospitalization. By the first half of the 20th century, mentally ill people were usually either at home or in institutions.

The year 1954 introduced the first antipsychotic drugs, which improved functioning for many people.  So many thought that people with mental illness could live outside of hospitals.

In the early 1960s, the Kennedy administration introduced a plan for more humane mental illness treatment.  In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. The program proposed closing the hospitals and replacing them with community mental health centers, where the mentally ill could be treated in homelike settings.  This included strict standards so only individuals “who posed an imminent danger to themselves or someone else” could be committed to a state psychiatric hospital.

Mental hospitals began to close in the mid-1960s. But Congress never approved the funds needed to open the equivalent number of community mental health centers.

President Jimmy Carter’s Mental Health Systems Act of 1980 was passed to continue federal funding for mental health programs.  In 1981, President Ronald Reagan, in The Omnibus Budget Reconciliation Act , repealed that act, eliminating the money needed for these centers.

In 1955, 558,239 severely mentally ill patients were institutionalized at public hospitals (Torrey, 1997). By 1994, by percentage of the population, we have 92% fewer hospitalized individuals (Torrey, 1997).

Today, community mental health centers do provide mental health services. But many people released under deinstitutionalization became their families’ responsibilities.

They also became homeless (26% of homeless have mental illness, according to HUD). Many of them are in prison. People with mental illnesses are overrepresented in prison. It’s estimated that 55 percent of male inmates and 75 percent of female inmates have mental illnesses.  Meantime, the CDC says there are 5.7 million emergency department visits with mental illness as the diagnosis annually.

brain
by karentwinem

Caregiver’s Guide to Brain Basics

Mental illnesses are brain disorders. Trying to understand the “why” behind an illness or the “how” behind medication requires caregivers to know some detail about how the brain works. For example: What’s a neurotransmitter? What are synapses? And what’s the difference between serotonin and dopamine?

This basic overview, which answers those questions, comes from material on the National Institute of Mental Health’s website. The site contains lots of information to answer your questions about the complexities of mental illness.

NIMH research shows that mental illnesses can be related to changes in the anatomy, physiology and chemistry of the nervous system. When the brain malfunctions, symptoms of mental illness start to appear.

Neurons are the basic working unit of the brain and nervous system, each enclosed by a cell membrane. These highly specialized cells conduct messages. Each neuron has three main parts:

  • A cell body with a nucleus (containing DNA and information the cells needs for growth and repair) and cytoplasm, the substance filling the cell where all the chemicals and small structures named cell organelles reside.
  • Dendrites that branch off from the cell body and are the neuron’s point of contact for receiving chemical and electrical signals (called impulses) from other nearby neurons.
  • Axon that send impulses and extend from the cell body to meet and deliver impulses to another neuron.

Synapses are tiny gaps between neurons where the impulses or messages move from one neuron to the other as chemical or electrical signals.

The brain continues to mature at least until a person is in his 20s. As scientists learn more about brain development, they can see what goes wrong when a person develops a mental illness. One of the mysteries of schizophrenia, for example, is why it often occurs for the first time when a person is in his late teens or early 20s. Many believe scientists will find the secret as they learn more the processes in the brain at that time.

What can go wrong in the brain?

Every cell contains a complete set of DNA, with all the information inherited from our ancestors. As we grow, we create new cells, each with a copy of the DNA. Sometimes the copying process goes wrong, resulting in a gene mutation.

Scientists also study epigenetics, which looks at how environmental factors, such as sleep, diet and stress, can influence our genes. Unlike gene mutations, epigenetic changes don’t change the DNA code. They affect how a gene turns on or off to produce a specific protein.

The role of neurotransmitters

All that we do depends on neurons communicating with each other through electrical impulses and chemical signals. Neurons activate with small differences in electrical charges, called action potentials. The ions (atoms with unbalanced charges) concentrate across the cell membrane and travel very quickly along the axon. (It’s a bit like dominoes falling.)

When the action potential gets to the end of the axon, most neurons release a neurotransmitter, or a chemical message, that crosses the synapse and binds to receptors in the next neuron’s dendrites. So neurotransmitters are key to sending chemical messages between neurons. In mental illness and other conditions like Parkinson’s disease, this process doesn’t work correctly.

