A Field Guide for Ohio Police Officers

Ryan Sargent, LPCC, MSEd. A clinician in private practice at Guiding Purpose Counseling in Gahanna, Ohio, who writes and trains on mental health, crisis response, and family systems.

The Call Nobody Trained You For

It’s 9:47 on a Tuesday night in a Gahanna neighborhood. Officer Riggs arrives at a split-level where the front door is open and the porch light is off. The caller is the man’s mother. She’s 68, exhausted, and hasn’t slept in three days. Her son—he’s 34—is in the back bedroom. He’s convinced he’s receiving wireless communications from California about a Columbus police officer who died ten years ago. He wants to show her the messages. He wants to show you the messages.

He’s calm. He’s oriented. He’s articulate about what he believes is happening. He’s feeding himself. There are no weapons in the house. He has made no threats. His mother is frightened, but he is not frightening.

You ask the question every officer in Ohio asks at some point: Can I take him somewhere?

Under Ohio law, the answer is almost always no.

Ohio’s pink slip statute—ORC 5122.10—was never designed for this call, and many officers are left with too little guidance for what comes next. The statute requires a substantial risk of physical harm to self or others. This man poses no such risk. He is delusional, paranoid, and deteriorating—but he is not dangerous. He is not committable. He does not believe he is sick. And he is not interested in your help.

This article is about what to do next.

You will leave here with a clear legal map of what the pink slip can and cannot do in Ohio. You will learn the single clinical concept—anosognosia—that changes how every gray-zone call feels. You will get a field communication toolkit built on LEAP principles and other practical engagement strategies. You will get exact language templates for what to say when someone hands you their delusions. You will get a Franklin County resource tree you can use tonight. And you will understand why the right legal tool for this population—Assisted Outpatient Treatment under ORC 5122.01(B)(5)—is almost never used by the people who need it most.

The Gray Zone

I’m using “subacute psychosis” here as a practical field term, not a DSM diagnosis. It’s the term that best describes the clinical presentation officers encounter more than any other in mental health calls: active delusions, disorganized thinking, paranoia, impaired insight—but no recent overt threats, no suicide attempt, no current violence, and enough preserved self-care to stay alive.

This is distinct from an acute psychotic crisis where someone is swinging a weapon or standing on a ledge. It is distinct from mania with agitation, from substance-induced psychosis, from personality disorder presentations with psychotic-like features. What makes the gray zone different is that the person is not requesting help, does not agree they are ill, is not imminently dangerous, and is not a candidate for involuntary hospitalization.

Officers experience a specific kind of moral friction on these calls—something is clearly wrong, and I cannot legally act on it. Clinicians experience a parallel version—this person needs care, and no statutory lever will deliver it.

And so the cycle repeats. Police contact. Emergency department. A four-hour hold. Discharge. Family desperation. Police contact again. Columbus’s Mobile Crisis Response Unit documented over 5,000 calls with only six arrests during its pilot phase. The Right Response Unit triaged 3,000 calls in 2023 and diverted 900 entirely. The volume is real. 

The resolution is not.

The tool you need for this call is not legal. It is communicative.

What the Pink Slip Actually Says

ORC 5122.10(A)(1) authorizes emergency hospitalization when the transporter has reason to believe the person is “a person with a mental illness subject to court order” and “represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination.”

Authorized filers include psychiatrists, licensed physicians, licensed clinical psychologists, certain psychiatric nurse practitioners and clinical nurse specialists, health officers, parole officers, police officers, and sheriffs. Note who is absent: Licensed Professional Clinical Counselors cannot pink slip. Licensed Independent Social Workers cannot pink slip. Marriage and Family Therapists cannot pink slip. A counselor’s clinical judgment may inform the officer’s decision, but the statutory authority rests with the officer or physician.

The substantive criteria under ORC 5122.01(B) all require overt, recent, or imminent manifestation:

Prong (B)(1) requires threats of or attempts at suicide or serious self-inflicted bodily harm. 

Prong (B)(2) requires recent homicidal or other violent behavior, recent threats placing another in reasonable fear, or other evidence of present dangerousness. 

Prong (B)(3)—grave disability—requires a substantial and immediate risk of serious physical impairment from a person unable to provide for basic physical needs, where community provision cannot be made immediately available. 

Prong (B)(4) requires a grave and imminent risk to substantial rights.

