An example of the pink slip form used to hold someone for mental health evaluation. KATIE WEDELL/STAFF

Will expanding ‘pink slips’ curb gun violence?

Part of Gov. Mike DeWine’s plan to reduce gun violence calls for expanding the use of “pink slips” or involuntary mental health holds at local hospitals.

Supporters say that could curb rising suicide rates but critics say it will further overburden an already flawed system.

The proposal would add substance abuse disorder and chronic alcoholism to the list of reasons a hospital could keep someone for what is commonly called a 72-hour hold.

“Current Ohio law does not go far enough to help those suffering from drug dependency or chronic alcoholism who also have a propensity toward violence,” DeWine’s STRONG Ohio plan says. “Doctors must release pink slipped patients if they are diagnosed as only suffering from a substance use disorder, despite any concerns about dangerous behavior.”

State Rep. Phil Plummer, R-Butler Twp., also has introduced a bill that would add addiction to the list of pink-slip eligible conditions.

RELATED: Mayor, state senator push ‘Do Something’ campaign after Dayton shootings

This change will address a growing problem with methamphetamine addiction in Ohio, said Plummer, the former Montgomery County sheriff.

“The meth problem we have, these people are really becoming psychotic,” he said. “Maybe it will eliminate them going to get guns.”

But some in the medical community are concerned that adding those with drug problems into the mix of involuntary holds will stretch a system that’s at capacity and won’t reduce gun violence or drug addiction.

“(A 72-hour hold) wouldn’t even really work for a drug user,” said Dr. Victoria Kelly, president of the Ohio Psychiatric Physician Association. “The treatment needs are different, the medical needs are different (from mental illness).”

What is a pink slip?

A doctor, mental health professional or a law enforcement officer can seek an involuntary admission to a psychiatric facility when they believe someone has a mental health disorder and is a danger to themselves or others due to a threat of harm, suicide attempt or inability to care for themselves.

That process is often called a pink slip because traditionally the form was on pink paper.

Once a pink-slip application is presented at a hospital or mental health facility, a 24-hour window exists to have the patient evaluated and determine if involuntary committal is appropriate.

RELATED: Gov. DeWine outlines plan to tackle gun violence

If it’s determined that the patient meets the criteria for an involuntary admission, they can be held for an additional three business days while a hearing is scheduled in probate court. That’s where the name 72-hour hold comes from.

Last year Dayton police responded to more than 2,300 mental health calls, nearly double the calls in 2011. Police requested pink slips on about 80 percent of them last year.

Montgomery County Probate Court opened more than 600 involuntary mental health commitment cases last year.

If a judge determines that a person is mentally ill and requires involuntary treatment, they can order them into a state or private psychiatric hospital or treatment facility for up to 90 days. Follow up hearings would determine if additional treatment is needed.

RELATED: Experts say mental health doesn’t predict mass shootings

Current state laws don’t specify that any weapons belonging to patients be removed during this process. Federal laws prevent anyone who has been court ordered into treatment from possessing or buying a gun.

But DeWine and Dayton Police Chief Richard Biehl acknowledged guns are rarely taken from people deemed by a judge to be dangerous because of mental illness.

“It has not been done in a consistent way,” Biehl said.

The STRONG Ohio bill would allow a judge to order seizure of any weapons when ordering someone into treatment.

Currently people who abuse drugs or alcohol but don’t have another mental illness can’t be held beyond the 24-hour assessment period. If they sober up and say they no longer want to hurt themselves or others, they must be released, said Dr. Roberto Colon, associate chief medical officer at Miami Valley Hospital.

That’s unfortunate because about 44 percent of suicides occur when someone is under the influence of drugs or alcohol, Colon said.

“This is important because we know a majority of gun violence deaths are suicides,” Biehl said.

RELATED: Dayton killer’s receipts raise questions about mental health care

At any point in the current process, if a patient volunteers to go to treatment, the court process stops, said Eli Sperry, a probate attorney with Young & Alexander Co. in Dayton.

“People with a stockpile of firearms who get pink slipped but want to keep their firearms can just sign a voluntary admission agreement,” Sperry said.

After completing court-ordered treatment, the current law also allows people to petition to get their weapons back if any have been removed.

“Once they are outside the crisis scenario, there is very little this process does to stop them from doing anything else in the future,” Sperry said.

