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Md.'s psychiatric bed shortage detrimental to patients and community

A judge is holding the state’s acting health secretary and other top officials in contempt of court, ordering them to open dozens of beds at state psychiatric hospitals by the end of the year. (Pamela Wood / Baltimore Sun)

Without access to treatment, people with a severe psychiatric illness, such as schizophrenia and bipolar disorder, fall prey to their psychosis and may engage in a range of illegal behaviors, from public urination to violent offenses. This leads to people being incarcerated simply because they need medical care. Such "criminalization of mental illnesses" happens across the nation. And it is shameful.

Maryland knows these problems firsthand. Officials within the state's Department of Health were held in contempt of court last year for failing to hospitalize inmates with mental illnesses for weeks after they had been ordered to do so. These wait times are akin to torture.

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The Maryland General Assembly responded by approving a bill during this year's legislative session to require state-run psychiatric hospitals to admit inmates within 10 business days after a court order. That legislation is necessary — but not sufficient. More steps are desperately needed to address the root cause of this problem: the insufficient number of state-run psychiatric hospital beds resulting from a decrease from 4,390 beds in 1982 to about 950 in 2016.

The Maryland Department of Health announced legislation, and other actions to address a longstanding shortages of beds for defendants referred by the courts for mental health treatment.

The Treatment Advocacy Center, in partnership with Parents for Care, surveyed Maryland community jails and found that inmates who have a psychiatric illness requiring hospitalization but do not have a court order compelling it must wait an average of 87 days for admission. Some waited a year, and some still wait. Despite meeting hospital admission criteria and being certified by two physicians as a danger to themselves or others, they were denied admission altogether.

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One woman committed suicide after waiting over a year for hospitalization. And after repeated refusals, some jails stopped asking for hospital placements.

These mentally ill inmates are not just statistics; each is someone's mother, sister, daughter, wife, father, son, brother or husband. Moreover, when treatment is delayed or denied during incarceration, the inmates often wind up in worse condition than before they were jailed. Extensive research shows that the longer an individual goes without treatment for psychosis, the longer the time that is needed for stabilization and the worse their overall prognosis.

State hospitals are overcrowded with mentally ill charged with crimes but expanding capacity isn't necessarily the right fix

In general, convicted county jail inmates in Maryland serve 18 months or less, often for minor crimes such as trespassing or parole violations caused by their brain disorders. The "lucky" ones will be foisted upon families that are ill-equipped to handle a psychotic loved one. Others will roam the streets. Many will endure repeat incarcerations, completing a vicious cycle of unnecessary human suffering.

Budget hawks may argue that increasing access to hospital treatment is too costly. But that view relies on false assumptions.

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In Fiscal Year 2017, Maryland's average cost of per inmate was $45,876 according to the Division of Correction. That adds up. Meanwhile, higher recidivism rates from non-treatment actually increase costs associated with law enforcement, courts and corrections beyond those of providing comprehensive therapeutic care.

Not only do inmates have a constitutional right to treatment, but our communities deserve to be protected from people who have become more — not less — dangerous after being locked up.

In jails across Maryland, mentally ill individuals who have been charged with crimes are languishing in cells despite court orders entitling them to evaluation and treatment in hospitals.

The shortage of state-run psychiatric hospital beds has also caused the Department of Health to ignore state law requiring admission to a state hospital for involuntary psychiatric emergency room (ER) patients who cannot be placed in a community hospital bed within 30 hours. This contributes to overcrowded ERs and ER wait times for all Marylanders that are the worst in the nation.

The Maryland Health Department, which did not respond to our jail survey, opened new state-run hospital beds in an effort to accommodate court-ordered inmates. However, officials have announced no plans to open psychiatric hospital beds to serve non-court-ordered inmates, emergency room involuntary patients waiting over 30 hours or community patients needing longer term treatment.

To reduce criminalization of mental illness, Maryland needs a more comprehensive mental health system, which includes sufficient state-run psychiatric hospital beds. More state-run psychiatric hospital beds will facilitate timely treatment, reduce recidivism and administrative costs, and improve both individual outcomes and the safety of our communities.

We do not need another contempt of court order to know this — nor should our state government.

Evelyn Burton (burtonev@comcast.net) is advocacy chair of Parents for Care.

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