The woman sat handcuffed in front of Baltimore Circuit Judge Gale Rasin, freshly convicted of second-degree child abuse for beating her 8-year-old grandchild with a belt.
She was 44, depressed, diagnosed with bipolar disorder and likely dealing with post-traumatic stress from being raped twice, according to a court medical report, yet she had received little treatment. Her father physically abused her growing up, and she, in turn, abused her own family, Rasin concluded during the hearing.
"Once you are out of jail, my goal is to see to it you don't go back," the judge told the woman, requiring that she "remain in psychiatric treatment and take all prescribed medication" while on probation, after completing a prison term.
Treatment requirements are unusual in the city court that handles felony cases. But next month, it will become the norm for some offenders with mental health problems, as Rasin and others launch a Mental Health Case Management Docket within Baltimore's Circuit Court — the first of its kind in the state.
While lower courts in the city, along with those in Prince George's and Harford counties, have mental health programs, this will be the only program in Circuit Court, where the crimes are more serious and frequently involve violence.
The goal is to reduce repeat offenses by providing community-based treatment for eligible defendants — like the woman in the beating case, who now says she's "doing wonderful" — in lieu of incarceration or typical probation.
It's a potentially life-changing opportunity for mentally ill defendants who have had little access to therapy, and it could reduce the cycle of crime, data show. But it requires a balancing act to ensure public safety.
Critics have raised concerns about the criminal justice system acting as a mental health provider and have questioned the ethics of urging people to take medication and to plead guilty — a program requirement — without putting up a fight.
"Good legal services should be a part of this decision," Kelly McAleer, a doctor of psychology, wrote on her blog, Forensic Focus.
Rasin will oversee the cases, which will be handled by specially assigned lawyers from the public defender's and state's attorney's offices.
"The goal here is to gather in one place those people who otherwise would probably be put on probation without any assessment, without any guarantee of their getting treatment, and to put them in this special docket where they will get what they need: special monitoring and supervision. And therefore, the public will get what it needs, which is protection," Rasin said.
The three-year pilot program will serve about 30 people, at an annual cost of $120,000. Funds will be raised mostly through private grants, which will pay for a full-time clinician to manage the cases and track the outcomes. The project is expected to lead to a 30 percent to 40 percent reduction in the participants' arrest rates, based on results from similar courts.
It's an expensive venture that mental health experts hope will pay off in the long run, mainly by reducing costs in the criminal justice system.
"We're committed to finding three years of funding for this project with the hope that it is successful," said Crista Taylor, director of the adult services division within Baltimore Mental Health Systems, which manages the city's public health system and helped Rasin develop the project.
Untreated mentally ill people are more likely to be arrested, more likely to be incarcerated and more likely to reoffend once they're released, experts say.
Roughly 16 percent of the prison population has a serious mental illness such as schizophrenia, bipolar disorder or major depression — compared with less than 5 percent of the general population, according to the National Institute of Mental Health. The federal agency estimates that 45 percent to 64 percent of inmates have some kind of mental health problem.
And they're frequently wrestling with other issues, including substance abuse, prior trauma and, after release, homelessness.
"We see lots of people who [have] all three of the above," said George M. Lipman, presiding judge of the mental health court within the city District Court, which addresses such areas of concern in a program that began in 2003.
The District Court deals with about 200 defendants, most charged with misdemeanor offenses, at any given time, and it held about 1,300 hearings and status conferences last year, Lipman said.
To participate, defendants must live in the city, be diagnosed with a serious mental illness and be eligible for public mental health services. Defendants are assessed and given treatment plans, with consequences if they don't follow them.
"Our goal isn't always to get the client out in the least amount of time," said Assistant Public Defender Sharon Bogins, who handles all the District Court mental health cases. "It's to stop the cycle."
About two dozen program participants showed up last month for an acknowledgement ceremony at the Baltimore District Court's Hargrove location in South Baltimore. They shook hands with Judge Lipman, posed for a picture and feasted on fried chicken.
Most were there to get a pat on the back for complying with their treatment and probation plans, while a handful were graduating from the program, having completed their probation.
"Probations have to end. This is not a perpetual criminal justice system were dealing with here," Lipman said.
A study published in the Archives of General Psychiatry in February showed that 18 months after entering a mental health court program, participants were about 38 percent less likely to be rearrested.
The outcome in Baltimore is unclear. The District Court mental health program has been persistently unable to implement a data collection system, according to a report released last year by the Maryland Judiciary Research Consortium.
Part of the problem is that no one has been assigned to collect the data, Lipman said. That's a problem the Circuit Court team vows not to repeat.
Sitting around a conference table in the court's medical office recently, Rasin, Bogins, Taylor and representatives from the Baltimore state's attorney's office and the Maryland Department of Health and Mental Hygiene laid out some of their plans, which include data collection and analysis from the start.
The Circuit Court program, expected to launch in May, is based on the District Court's and has similar criteria for participation, including compliance with publicly provided treatment programs. And there will be rigorous discussion among all parties before individuals are accepted.
"Obviously, public safety is our office's chief concern," said Deputy State's Attorney Elizabeth Embry.
There are more than 250 courts nationwide with mental health programs, and half of them handle felony cases. Murderers won't likely be considered for Baltimore's program, Rasin said, but defendants such as the woman she saw in the beating case in October 2009 will.
The Baltimore Sun is not naming the woman, because she is a victim of sexual crimes. She was released from prison in late 2009 and began attending a grandparenting program and therapy with two counselors.
"We're not going to be friends, but we are going to have a relationship over the next four years or so in which I am going to not watch out for you, but watch over you," Rasin told the defendant at her sentencing hearing, according to a recording. "I want you to get through this probation, to be healthy and to be productive."
At a June status conference with Rasin, the woman said she was doing much better in treatment, which she had avoided for years. "I didn't want to come to terms that I had a problem and had to stay on meds," she said.
Last month, the woman returned for another such checkup. She called herself blessed.