Pink slipping v. red flag laws

The governor’s office set out to address the hypothetical person DeWine described as “a ticking time bomb.”

“Everyone knows they’ve got issues … and access to firearms,” DeWine spokesman Dan Tierney said.

A plan announced two days after the Oregon District mass shooting on Aug. 4 called for what DeWine called safety protection orders, similar to red flag laws enacted in other states. That process allows for a concerned individual to ask a judge to take away someone’s guns.

RELATED: Do red flag laws work? What we found in Indiana

But the governor’s office heard constitutional concerns about that process, Tierney said. They also realized that about 70 percent of what the proposed safety protection orders sought to accomplish was already part of the pink slip process if the removal of weapons was properly enforced, he said.

“The governor’s goal is that this be constitutional,” Tierney said.

Pink slipping is already a common legal action that’s been proven constitutional, he said, so the goal became to improve and expand that process instead.

Red flag laws also have a flaw, Tierney said, because they don’t require treatment for mental health or substance abuse disorders. The proposed pink slip changes would both remove guns from potentially dangerous people and get them into treatment, he said.

Civil rights concerns

Mental health professionals have reservations about forcing someone with substance abuse disorder into treatment, said Kelly of the physician association.

“This is not the right answer,” she said. “It really has the potential to violate due process rights, overrun emergency rooms, confine people to almost prison-like environments or a forced detox where it’s unsafe.”

That’s because the six state psychiatric hospitals and additional private facilities are already overwhelmed, she said, and not equipped to deal with drug withdrawal symptoms.

RELATED: Can DeWine get his gun reforms through the Legislature?

There’s also the issue of stigma.

“Just having a mental illness does not increase your risk of violence,” Kelly said. “And yes people who have severe alcohol and substance abuse disorders absolutely need treatment and they need help, but this is not the way to increase gun violence prevention.”

Dayton police data shows that roughly 5 percent of the individuals they pink slip annually have a history of violent crime arrests.

Kelly and Colon are glad that the conversation about mental health resources is being had, even if they don’t believe those measures will prevent gun violence.

Current system isn’t fail proof

Breakdowns in the current pink slip system have lead to violence.

In 2016, Muhammad Shabazz Ali was pink slipped by police to Grandview because he had thrown chairs at Day-Mont Behavioral Center and demanded medication. He told police he needed medication so he didn’t hurt himself or others, according to the application for involuntary admission.

A social worker consulting with an on-call psychiatrist determined Ali wasn’t a threat, according to a pending wrongful death lawsuit. The evaluation said Ali had no history of assault, but he had spent more than two decades in prison under a different name for killing his pregnant girlfriend.

Less than three hours after his release he shot and killed three people. Ali has been convicted in those deaths and was sentenced to life in prison.

READ MORE: Lawsuit: Man ‘wrongfully discharged’ from center before triple homicide

Last year, Dayton police responded to a call about an attempted suicide and transported convicted felon Travion Montgomery to Miami Valley Hospital for a pink slip evaluation. He had a history of violent offenses.

He was released from the hospital and police custody because Dayton officers were unaware of a warrant out for his arrest for taking off an ankle monitor following a robbery charge.

Montgomery was arrested a month later for choking a woman, leaving her on life support. He was convicted of that crime in February.

Dayton police officers often say the people they pink slip are released quickly from local hospitals, Biehl said. Those people then end up in the local jail that Plummer and current Sheriff Rob Streck have long complained is becoming a make-shift psychiatric ward.

Hospitals, Colon said, use a rigorous process to determine if someone is truly a threat to themselves or others and therefore qualifies for an involuntary hold. They don’t turn people away even if their inpatient beds are full and often doctors spend hours calling facilities to find a spot for someone in need of care.

RELATED: Ohio lawmakers look to free up state psychiatric beds

It is possible, he said, for people to lie and fool a doctor doing the initial evaluation, especially when drugs are involved, and the person is in withdrawal and wants to leave.

“How do you help patients who are sometimes making decisions that aren’t in their best interest?” Colon said.

He agrees with expanding pink slip eligibility to include drug addiction. But more also needs to be done to increase access to mental health care, Colon said, because the system is taxed as it is. Violent people can’t have roommates, for example, so he said it cuts down on how many beds are available in hospitals.

Kettering Health Network, which runs Grandview Hospital, did not respond to requests for comment on this story.

Staff Writer Cornelius Frolik contributed to this story.

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