Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
It was 1957 when thirteen-year-old Terry Russell got off the school bus and saw a police van outside his home. “The police were there to take my brother to the state hospital,” says Russell. His brother, who had schizophrenia, would go to the state hospital for five to six months and then return home. “He’d do well for about the same amount of time before the cycle started all over again.”
The day the police arrived to pick up his brother, Russell entered the house to find his mother crying in her bedroom. “I’ll never forget what she asked me. ‘What are the people at church and the neighbors going to think?’ She didn’t say anything about my brother.”
Their dad worked long hours but he suspects it wasn’t just to put food on the table. “He wanted to escape what was happening with my brother.”
Russell felt angry at his brother for disrupting the home and how friends and neighbors ostracized their family because people didn’t understand mental illness. “I also didn’t get why he acted that way.”
Today, after half a century working in the mental health field, Russell has dedicated his life to creating improved understanding and mental healthcare access. After four years in the military, he earned a master’s in social work from Ohio State University. At 29, he became the youngest director of Clark County’s Alcohol Drug Addiction and Mental Health Board.
Russell has attempted retirement several times. In 1998, he retired from the board. Days later, he became the executive director of NAMI Ohio. He tried again in 2022. “I’m in the office today,” he laughs.” “I retired as the NAMI executive director but now I’m their senior advisor.”
He’s heading up the Terry Russell Housing Initiative, a project focusing on new housing for people with severe mental illness. He points out that stable housing is vital to recovery. “We need a community support system that gives an umbrella of support to people so they can live a quality life but housing is expensive, so we don’t talk about it.”
Much like how Covid was a tipping point in normalizing mental health discussions, Russell says his own mental health challenges helped him better understand his brother. After a 13-month military tour in Korea, he returned home and struggled with the transition. “It was a culture shock to come back,” he says. He also felt angry about the time he lost with his daughter. “She was 12 months old when I left and two when I returned.”
Russell’s relationship with his brother strengthened and he wanted to help him. “That’s when I realized there was no help.” The only option was the Columbus State Hospital. “I’ll never forget being a 13-year-old boy walking into that old state hospital — that gloomy tile, barred windows — scared to death.” It wasn’t a place he wanted his brother to return to.
Since then, the state hospital has been rebuilt twice. Now, it will be replaced with a 270,000-square-foot, 208-bed facility that includes mostly private, single-occupancy rooms and is scheduled to be completed this year. The exterior courtyard will feature a basketball court and a walking loop. “I’ve gotten to watch this beautiful facility be built,” says Russell.
Like many states, law enforcement has long been Ohio’s mental health crisis response. “They’re a quasi-mental health system, and we’ve had to do something about that — we can’t continue to have police go out to homes and get into confrontations.”
While de-escalation is vital for law enforcement to know — NAMI Ohio has a grant to ensure all officers in the state are CIT-trained — they’re still not the correct response for a mental health crisis. In 2019, Ron Bruno, a retired Utah police officer and former executive director at Crisis Intervention Team (CIT) International, told #CrisisTalk that “mental healthcare shouldn’t come in a police car.” “It fell to us, but we aren’t the best solution or help to a person in an escalated state,” he said.
Instead of continuing to default to law enforcement, says Russell, Ohio has had to invest in a crisis system. With 988, many state leaders have said they aim to fix their broken mental health system. “Well, ours wasn’t broken because it was never developed in the first place,” says Russell.
Ohio Gov. Mike DeWine shared similar sentiments in his 2023 State of the State address. He said the Community Mental Health Act of 1963’s promise of a community mental health system was never fulfilled. “That promise was never fully kept — not nationally, nor in Ohio — and the community system of care was never fully built,” he said. “But, with your help, we have started to make progress.”
Building a comprehensive and interconnected crisis system in a state with 88 counties is no easy feat. Each county has three member county commissioners who run the counties, and there are 50 Alcohol Drug Addiction and Mental Health Boards that plan, evaluate and fund mental health and addiction services locally. “Each board is doing it their own way, which means we don’t have one mental health system in Ohio; we have 50.” According to the Department of Mental Health and Addiction Services’ crisis systems landscape analysis released in March, funding is especially problematic for smaller rural Alcohol Drug Addiction and Mental Health Boards and those without levies.
Only two crisis services are billable through Ohio Medicaid. They are Mobile Response Stabilization Services (a mobile crisis service for children) and residential crisis services for adult and child mental health and adult and adolescent substance use disorders.
Russell says, similar to school systems, there are vast discrepancies in mental health systems throughout the state, with wealthy counties having the most access to resources and those without, not. “That impacts the services people can access,” he says.
He points out that system change requires involving people with lived experience. “We aren’t always right, but our perspective of how it should be differs from the current system.”
In a recent meeting with policymakers, mental health leaders told Russell, ”Nothing happens fast — it’s going to take time to make these changes.” Russell responded that time was of the essence. “I told him, ‘I got a call this morning from a mother whose daughter has been in bed for three days, beating her head against the wall. Do I tell her to wait until we’re ready?’” Mental health emergencies, he said, wait for no one.
In Ohio, people with lived experience have been integral to the system redesign, which has four architectural pillars: connect, respond, stabilize and thrive. The redesign incorporates the National Council for Mental Wellbeing’s Roadmap to the Ideal Crisis System and the essential components for a crisis system to function appropriately as laid out by SAMHSA’s National Guidelines for Behavioral Health Crisis Care. These components include regional or statewide crisis call centers that coordinate in real-time, centrally deployed 24/7 mobile crisis, and 23-hour crisis receiving and stabilization programs. Also integral to the guidelines is no wrong door, a practice where crisis care facilities accept everyone who comes, including walk-ins, referrals, and mobile crisis and first responder drop-offs.
Often less discussed are elements the guidelines state must be woven throughout the entire behavioral health crisis system, such as trauma-informed and recovery-oriented care, peer support specialists, partnership, and system interconnection so that people can be diverted from 911 and law enforcement response and behavioral health call centers can connect with mobile crisis services to deploy an in-person response. “Most crisis calls, something like 80%, can be handled over the phone,” says Russell, “but people also need mobile crisis and safe places to go or take their loved ones.” “Mobile crisis has to be available in every community so police aren’t called — that’s just common sense.”
Despite increased discussions about mental health, not everyone is on board with change, and it takes political will to move the marker. Russell is reminded of what Robert F. Kennedy said when addressing the United States Conference of Mayors in 1964: “Progress is the nice word we like to use,” said Kennedy. “But change is its motivator. And change has its enemies.”