Return to the bedroom. The man with the California transmissions fails every prong. He is not suicidal. He has not been violent. He is feeding himself. His rights are not imminently at risk. An officer who pink slips him anyway risks the hospital releasing him within hours—the clinical care officer screens at intake—civil due-process exposure, and worst of all, poisoning the relationship with this patient for every future call.

The pink slip is not the right tool. So what is?

“It’s not denial. It’s a symptom.”

Anosognosia: The Concept the Whole Call Turns On

Most officers have never heard the word. Most clinicians have heard it but do not teach it to their law enforcement colleagues. That gap has serious consequences.

Anosognosia is a brain-based unawareness of illness. It is not denial. It is not stubbornness. It is not lying. It is a neurological feature of serious mental illness—a symptom, not a character flaw—caused by structural and functional changes in the frontal and parietal lobes of the brain. Research shows that approximately 50% of people with schizophrenia and 40% of people with bipolar disorder have it. Of 22 neuroimaging studies comparing patients with and without insight, 20 found significant brain differences in the same regions implicated in post-stroke anosognosia.

Here is why this matters on the call: when you try to reason a person out of a delusion, you are asking a brain circuit that does not function normally to do something it cannot do. The standard officer instincts—use logic, confront the false belief, present evidence—make the call worse. Not because the officer is wrong about the facts, but because argument cues the person that the officer is an adversary rather than a potential ally.

Dr. Xavier Amador, the Columbia University psychologist who developed the LEAP (more below) method for engaging people with anosognosia, frames the principle this way: the path to voluntary engagement runs through relationship, not argument.

Ohio law actually names anosognosia—without using the word. ORC 5122.01(B)(5)(iii) describes a person who, “as a result of the person’s mental illness,” is “unlikely to voluntarily participate in necessary treatment.” That statutory language is the legal recognition that some people cannot see their own illness. And it is the basis for Assisted Outpatient Treatment—the correct legal tool for this population, which we will return to.

The clinical pivot is this: you stop trying to convince and start trying to connect. That pivot has a name. It is called LEAP.

LEAP in the Field

LEAP—Listen, Empathize, Agree, Partner—was developed by Dr. Xavier Amador specifically for engaging people with anosognosia. It has been adopted by CIT (Crisis  programs nationwide and is consistent with the IACP’s (International Association of Chiefs of Police) model policy on responding to persons experiencing a mental health crisis. It was not designed for a therapy office. It was designed for exactly the kind of encounter Officer Riggs is on right now.

Listen
Not “active listening” in the therapist sense. Officer-adapted listening means asking open questions about what the person is experiencing—“Tell me what’s been happening”—and reflecting back what they say without challenging any of it.

“So you believe your neighbor has put listening devices in your walls. That’s what you’re dealing with.”

Do not say “I understand.” Clinical research shows it feels dismissive to people in crisis. 

Say “I hear you” or reflect the specific content. Do not correct. Do not omit the uncomfortable parts. The person needs to know you heard the whole thing.

Empathize
Empathize with the emotion underneath the delusion, not the delusional content itself.

“That sounds exhausting.”

“If what you believe is true, I’d be scared too.”

“I can see you haven’t been sleeping.”

This is clinically honest. You are empathizing with real suffering without endorsing a false belief. The person’s fear is real even when the threat is not.

Agree
Find something—anything—both parties can agree on. Not agreement about the delusion. Agreement about what matters.

“We both want you to be safe tonight.”

“We both don’t want the police called again next week.”

“We both want your mom to stop crying.”

This is the foundation of cooperative movement. It shifts the dynamic from officer-versus-patient to two people trying to solve the same problem.

Partner
Offer to work on the agreed goal together. Frame any suggested service as instrumental to that shared goal—never as a concession of illness.

“If we both want the calls to stop, let me tell you about the Crisis Care Center on Harmon Avenue. Would you come look at it with me?”

“I’m going to call someone from Netcare who can come talk with you here. You don’t have to go anywhere.”

LEAP does not guarantee voluntary engagement. But confrontation usually increases resistance. The evidence from CIT outcomes and co-responder programs consistently shows that relational approaches produce more voluntary service connections, less use of force, and fewer repeat calls than command-and-control tactics in psychiatric encounters.

