Over the course of about a year, a 43-year-old Middle River man called police 62 times, often “rambling” or “speaking in nonsensical speech” about such things as the military infiltrating his home or his neighbors operating a sex trafficking ring involving the Baltimore Ravens.

Police described his 911 calls in court documents charging him with making false statements to officers. He was eventually convicted of two such counts and sentenced to two years of supervised probation, with the condition that he undergo mental health treatment.

But in April, after he allegedly threatened to kill his neighbor’s family with an airsoft pistol, the man’s probation agent reported to the court that he didn’t verify that he was in treatment. After he was arrested, a Baltimore County judge, at prosecutors’ request, ordered him evaluated for mental illness. Heeding the opinion of state doctors, the judge found he was too mentally ill to face charges that he violated his probation and that he presented a danger to himself or others.

On May 7, she ordered the Maryland Department of Health to admit him for psychiatric care within days. Yet the man remained until June 20 at the Baltimore County Detention Center, where correctional officials reported that detainees in the mental health unit sometimes smear feces on the walls, flood their cells and refuse daily activities, such as showers.

People with severe mental illness, accused of crimes in Maryland but deemed too sick by the courts to participate in their cases and who are considered dangerous, are languishing behind bars long beyond the 10-day deadline prescribed by state law for the health department to admit them to one of its five psychiatric facilities following a judge’s order.

It takes about 53 business days for a defendant to be admitted, the health department said. But at recent court hearings, some defendants had spent six months or more behind bars before being transferred.The health department’s 1,056 psychiatric beds are perpetually full, with patients staying in the department’s care on average more than two years, health officials said. With a rapidly increasing number of court orders, the health department said it has a waitlist of close to 200 defendants.

The health department’s 1,056 psychiatric beds are perpetually full, with patients staying in the department’s care on average more than two years, health officials said. With a rapidly increasing number of court orders, the health department said it has a waitlist of close to 200 defendants.

Meanwhile, defendants often deteriorate in jails ill-equipped to care for their mental health, experts said.

“It’s inappropriate for individuals with serious mental illness, who are in such bad shape that those around them feel like they’re not even fit enough to go through the justice system, to languish in jails, which are some of the most nontherapeutic places that you can imagine,” said E. Lea Johnston, a professor at the University of Florida’s Levin College of Law.

Such delays are a nationwide crisis that dates to the 1960s, when the country transitioned away from institutionalizing the mentally ill in favor of community care, researchers said. But mental health care in the community never materialized, leaving sick people to deteriorate without support.

“Individuals with mental disorder are increasingly in contact with the criminal justice system. That’s a function of not having enough community mental health resources,” said Johnston, whose research focuses on mental health and criminal law. “So individuals are more symptomatic, or are openly symptomatic, and come to the attention of law enforcement, and then these individuals are arrested.”

The crisis is not new in Maryland — a Baltimore judge in 2017 held the health department in contempt of court, prompting the Maryland General Assembly to enact the law requiring the health department to admit defendants within 10 days of a judge’s order — and has only gotten worse. Frustrated judges are imposing large fines against the department.

“It’s an overwhelming problem, because the volume of competency decisions is increasing, and it’s certainly far exceeding the capacity that we have today,” Dr. Laura Herrera Scott, Maryland’s health secretary, told The Baltimore Sun.

She pointed to data showing the courts committed almost twice as many people in 2023 than in 2020. The department has added 43 beds since 2018 and none since 2021, spokespeople said.

While health officials, judges and lawmakers search for answers, defendants suffer.

‘I want my client not to die’

A Catonsville man was accused of a Baltimore carjacking in 2022, with witnesses telling officers he “appeared to be under the influence of narcotics,” police wrote in charging documents.

In April 2023, he appeared by video on the city circuit court’s mental health docket, with court doctors having found his mental illness prevented him from understanding the proceedings and assisting his defense lawyers. They also believed he posed a danger to himself or others.

Circuit Judge Gale E. Rasin deemed the man incompetent to stand trial and ordered the health department to admit him.

“You should be transferred to a hospital for treatment,” she told him. “I cannot tell you when exactly that is supposed to happen.”

Two months later, the man’s public defenders appeared before Rasin again. Their client remained in jail and was getting sicker. He weighed about 90 pounds, 35% less than the 140 police listed on his charging documents.

“He is in a fetal position in a bed. … He refused his food,” one of the public defenders, Michael Cooper, told Rasin.

Rasin read an earlier note from the jail’s behavioral health staff, which said he “was staring with a blank expression, was irritable and argumentative and had a belief he was being poisoned.”

“My only question at this point,” the man’s other public defender, Sharon Bogins Eberhart, said, “is: when is he going into a state mental health facility, as has been ordered by the court and as required by statute within 10 business days. … I just want to know when he’s going. I want my client to get better. I want my client not to die.”

Rasin questioned whether the health department was conducting “acuity checks” and whether they were working.

Every week, department clinicians check in with local detention centers to evaluate the severity of defendants’ psychiatric conditions. Those deemed most mentally ill are moved up the health department’s waitlist, health officials said. Clinicians also must try to admit the person before they serve the maximum amount of time they could legally spend in jail if sentenced.

A health department official who attended the court hearing said the Catonsville man was slated to be taken to a hospital the next day.

“This is a life-threatening situation. The system, the hospital system, it’s just broken. I think I said that five years ago,” said Rasin, the judge who held the health department in contempt in 2017.

The man was admitted to the hospital the next day. After six months, doctors determined he was competent to stand trial, but recommended that he remain in their care.

Prosecutors later dismissed the charges against him because a witness was no longer available, a state’s attorney’s office spokesman said. He added that the hospital delays can hinder prosecutions because victims and witnesses become disillusioned by the lengthy process.