Important neurotransmitters include:

  • Serotonin controls functions including mood, appetite and sleep. People with depression usually have lower levels of serotonin. Some medications that treat depression block the recycling, or reuptake, of serotonin by the sending neuron. So more serotonin stays in the synapse for the receiving neuron to obtain. This medication, called selective serotonin reuptake inhibitor (or SSRI) causes more normal mood functioning.
  • Dopamine controls movement and aids the flow of information to the front of the brain, where thought and emotion take place. Low levels of dopamine can result in Parkinson’s disease, which affects the person’s ability to move and causes tremors, shaking and stiffness. Some research suggested that having too little dopamine in the thinking and feelings sections of the brain could play a role in schizophrenia and attention deficit hyperactivity disorder.
  • Glutamate is the most common neurotransmitter. When it is releases, the chances that the neuron will fire increase. So it enhances the electrical flow among brain cells. It also may be involved in learning and memory. Problems in making or using glutamate have been linked in autism, obsessive compulsive disorder, schizophrenia and depression.

Regions of the brain

Many neurons working together form a circuit. And many circuits working together form specialized brain systems. Research into the causes of mental illness tend to focus on these regions:

  • Amygdala activates the “fight-or-flight” response to confront or flee from a situation. Scientists are studying the amygdala’s involvement in anxiety disorders, including post-traumatic stress disorder and phobias.
  • Prefrontal cortex is where the brain’s executive functions are. These include judgment, decision making and problem solving. The prefrontal cortex also works in short-term memory and retrieves long-term memory. It helps to control the amygdala during stressful events. Research shows the people with post-traumatic stress disorder and attention deficit hyperactivity disorder have reduced activity in the prefrontal cortex.
  • Anterior cingulate cortex has many roles, including controlling blood pressure and heart rate. It also helps us respond when we sense a mistake, feel motivated, stay focused on a task and manage emotional reactions. Reduced activity or damage in this area is linked to attention deficit hyperactivity disorder, schizophrenia and depression.
  • Hippocampus helps create and file memories. When it is damaged, the person can’t create new memories. However, the person can still remember past events and learned skills, as well as carry on a conversation, because those activities are in different parts of the brain. The hippocampus may be involved in mood disorders through its control of a major mood circuit called the hypothalamic-pituitary-adrenal axis.

No one expects caregivers to become brain scientists, but having a general understanding of the brain will help when learning about medicines and research. The more knowledge we have, the better.

a dead person with a COVID toe tag
by karentwinem

Stigma at Its Worst: Schizophrenia and COVID

I am furious about this.

Do you know what the second highest risk factor for dying from COVID is? The highest is old age. The second highest is having a diagnosis of schizophrenia.

This was first reported much earlier in the pandemic. I heard about it. I even mentioned it to an Ohio State University friend who used to head up my city’s health department. But scientists seem to be repeatedly surprised by it. And the government has done basically nothing about it.

Now it’s Year 3, and it’s news on NPR????

If the second highest risk factor for COVID deaths were health disease or lung disease or diabetes, do you think something would have been done to reach out to those folks? Of course. So why was there no effort to help people with schizophrenia?

People with schizophrenia were left off the priority list for help in my state, Ohio, and many others. My loved one with a schizophrenia diagnosis had to wait until people his age were allowed to get vaccines.

NPR interviewed Katlyn Nemani, a neuropsychiatrist and researcher at New York University. She described the initial reaction to the data showing that people with schizophrenia were three times more likely to die from COVID than the general population. It was disbelief.

“They said it must be because people with schizophrenia are already worse off health-wise, or because they have trouble accessing health care,” she said. That turned out to be wrong.

Studies from countries with free universal health care … the United Kingdom, Denmark, Israel, South Korea and so on … came in, also showing that people with schizophrenia were two to five times more likely to die from COVID.

Yet, the CDC didn’t add schizophrenia to the list of high-risk conditions until people began getting booster shots in October 2022. Other countries, like England, Germany and Denmark, put people with schizophrenia on the priority lists for vaccines at the beginning.

Nemani told NPR that this discovery could be good for people with schizophrenia. She said it may mean that the badly understood illness has a component in the immune system or elsewhere in the body. It could lead to new understanding and new treatments … for those with schizophrenia who are still alive, that is.

My own guess? It’s stigma. Far too many people think that the lives of people with schizophrenia do not matter. If they die from COVID, so what?

Schizophrenia is tough enough without the stigma. It affects 24 million people in the world, including 2.8 million in the United States.

This is barbaric. It’s time to fight for people to see the disease as a disease, not a disqualifying condition for living a good life. I am furious. I am sickened. I am sad.