Brief Engagement Strategies for the Field

Several techniques often associated with motivational interviewing translate well to a 5–15 minute encounter—not as a clinical method, but as practical habits that improve voluntary engagement on gray-zone calls.

Engage first, assess second. Rapport before information. The first ninety seconds of tone, stance, and introduction determine whether the person will talk to you.

Roll with resistance. Do not argue with the delusion. Sidestep to the shared goal. When someone says “I’m not going to any hospital,” a simple reflection—“You don’t want to go to the hospital”—said with downward inflection, validates their position without agreeing that the hospital is unnecessary.

Emphasize autonomy. Paradoxically, the single most effective move with a refusing person is confirming their right to refuse. “It’s absolutely your call. Nobody is going to make you do anything tonight.” This removes the reactance that sustains refusal. When people feel their freedom is protected, they are more likely to accept help voluntarily.

Offer a menu of options. “I can drive you to the Crisis Care Center, your mom can take you tomorrow, or you can take this card and call 988 tonight—what sounds right?” This dramatically increases voluntary compliance compared to “You have to come with me.”

The biggest error in brief engagement is unsolicited advice-giving. Officers default to “You should really go to the hospital.” Replace with permission-asking: “Can I share what I’ve seen work for other folks?” The difference is the difference between a lecture and a conversation.

When Someone Shows You Their Delusions

This is the moment most officers get wrong—not because they are bad at their jobs, but because no one taught them a third option.

Option one: argue the delusion. “No sir, there are no listening devices.” This reads to the person as proof you are part of the conspiracy. Research on the belief-disconfirmation paradox shows that contradictory evidence often strengthens delusional conviction. You have made the call worse.

Option two: agree with the delusion. “Yeah, I can see the devices.” This is ethically dishonest, reinforces the belief through social validation, destroys your future credibility, and can paradoxically amplify terror because external confirmation makes the imagined threat feel more real.

Option three: acknowledge the experience without endorsing the content.

“I’m not picking up what you’re picking up. But I can tell it feels very real to you right now. How long has this been happening?”

This is the IACP-recommended approach. The canonical CIT script is structurally identical: “I can see you are worried about someone harming you. I don’t know of anyone who wants to hurt you, but I really would like to assist you in any way I can to help you feel safer.”

Here is the structural formula that appears across every evidence-based framework: acknowledge the experience, state your own reality gently without demanding the person accept it, and pivot to concrete present-focused help.

When someone hands you a notebook of evidence, photographs, diagrams: Look at what they show you. Do not refuse. Do not mock. Do not pretend to see what they see. Say: “You’ve clearly spent a lot of time on this. I can see how much this matters to you. What I want to talk about is how you’re doing tonight—sleep, food, how you’re feeling.” Then redirect to concrete, present-tense assessment.

When someone asks if you are part of the plot: “I’m Officer Riggs from Gahanna PD. I’m not part of anything except responding to this call. I know the uniform can make things feel different. I’m not here to hurt you.”

When someone is mid-dialogue with a voice: Wait. Do not interrupt. When they are present, say: “It looked like something was happening just now. Are you okay?”

What Not to Do

These ten errors are drawn from CIT training literature, IACP guidance, and clinical de-escalation research. Every one of them is common. Every one of them makes the call worse.

One. Do not argue the delusion. You will not win, and the attempt costs you the relationship.

Two. Do not stand in formation or block exits unnecessarily. It amplifies paranoia.

Three. Do not call for additional units visibly unless safety requires it. Volume of response triggers flight.

Four. Do not use the person’s first name repeatedly if they seem suspicious of you. It can feel like surveillance.

Five. Do not promise what you cannot deliver. “They’ll help you at the hospital” is a promise the ED may not keep.

Six. Do not pink slip to “get them seen.” It breaks the law, breaks the person, and breaks the clinician’s future relationship with the patient.

Seven. Do not lecture the family that they “should have done more.”

Eight. Do not hand the family a generic 988 card and leave.

Nine. Do not assume substance use because the person is disorganized. Psychosis and intoxication present differently.

Ten. Do not confuse subacute psychosis with non-compliance. Anosognosia is not defiance. It is a brain condition.

When the Pink Slip Is Actually Warranted

This article is not anti-commitment. There are bright lines, and officers need to recognize them:

A named target of violence. A weapon visible or reported. A recent suicide attempt or clear imminent plan with means and intent. Severe dehydration or starvation. 

