Dozens of mentally ill men and women who have been charged with crimes are languishing in jails across Maryland despite court orders to send them to state hospitals for evaluation and treatment.
The state Department of Health and Mental Hygiene, which spurned a consultant's warning four years ago, does not have enough beds or staff to treat new patients, officials say. The shortage comes as 80 percent of those admitted to such facilities are arriving via the criminal justice system.
Union officials blame the shortages on what they call the state's cost-saving policy of pushing care of the mentally ill into the private sector.
The state's psychiatric inpatient capacity declined from about 3,000 beds in the 1980s to about 960 now, a squeeze the state's top health official calls a crisis.
"Currently, all of the in-patient facilities operated by DHMH are full, and in fact, our system has been consistently over census for the past year," Maryland Health Secretary Van T. Mitchell wrote to a Prince George's County judge in April. "The implications of this for the patients and staff in our facilities are grave: Operating over census means we are at risk of not having adequate staff to maintain a safe patient-care environment or to provide quality care."
On Wednesday, a Baltimore lawyer filed a motion seeking a preliminary injunction against the department for turning away would-be patients.
The shortages affect people such as Fredia Laverne Powell.
Powell, charged with second-degree attempted murder and other offenses, was brought before Baltimore Circuit Judge Gale E. Rasin in shackles.
Appearing disheveled in an ill-fitting, jail-issue pink jumpsuit, the 62-year-old woman launched into an angry tirade against the judge and court officials.
"I am the inspector general," she declared before trailing off into incoherence.
Rasin quickly determined that the woman needed emergency mental health treatment.
"It is clear to me that Ms. Powell belongs in a hospital immediately," Rasin said. She ordered that Powell be taken the next day to Clifton T. Perkins Hospital Center in Jessup, where Maryland treats its most dangerous mentally ill people charged with crimes.
Officials at the Women's Detention Center in Baltimore transported Powell to Perkins, but she was refused admission because there were no beds available. She was taken back to the jail, where she remained Wednesday.
In the motion filed Wednesday on behalf of Powell and three others, former city solicitor Ralph S. Tyler contended that the state has no right to hold incompetent criminal defendants in jail.
Rasin issued orders requiring six Department of Health and Mental Hygiene officials to show why they should not be held in civil contempt. A department spokesman declined to comment on pending litigation.
As of last week, 85 people referred by courts or jails were on waiting lists for five state mental health facilities. Defense lawyers, prosecutors and detention center officials say the problem is severe and getting worse.
Mitchell was attempting to explain in his April letter why his department was unable to comply with legally binding orders to admit patients who had been found incompetent to stand trial or adjudged not criminally responsible for their actions. There was no room at Perkins, the Spring Grove Hospital Center, Springfield Hospital Center or other facilities.
Mitchell, one of the targets of Rasin's order, told the Prince George's judge that his department would create a group to work on solutions and invited the judiciary to participate. He named the group last week and instructed it to complete a report by August.
"Over the last six months, it's becoming increasingly obvious to us that the way we're going about it is not the best approach," Mitchell told The Baltimore Sun.
The head of the union that represents workers at Health and Mental Hygiene Department facilities says the bed shortages are the result of a deliberate policy of pushing care into the private sector.
"You can't have it both ways," said Patrick Moran, president of AFSCME Council 3. "You can't say we don't have capacity when you're shutting facilities or units and you're not willing to hire anyone."
In court last week, Rasin expressed concern for Powell's safety if she cannot get prompt treatment.
"In the vernacular, she's cruising for a bruising if she talks in jail as she talks in court," the judge said. "We've got to get her in the hospital. Other prisoners are not going to be as tolerant of her speech."
Detention center officials say they are struggling to cope with the delays in transferring mentally ill people from their jails.
Deborah Richardson, director of the Baltimore County Department of Corrections, said the typical delay in transferring a detainee to Spring Grove is seven days. For Perkins, she said, it is up to 30.
"Even seven days is too long," she said.
Richardson said corrections officers have a hard time dealing with mentally ill prisoners.
"They can be aggressive. They can be a challenge," she said. Among the problems, Richardson said, were prisoners "not wanting to bathe, not wanting to communicate with staff."
Richardson showed a reporter the men's mental health unit at the county jail. Twenty-seven men in orange jumpsuits milled around under the supervision of correctional officers in a control room.
Richardson said the jail is able to stabilize most of its mentally ill inmates but cannot offer them a full range of treatments. A state hospital can require a patient to take medicine, she said; the jail cannot.
"The majority of them do not belong in a correctional institution," she said. "We can't close our doors and say we're not taking them."
A 'long-standing problem'
Paul DeWolfe, Maryland's chief public defender, said the bed shortage is a "long-standing problem" that has reached a critical stage.
"As a result, severely mentally ill people are sitting in jail — and that's probably the worst place for them to be," he said. "They are turning our jails into de facto mental hospitals."
DeWolfe said he does not see a contempt finding as the solution.
"What has to happen is that the executive branch has to provide the funding and spend the money to take care of these mentally ill patients," he said.
Baltimore County State's Attorney Scott Shellenberger said the problem worries prosecutors as well. If hospital beds are not available, he said, cases could be lost.
"At some point there could be problems of dismissal," said Shellenberger, a Democrat. "We need more beds. It's just that simple."
Del. Kathleen Dumais, a Montgomery County Democrat who serves as vice chairman of the House Judiciary Committee, said none of the judges she knows wants to release a potentially dangerous person.
"They're very much in a box and very frustrated," she said.
Dumais said she has been watching the problem grow since she was elected to the General Assembly in 2002. She said Republican Gov. Larry Hogan has not done much to solve the problem, but neither did his predecessor, Democrat Martin O'Malley, or the previous Republican governor, Robert L. Ehrlich Jr.
The state hired the CannonDesign consulting group about five years ago to study the system's needs. In a 2012 report, the group noted severe deficiencies and recommended that the state add at least 216 mental health hospital beds.
O'Malley administration Health Secretary Dr. Joshua M. Sharfstein rejected the recommendation in a 2012 letter to the legislature's budget chairmen. He said it would be "premature to undertake the substantial expense of building a new facility."
Sharfstein declined to comment this week.
Matthew A. Clark, a spokesman for Hogan, said the department is trying to create added capacity within its existing facilities. He would not commit to increased spending to add beds.
"We're not going to be providing any previews of next year's budget as yet," he said.
Mitchell said the pressures on the mental health system have increased with the growth in the number of patients referred through the criminal justice system.
He said those patients made up 30 percent of the population in the facilities 10 to 12 years ago. It's now 80 percent, he said, and the patients are staying longer.
Dr. Erik Roskes, director of the department's forensic services unit, said the main cost of increasing capacity would come from hiring more staff.
"It's not just a matter of going to Mattress Discounter and buying a bunch of more beds," he said.