CANTON -- Those who need help for mental issues don't always recognize it.

And sometimes family members feel it's impossible to force someone to get help if that person doesn't want it.

But freedom for the person suffering from a mental health problem can become limited quickly once he or she poses a danger to themselves or others and safety forces are notified.

"The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder," according to the National Institutes of Mental Health list of symptoms defining bipolar disorder.

Ohio law enables people to be involuntarily hospitalized so that they can get treatment via two methods: probating or pink-slipping, said Carole Vesely of the Crisis Intervention and Recovery Center, which also provides Crisis Intervention Training to area police departments.

In a two-week span, Canton police shot two people who, according to family members or close friends, suffered from mental health problems.

Hayden Stutz, 24, of Canton, was fatally shot by a Canton police officer on May 24 while holding his girlfriend and falsely claiming to have a gun. The woman told officers Stutz had been diagnosed three years ago with a bipolar disorder. Stutz's employer and family friends said the next day that his brother had tried unsuccessfully to get him help in the days preceding his death.

On Tuesday, a Canton police officer shot Kevin Jones, who walked into Refuge of Hope men's shelter wielding a bat and swung it twice at the officer, according to police accounts. Jones was shot twice in the abdomen and remains hospitalized, according to police. Family members of Jones have said he has a history of mental health problems.

Probating is a civil action asking the county probate court to invoke involuntary hospitalization for mental health treatment. Pink-slipping speeds up the process, enabling someone other than a judge to involuntarily commit a person immediately when that he or she behaves in a threatening manner.

The probate court judge will also see a pink slip, but here in Stark County, it's usually from Heartland Behavioral Healthcare, the state psychiatric hospital in Massillon, where a doctor or a psychiatrist has filled out the form describing the patient's need.

The process

Lynn Altenhof, deputy clerk for Stark County Probate Judge Dixie Park, said using the probate court option is fairly common in Stark County and the patient is usually already in a hospital.

A doctor or a clinical psychologist or psychiatrist typically files an affidavit explaining why someone needs to be committed for treatment for up to 90 days, Park said. After it's filed, a hearing must take place within seven days.

Pink-slipping speeds up the process, giving the power to involuntarily commit a mentally unstable person to someone other than a judge.

The two-page form (it is pink) declares a person "represents a risk of physical harm" to themselves or others and that he or she would benefit from hospital treatment. It also contains space for the person filling it out to say why they believe the person is at risk. "Every reasonable and appropriate effort should be made to take this person into custody in the least conspicuous manner possible."

Not just anyone can fill out this form. Ohio laws limits this power to psychiatrists, licensed clinical psychologists, doctors, health officers, parole officers, probation officers, the sheriff or police officers.

"Once a person is pink-slipped, they have to be evaluated within 24 hours," Park said. The person can only be held an additional 72 hours -- usually in a psychiatric ward -- and, once the affidavit is filed, a hearing must be held within five days. Then, Park said, the court can grant a continuance for 10 days, "because hearings are held once a week." And the person is hospitalized for the duration, which can be as long as 14 days but usually isn't.

This year Probate Court has seen 85 affidavits filed from Stark and 12 surrounding counties, Altenhof said. Of those, 50 people were committed, although some of them had been through the process on prior occasions.

Outside of the court, the Crisis Center is the only agency in the county that can get someone directly admitted involuntarily into Heartland, although the center can also get them admitted into Akron Children's Hospital in Akron, Belmont Pines in Youngstown and Laurelwood in Willoughby. (Aultman Hospital in Canton is the only hospital in the county that provides private psychiatric care for adults, although Affinity Medical Center in Massillon and Alliance Community Hospital in Alliance have geriatric psychiatric units for those age 55 and older.)

While law enforcement officers are legally entitled to "pink slip" an apparently mentally disturbed person in crisis, they tend to rely more on the Crisis Center, which also can send a mobile crisis unit to the scene, Vesely said.

"Most of the police officers here, their departments do not let their officers use pink slips," Vesely said. "They say they don't want their officers to be mental health professionals."

Law enforcement

The pink slip process "is a tool that we will use when we need to," said Capt. William Peel of the Massillon Police Department. "We have in the past and I'm sure we will in the future. But you're asking police to make a mental health judgment. It's a form of arrest."

Typically, however, officers will treat an issue as a medical condition and take the person in crisis to a hospital, he said. If someone appears suicidal, the officers contact the Crisis Center.

Maj. C.J. Stantz of the Stark County Sheriff's Department said deputies with either take the suspect to a hospital where a doctor can diagnose that person and possibly write a pink slip or contact the Crisis Center for a mobile crisis unit.

"If we have that resource, why not use it? Why not have a professional make that determination?" he said, adding that deputies have also been pretty successful at de-escalating situations and convincing suspects to go willingly to a hospital.

Canton Police Capt. Dave Davis, who heads the Patrol Division, said city police officers are permitted to use pink slips, but only do so in "very limited circumstances."

Davis said if an officer sees evidence a person is suicidal or homicidal and displays a risk of physical harm, "or if they're showing any kind of violent or psychotic behavior, the officer would have to assess the situation and do what he believes is necessary at the time."

Typically, however, officers take the person to a hospital emergency room, where a doctor can weigh in.

The Canton Police Department does not track how often pink slips are written. Davis said those incidents are labeled as anything from "mentally ill person" or "suicidal" to "just a trouble call."

How to get help

The three most prevalent mental health disorders that may need addressed through involuntary hospitalization are bipolar disorder, schizophrenia and clinical depression, Vesely said.

She recommends anyone hoping to get help for someone in crisis with one of these conditions call the Crisis Center or police.

"Police and fire are super when it comes to responding and trying to make sure this individual gets to treatment that's most appropriate for them," she said.

At the Crisis Center, the person suffering from an apparent mental disorder "has to be willing to interact with us," Vesely said. "We have to physically see that person."

But the process can start with the family, and often does.

"If your loved one is not willing to come, we're telling you what your options are," she said. "Sometimes we have family members who call and say, "Should I be worried because this or that happened?' If your loved one is serious enough that you feel they have to go to the hospital, are you willing to call law enforcement or medics to assist?"

Evidence of clinical depression, bipolar disorder and schizophrenia can begin as early as the late teens or early 20s, although "we are seeing individuals younger than that," Vesely said. "Some of them are preteens with clinical depression and bipolar disorder. School behavioral health personnel are seeing them as young as middle school and, across the community, we're seeing them with anxiety disorder as young as 6 and 7 years old."

The Crisis Center is open around the clock, and can be reached by dialing 330-452-6000.

Vesely recommends getting help early, "when those initial symptoms begin surfacing. Don't ignore it because the stigma is still out there. The longer an illness is not treated, we're going to see more problems."