Wandering into traffic. Command auditory hallucinations directing harm with an expressed intent to obey.

When these indicators are present, document precisely. Quote the person’s statements verbatim. Note observable behaviors. Note what they ate, drank, and slept in the last 24 hours. Note the time of last medication. Collect family corroboration. This documentation is what survives the ED screening—it is what determines whether the hold converts to commitment or whether the person walks out three hours later.

What Comes After the Call: AOT and the Resource Tree

If the pink slip is the wrong tool for subacute psychosis, what is the right one?

Ohio has Assisted Outpatient Treatment. Senate Bill 43, effective in 2014, added ORC 5122.01(B)(5) as an outpatient-only commitment criterion. Its criteria map precisely onto the gray-zone population:

First: The person is unlikely to survive safely without supervision.

Second: There is a history of treatment non-compliance—either two hospitalizations in 36 months or one act or threat of serious violence in 48 months.

Third: As a result of mental illness, the person is unlikely to voluntarily participate in necessary treatment. This is the anosognosia prong.

Fourth: Treatment is needed to prevent a relapse likely to result in substantial risk of serious harm.

The filing pathway is straightforward: under ORC 5122.11, any person with reliable information can file a probate affidavit, subject to local probate procedures. For law enforcement, this is documentation work, not enforcement work. For families, this is the pathway that does not require waiting for a crisis to become dangerous before the system will act. Initial orders run 90 days. Renewals can extend up to two years. The order cannot compel medication—it is a leveraged tool that uses judicial oversight to create a structure around treatment.

Most Franklin County officers and families do not know the affidavit pathway exists. That is worth changing.

The Franklin County Resource Tree

Netcare Access: 614-276-CARE. Franklin County’s 24/7 adult behavioral health crisis provider. Runs the crisis line, walk-in assessment center, crisis stabilization unit, community mobile team, and probate pre-screening. Serves Gahanna.

Franklin County Crisis Care Center: 465 Harmon Avenue. Opened September 2025. No wrong door, 24/7, no appointment, no referral, no insurance requirement. In its first four weeks, 60% of people served were brought by first responders. This is the new anchor drop-off.

For youth under 21: Call 988 and request MRSS. Mobile Response and Stabilization Services through Nationwide Children’s Hospital. 1-888-418-MRSS. Response within 60 minutes.

For ongoing care coordination: Southeast Healthcare Services ACT teams, the Franklin County Sheriff’s SMART Team, or the Columbus Division of Police Mobile Crisis Response Unit (non-emergency 614-645-4545).

For AOT filing: Franklin County Probate Court. Any person with reliable information can file under ORC 5122.11. Contact the ADAMH-affiliated AOT coordinator.

For Gahanna specifically—and for every Franklin County suburb—this same tree applies. None of these communities currently staff a dedicated co-responder, which is why knowing this tree matters.

Back to the Bedroom

Return to the Tuesday night call. The man in the tinfoil-lined bedroom. The mother on the porch. The officer who now understands anosognosia, who has practiced LEAP, who knows the Franklin County resource tree, and who recognizes that ORC 5122.10 was never built for this moment.

The officer sits down—literally, on the floor if that is where the man is—and says: “Tell me what’s been happening.” She listens. She reflects. She empathizes with the fear without confirming the transmissions. She finds an agreement: “We both want your mom to get some sleep tonight.” She offers a menu: Netcare can send someone here, the Crisis Care Center is open around the clock, or here is a card for 988.

The man does not go anywhere that night.

But two weeks later, the mother files an AOT affidavit. She has documentation from three prior hospitalizations. The probate court orders 90 days of outpatient treatment. A case manager from Southeast Healthcare begins visiting. Eight months later, the man is on a long-acting injectable, has a case manager he trusts, and the family has not called 911 since.

That outcome is not guaranteed. But it is only possible when everyone on the call knows what the pink slip can and cannot do—and has something better to offer when it cannot.

Officers do not need to become clinicians to handle these calls better. But they do need a clearer map. In Ohio’s gray-zone psychosis calls, the question is often not “Can I pink slip him?” but “What can I do tonight that lowers danger, preserves trust, and improves the odds of voluntary help later?” The answer is usually not force. It is lawful restraint, practical communication, careful documentation, and knowing the next step.