State health officials have significantly reduced a backlog of patients waiting for beds in mental health hospitals.
A dozen people now sit in jail waiting for a spot — down from 85 a few months ago, the state's health secretary told lawmakers on Tuesday.
The state-run psychiatric hospitals have released dozens of patients who were ready to be discharged to make room for court-ordered patients. And they're planning to add a few more spaces for patients by shuffling money and resources, said Secretary Van T. Mitchell during a briefing before members of four legislative committees.
Mitchell cautioned that more work is needed.
"This is a long-standing complex problem that is about more than just beds," he told lawmakers.
State judges called Mitchell into court this year to explain why the state's hospitals weren't accepting defendants who were ordered into treatment after being found not competent to stand trial. He called it a learning experience that was "extremely beneficial."
Meanwhile, employees at those hospitals have complained that chronic understaffing makes them unsafe places to work.
Lawmakers indicated they were pleased to see Mitchell's initial steps. But some said they expect the state to develop longer-term solutions.
Del. Erek L. Barron said more work needs to be done to keep mentally ill people out of the courts in the first place.
"We're talking about a population that is about as deep into the criminal justice system as you can get, but they don't necessarily have to get this far," said Barron, a Prince George's Democrat.
Del. Kathleen M. Dumais, vice chairwoman of the House Judiciary Committee, said she's troubled that those waiting for beds are stuck in jails "that aren't set up to treat them."
And because the court orders actually commit the individual to the state Department of Health and Mental Hygiene — and not sentenced to the custody of the county or state correctional system — it creates a legal liability issue for the jails that might amount to illegal imprisonment, said Dumais, a Montgomery Democrat.
"How do we prevent us being in this place where people are being illegally detained?" she asked.
Erik Roskes, director of forensic services for the Behavioral Health Administration, likened the effort to turning around the Titanic.
"I'm hoping we don't run into the iceberg," he said.
To make room for new patients, 59 of 98 patients who were deemed "ready to discharge" were actually discharged. Some had remained hospitalized because of issues such as difficulty enrolling them in an outpatient psychiatric treatment program.
A private provider worked with the state to set up a 16-bed unit at Springfield Hospital Center in Eldersburg to help patients "step down" from inpatient psychiatric care to outpatient care. That freed up space within the main treatment program at Springfield.
Mitchell said some minor renovations at Clifton T. Perkins Hospital Center in Jessup — which houses patients with the greatest potential for violence — could add room for 16 more patients. The renovations would cost about $300,000, and the money for salaries would come from reducing overtime costs elsewhere in the state hospital system.
Mitchell also set up a work group that came up with recommendations, such as adding even more beds to the approximately 900 in state hospitals, improving crisis services in the community and increasing outpatient treatment offerings.
Mitchell said he'll develop a multiyear plan for carrying out the work group's recommendations that he will present as part of the next state budget. He didn't say how much money might be needed.
Three judges who testified expressed frustration at what they see as a system failure.
Judge John P. Morrissey, chief judge of the District Court of Maryland, said too often defendants are ordered to treatment, put on a bus to a state hospital and turned away.
"You need to get them into a facility as quickly as possible," he said. "We don't expect it to be immediately, but we expect it to be prompt."
Representatives from AFSCME, the union that represents state hospital workers, said hiring more employees and paying them better would help them offer better quality treatment to patients.
And representatives of private mental health groups said they too need more funding to treat people when they get out of state hospitals and to help people before they end up in the criminal justice system.