A woman who answered the door in June at an address affiliated with him in online records identified herself as his aunt but declined to speak with a reporter. She said her nephew, now 31, was in a state mental hospital.

Bad conditions, worsening waits

The Baltimore County Detention Center’s deputy director visited the Towson jail’s mental health unit before testifying at a May 8 hearing where a judge was considering fining the health department for failing to admit five defendants within 10 days.

“I get there and folks are screaming,” Hilary Siakor-Sirleaf told Circuit Judge Nancy M. Purpura.

He described how the unit’s squalid conditions, including walls painted with detainees’ excrement, strained his staff.

“Every day, my officers are cleaning,” Siakor-Sirleaf added. “They’re more like housekeepers.”

James Dills, district public defender for Baltimore County, asked Purpura to impose fines on the back of an appellate opinion that deemed such sanctions appropriate. Calling the delays a “recurring problem,” the appeals judges cited a previous appellate opinion that said “a defendant found incompetent to stand trial may not be detained ‘unless the government is taking steps to provide treatment to restore the defendant to competence.’”

Dills struggled to contain his frustration.

“The numbers aren’t changing. They’re getting worse. There’s the human side of it,” said Dills, referring to one of his clients who had been in jail for six months. “He’s still psychotic. He’s still saying the same types of things he was saying six months ago.”

Bryan Mroz, deputy secretary of the department’s health care system and operations, testified for the health department, saying fines wouldn’t bring it into compliance with the law, because it can only admit patients for the beds it has.

“Every bed in our hospital system, including those at Clifton T. Perkins, are maxed out,” said Mroz, referring to the state’s lone maximum security psychiatric hospital. “They’re all filled. And I can only admit [someone] when I discharge someone.”

He testified that the department was adding 44 beds at a Western Maryland facility and expanding capacity at Clifton T. Perkins, but explained that hospital bed capacity was only part of its strategy. The department is also adding assisted living space within its facilities to ease placing patients into step-down care.

And the department brought on social workers to help patients get the paperwork they need to receive follow-up care, testified Mroz, adding that it also was working to stand up crisis response teams across the state to divert low-level offenders from the criminal legal system.

“We’re spending millions and millions of dollars trying to solve this,” Mroz told Purpura.

Purpura began her ruling by reading from the preamble to the 2018 law that created the 10-day deadline, which described the issue as a “serious public safety risk and a violation of the United States Constitution.”

“Keeping potentially dangerous, seriously mentally ill defendants from treatment exacerbates their problems and violates their right to due process,” she read. “The crisis of delayed treatment for seriously mentally ill and incompetent defendants in Maryland has been foreseeable for many years and well documented, facilitated by a steady reduction of capacity and staff in state hospitals while the demand for forensic beds has remained constant.”

The judge ordered the department to pay $1,000 a day for defendants who had been in jail anywhere from 46 to 182 days beyond the 10-day deadline, adding up to $608,000.

‘Worst of all worlds’

In December, a 34-year-old woman experiencing homelessness asked to borrow the cellphone of an employee at a Royal Farms in Essex and became hysterical when he asked her to return it. The employee called 911.

When police arrived, they told her to leave, but she said she wanted to go to jail and pushed over several display cases, according to court documents charging her with trespass, malicious destruction of property, disturbing the peace and resisting arrest. The woman, officers wrote, “had to be physically removed out of the store.”

In court April 30, a Baltimore County judge deemed her incompetent to stand trial and dangerous, ordering her committed to the health department. She remained in jail until the department admitted her June 28, almost two months later and after the judge threatened fines.

By the time doctors find those they’re treating mentally fit to stand trial, many plead guilty, are sentenced to time served and released without connection to follow-up mental health care, said Johnston, the law professor.

Those accused of low-level offenses sometimes spend more time waiting for treatment than they would if sentenced to the maximum penalty.

“What we have right now is almost the worst of all worlds,” Johnston said. “Something, almost anything, is better than that.”

How to fix this crisis depends on “whether one thinks that our criminal justice system has too large a footprint currently, whether we are over-criminalizing to begin with,” Johnston said. “If one adopts that perspective, then we shouldn’t be prosecuting petty offenses that reflect symptomatic behavior.”

That would require treating mentally ill people accused of petty crimes in a different setting.

“If you take for granted that we continue to over-criminalize, then I do think that you have to make more use of outpatient treatment — outpatient evaluation, or evaluation within the jails, and outpatient treatment and education opportunities — if you want to restore individuals’ competency,” Johnston said.

Health Secretary Herrera Scott said the multifaceted problem requires a comprehensive solution.

“There’s a lot of activity both upstream and downstream, downstream being the residential rehab programs and assisted living units for people to discharge to, but upstream like how do we prevent people from entering the judiciary,” she said in an interview.

State Del. Luke Clippinger, a Baltimore Democrat who chairs theHouse Judiciary Committee, agrees. He’s encouraged that stakeholders like local police and state’s attorneys, public defenders, the courts and the health department are discussing solutions. At the same time, he recognizes the urgency because of his day job as an Anne Arundel County prosecutor.

“Finding that true global solution is something I very much feel that they’re moving towards,” said Clippinger, adding that his committee would watch this closely. “We’ll have some conversations in the legislature in the next session and probably have a briefing before the next session.”

The mother of the woman who was arrested at the Royal Farms attended one of her daughter’s court hearings in June alongside a pastor from an Essex church who occasionally fed the woman.

On the courthouse steps, the mother and pastor described the woman, who was in jail at the time, as a “sweet girl” who was “very sick.”

“This mental health system is broken,” the mother said. “My daughter is suffering.”